75. Vulvar and vaginal cancer.

Question 1

what is the etiology of vulvar carcinoma ?

Answer 1

unclear

risk factors :

precancerous lesion - lichen sclerosus

CIN

or vulvar dystrophy - lichen simplex chronicus
lichen planus
= scc

HPV- type 16 18 33

immunodeficiency

smoking

all resulting in
progression from vulvar intraepithelial neoplasia

Question 2

what are the signs and symptoms for vulvar cancer ?

Answer 2

asymptomatic

late stages
chronic pruritus - precede invasive vulval cancer

bleeding

dysuria

offensive discharge

Lumps or growths of various shapes, often wart-like lesions or ulcers
asymmetry, uneven borders

Reddish, blackish, and/or whitish patches of discoloration

Question 3

in vulvar cancer what is the commonest site ?

Answer 3

labium major the anterior 2/3 rd

Question 4

what are the histological types of vulval cancer ?

Answer 4

Squamous cell carcinoma (> 80% of cases)
Basal cell carcinoma
Melanoma

Paget disease of the vulva- A rare, intraepithelial adenocarcinoma

Eczematoid lesions 
Raised, well-demarcated borders
Erythematous patches with white scaling
Crusting and ulcerations
Local pruritus

Question 5

what’s the diagnosis ofvulvar cancer ?

Answer 5

pelvic examination colposcopy

confirmed through biopsy

CT scan , PET scan MRI - needed for staging

Question 6

what are the dd for vulvar cancer ?

Answer 6

vulvar dermatosis

condyloma

Question 7

what is the staging of vulvar cancer

Answer 7

3 - same as above with positive inguinofemoral lymph nodes

figo

1 - tumor less than 2cm confine to vulva and perineum
negative nodes
<1mm stromal invasion -a
b- than 2cm confined to vulva or perineum >1mm stromal invasion

2- tumor of any size 
with spread to 1/3 lower urethera or 
anterioir 1/2 vagina or 
anus 
negative node 

stage 4a - bladder mucosa , rectal mucosa , upper2/3
urethera upper 2/3 of vagina

b - any metstaisi involving pelvic lymph nodes

Question 8

what is the primary prophylaxis of vulvar cancer ?

Answer 8

HPV vaccination

therapy for epithelial disorders of vulva
and pruritus in vulva

liberal use of simple vulvoectomy in post menopausal women with VIN

Question 9

what is the treatment for vulvar cancer ?

Answer 9

vulvectomy ,
bilateral bilateral inguinofemoral lymphadenoectomy

same with adjuvant radiotherapy for in stage 2 or more

Question 10

what is the etiology of primary vagninal cancer ?

Answer 10

HPV -16 and 18
progression for vaginal intraepithelial neoplasia
history of cervical cancer

same as vulvar neoplasia

Question 11

primary vaginal cancer are very rare ?

Answer 11

yes usually is secondary to cervical

Question 12

what is the histological classification of primary vaginal cancer ?

Answer 12

Squamous cell carcinoma
Most common type

Clear cell adenocarcinoma

Sarcoma botryoides
Rare, highly malignant embryonal rhabdomyosarcoma that arises most commonly, but not exclusively in the genitourinary system
peak incidence in childhood (< 4 years)

Question 13

what are the signs and symptoms of vaginal cancer ?

Answer 13

early stages asymptomatic

late stages 
vaginal discharge 
Leukoplakia, vaginal ulceration with contact bleeding
abnormal vagnal bleeding 
pain during intercourse

Question 14

where does vaginal cancer usually occur ?

Answer 14

upper third of the posterioir vaginal wall

Question 15

how do we diagnose vaginal cancer ?

Answer 15

speculum and colposcopic examination

biopsy is used as confirmatory

PET / CT / MRI - staging of the cancer

Question 16

what is the staging of the vaginal cancer

Answer 16

stage 0- carcinoma in situ - not below the basement membrane

stage 1 - carcinoma limited to vaginal wall
1a - limited to upper third
1b - lowed hird

stage 2 - subvaginal tissue extension but not to the pelvic walls

stage 3 - extended to pelvis walls

stage 4 -
a- carcinoma extended beyond the true pelvis or involved the mucosa of bladder and rectum

b - or distant metastasis

Question 17

what is the treatment for vaginal cancer ?

Answer 17

Stage I
Squamous cell cancers: Radiation therapy

partial or radical vaginectomy

Stage II
using both brachytherapy and external beam radiation

radical vaginectomy

adjuvant chemo

stage 3 and more
surgery not used
The usual treatment is radiation therapy, often with both brachytherapy and external beam radiation. Chemo might be combined with radiation to help it work better

Question 18

secondary vaginal cancer occurs when ?

Answer 18

carcinoma of vulva , cervix , urethera

metsatsisi in the lower vaginal wall - choriocarcinoma , endometrial carcinoma

Question 19

On a cytologic specimen, which of the following findings would be most suspicious of herpes virus
infection?

Answer 19

intranuclear inclusion bodies