CPC vulval cancer Flashcards
vulva cancer - age
75% diagnosed >60y/o
mean age of presentation 74
can present at any age from 27-97
presentation of vulval cancer
pain
itch
bleeding
lump/ulcer
is vulval cancer common
no
much lower incidence than other gynae cancer
risk factors for vulval cancer
- intraepithelial neoplasia or cancer at other lower genital tract site
- lichen sclerosus
- smoking
- immunosuppression
what is lichen sclerosus
chronic dermatosis
1 in 300 women
believed to be AI in origin
unrelated to HPV
progression to cancer is a rare complication
HPV related VIN and vulval cancer
usual type VIN
younger women
multifocal
multizonal
immunosuppression
past hx of intra-epithelial neoplasia
non-HPV related VIN and vulval cancer
differentiated VIN
older women
lichen sclerosus
often presents as cancer at first diagnosis
stage 1 vulval cancer - size, nodes, survival
<2cm
no nodal involvement
97%
stage 2 vulval cancer - size, nodes, survival
>2cm
no nodal involvement
85%
stage 3 vulval cancer - size, nodes, survival
local spread
unilateral nodes
46%
stage 4 vulval cancer - size, nodes, survival
distant spread or advanced local spread
pelvic nodes
50%
histopathology of vulval cancer
punch/excisional biopsy
consider other possible diagnoses
possible diagnoses from histopathology
inflammatory incl. lichen slcerosus
dysplasia - VIN
malignant - squamous cell carcinoma
what is vulvar intraepithelial neoplasia
abnormal proliferation of squamous epithelium
can progress to carcinoma
what is usual type VIN
aka classical/warty
associated w/ HPV infection
low grade (VIN 1) or high grade (VIN 2 and 3)
what is differentiated type VIN
older women
not HPV related
always high grade
usually associated w/ lichen sclerosus
what is shown here
normal squamous epithelium
intact BM
cells move towards the top as they mature into a basket-weave appearance
what is shown here
classical/warty VIN
overlying hyperkeratosis
cells are larger as they move towards the top
not organised arrangement of cells
koilocytosis
basal cells are all intact - no invasion
what is shown here
differentiated VIN
squamous epithelium isn’t nicely arranged
thickened and variable thickness
overlying hyperkeratosis
sclerosis
but intact basal cells and no invasion
squamous cell carcinoma - what is it
malignant tumour of squamous cells
ability to invade adjacent tissues and spread to distant sites
how do we stage vulval cancer
FIGO staging
what is very important to measure on biopsy
depth of invasion
what is labelled in this image
what else can be seen
keratinisation
grossly abnormal
squamous cells invading into underlying connective tissues
keratinisation shouldn’t be deep within the tissue - raises suspicion of squamous cell carcinoma
surgery for vulval cancer
individualised surgery
local excision
unilateral or bilateral node dissection.
management of vulval cancer
surgery
RT
chemotherapy
groin node dissection - which nodes
inguinal and upper femoral nodes
how is groin node dissection done and why
separate node incisions i.e. not along with tumour removal
staging and remove nodal disease
morbidity from groin node dissection
associated with significant morbidity
wound infection
lymphocysts
nerve damage
