GTG Guideline for Diagnosis and Management of Vulval Carcinoma 2014 Flashcards

1
Q

What is the incidence of vulval cancer in UK?

A

Rare
3.7/100,000

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2
Q

What is an incisional biopsy?

A

Used for Dx, interface between normal and abnormal epithelium

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3
Q

What is excision biopsy?

A

Includes all the abnormal epithelium, does not provide tumour free zone of 1cm. Used for VIN low suspicion of invasive carcinoma.

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4
Q

What is radical excision?

A

Clearance of 1cm after fixation on all aspects of the tumour

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5
Q

What is the risk of developing invasive disease with lichen sclerosis?

A

4%
Not clear if treatment reduces this risk.

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6
Q

What are the 2 types of VIN and how are they classified?

A

Differentiated VIN (d-VIN) - associated with lichen scelrosus

Undifferentiated VIN - associated with HPV

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7
Q

Which women should have a 2 WW?

A

Vulval lump
Vulval bleeding due to ulceration

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8
Q

Which women should have a vulval biopsy?

A

Any change to the vulval epithelium in PM women
- swelling, polyp, lump, elevation, irregularity, warts.

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9
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

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10
Q

What are the other types of vulval cancer?

A

Melanoma
Paget’s disease
Bartholin gland tumour
Adenocarcioma
Basal cell carcinoma

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11
Q

How does vulval cancer spread?

A

Local invasion
Lymph - inguinal/femoral
Haematogeonuos

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12
Q

FIGO 1a

A

Size <2cm, stromal invasion ,<1mm

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13
Q

FIGO 1b

A

Size >2cm or stromal invasion >1mm

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14
Q

FIGO 2

A

Any size, extension into:
- lower 1/3rd urethra
- lower 1/3rd vagina
- lower 1/3rd anus
Negative nodes

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15
Q

FIGO 3

A

Extension to upper part of adjacent structure +/- LN

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16
Q

FIGO 3a

A

Upper 2/3 urethra, vagina
Bladder/rectal mucosa
Regional LN <5mm

17
Q

FIGO 3b

A

Regional LN >5mm

18
Q

FIGO 3c

A

Regional LN met + extracapsular spread

19
Q

FIGO 4
4a
4b

A

Distant met, bone, ulcerated LN

4a Pelvic bone, ulcerated regional LN met

4b Distant met

20
Q

If vulval cancer has no nodal involvement what is the 5 year prognosis?

A

> 80%

21
Q

If inguinal nodes involved, 5 year prognosis?

A

50%

22
Q

If iliac or pelvic nodes involved?

A

10-15%

23
Q

Treatment of FIGO1a (<2cm diameter/stomal invasion <1mm)

A

Wide local excision, without groin node dissection

24
Q

When should groin node dissection be considered?

A

Depth of invasion >1mm
Or tumour diamter >2cm

ie >1a FIGO

25
Q

When can sensual lymph biopsy be offered?

A

If squamous
<4cm
Univocal
No evidence of lymph node mets

If does not meet this criteria for groin node dissection

26
Q

Which other cancers should not be offered groin node dissection

A

1a squamous
Verrucous tumour
Basal cell carcinoma
Melanoma

27
Q

For cancers equal or >1b, what surgical treatment is offered?

A

Radical vulvelectomy + bi-inguinal lymphdenopathy

Surgery mainstay for management of vulval cancer. Radioatherpty and chemotherapy considered in advanced cases.