6 - Gynae - Disorders of the Vulva and Vagina - Carcinoma of the Vulva

Question 1

age group most common in? 95% of vulval malignancies are ?

3 others that account for the rest of ca’s?

Answer 1

> 60
SCCs
BCC, adenocarcinomas, melanomas

Question 2

aetiology - can arise from VIN or ??

also ass w lichen ? , ?, smoking and ? disease of vulva

Answer 2

de novo
sclerosus, immunosuppression
pagets

Question 3

4 main clinical features

why often present late?

Answer 3

pruritis, bleeding, discharge, mass

lesions go unnoticed or embarrassment

Question 4

Ex - ? or mass, mostly on labia ? or ?

inguinal ? may be enlarged, hard and ?

Answer 4

ulcer
majora
clitoris
LNs
immobile

Question 5

Spread and staging - 50% presx at stage ?
vulval ca spreads ? by ? drainage of vulva > ? then ? inguinal nodes > ? > est iliac nodes
can spread contralateral - staging is ? and ?

Answer 5

stage  1
locally 
lymph
sf
deep
femoral
surgical 
histo

Question 6

Ix - what is established with biopsy? what needed to asses fitness for surgery?

Answer 6

histo type/diagnosis

CXR, ECG, FBC, U+E, Cross match

Question 7

describe staging

Answer 7

1 - vulva/perineum and no nodes
2 - any size, local spread, no nodes
3 - any size with positive nodes
4 - in upper urethra/vagina, rectum/bone/bladder or distant mets

Question 8

trt - what first? then wide local ? with separate ? ? dissection, bilateral unless tumour ? from midline
? if LNs involved

Answer 8

biopsy
excision
groin node
>2cm
RTx

Question 9

Prognosis - at stage 1 5y survival rate is ?

what about stages 3-4 ?

Answer 9

> 95%

40%