9 - Vulval Cancer

Question 1

what age is most common for diagnosis of vulval cancer?

Answer 1

age 74

75% of diagnoses > 60 years

Question 2

4 main symptoms of VC?

Answer 2

pain

itch

bleeding

lump/ulcer

Question 3

4 RFs of VC?

Answer 3

Intraepithelial neoplasia/ cancer at other lower genital tract site

Lichen sclerosus

Smoking

Immunosuppression

Question 4

VIN?

Answer 4

Vulva intra-epithelial Neoplasia

Question 5

when is VIN likely?

Answer 5

when the cancer is HPV related

Question 6

HPV related VC - who is usually affected and what do they have a history of?

Answer 6

younger women with history of VIN and immunosuppression

Question 7

when is differentiated VIN likely?

Answer 7

when VC is non-HPV related

Question 8

non-HPV related VC - who is usually affected and what do they have a history of?

Answer 8

older women with history of lichen sclerosus and presents as cancer at first diagnosis

Question 9

describe stage 1 VC in terms of size, nodes involved and survival rates?

Answer 9

<2cm
no nodes
97% survival

Question 10

describe stage 2 VC in terms of size, nodes involved and survival rates?

Answer 10

> 2cm
no nodes
85% survival

Question 11

describe stage 3 VC in terms of size, nodes involved and survival rates?

Answer 11

local spread
unilateral nodes
46% survival

Question 12

describe stage 4 VC in terms of size, nodes involved and survival rates?

Answer 12

distant/ advanced local spread
pelvic nodes
50% survival

Question 13

how is histopathology achieved?

Answer 13

punch/ excisional biopsy

Question 14

possible inflammatory diagnosis of histopathology?

Answer 14

lichen sclerosus

Question 15

possible dysplasia diagnosis of histopathology?

Answer 15

VIN

Question 16

possible malignant diagnosis of histopathology?

Answer 16

squamous cell carcinoma

Question 17

definition of VIN?

Answer 17

Abnormal proliferation of squamous epithelium; can progress to carcinoma

Question 18

usual type of VIN?

Answer 18

Associated with HPV infection

Low grade (VIN 1) or high grade (VIN 2 and 3)

Question 19

differentiated type of VIN?

Answer 19

In older women

not HPV related

always high grade

Question 20

type of cell present in classical VIN histology slide?

Answer 20

Koilocyte

Question 21

staging used for VC?

Answer 21

FIGO staging

Question 22

what is important to measure for squamous cell carcinoma?

Answer 22

depth of the invasion

Question 23

what can be seen in squamous cell carcinoma histology slides?

Answer 23

keratinisation

Question 24

3 types of surgery to treat vulva cancer?

Answer 24

individualised surgery

local excision

unilateral/ bilateral node dissection

Question 25

other treatments for VC?

Answer 25

radiotherapy

chemotherapy

Question 26

what does groin node dissection involve?

Answer 26

inguinal and upper femoral nodes

Question 27

3 aspects of significant morbidity associated with groin node dissection?

Answer 27

Wound infection

Lymphocysts

Nerve damage