General Flashcards
What proportion of vulval cancers are HPV positive?
55-60%
Risk factors for vulval cancer
previous abnormal smear
chronic immunosuppression
smoking
chronic inflammatory conditions - LSA or vulval dystrophy
What is the lymphatic spread from the vulva
Superficial inguinal LN then Deep inguinal LN then Pelvic LN
Management on initial presentation
measurements of primary tumour
assess extension in to midline/adjacent mucosal or bony structures
Inguinal LN palpation
Often multifocal - so assessment of vagina and cervix should be performed.
Patterns of spread of vulval cancer
- Local growth and extension in to surrounding organs
- Lymphatic embolisation to regional groin lymph nodes
- Haematogenous dissemination to distant sites.
Inguinal LN are more likely with what factors present?
size over 2cm
poor differentiation
increasing depth of stromal invasion
invasion of lymphovascular spaces.
‘rules’ of lymphovascular spread
- Superficial inguinal LN most frequent site
- caused by emboli
- mets to the contralateral side unusual if ipsilateral side is negative.
- stepwise LN spread - superficial inguinal to deep inguinal to pelvic
What is the most common histology?
SCC
then melanoma (9%) (25% of these may be unpigmented)
What Ca is Paget disease linked to?
May be associated with an underlying adenocarcinoma
Where do most primary adenocarcinomas of the vulva arise?
Bartholin gland
When to worry about a bartholin gland?
BGCS - if Bartholin’s ?abscess over 40, exclude first.
What proportion of women with a carcinoma of the Bartholin gland have inguinofemoral LNM at the time of diagnosis and why?
Deep so hard to diagnose early
20%
What margins are required
check this
8mm in formalin-fixed tissue.
When do most recurrences occur?
Within the first two years
what is Gorlin’s syndrome
multiple basal cell carcinomas
