GTG Guideline for Diagnosis and Management of Vulval Carcinoma 2014

Question 1

What is the incidence of vulval cancer in UK?

Answer 1

Rare
3.7/100,000

Question 2

What is an incisional biopsy?

Answer 2

Used for Dx, interface between normal and abnormal epithelium

Question 3

What is excision biopsy?

Answer 3

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

Question 4

What is radical excision?

Answer 4

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

Question 5

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

Answer 5

4%
Not clear if treatment reduces this risk.

Question 6

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

Answer 6

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

Undifferentiated VIN - associated with HPV

Question 7

Which women should have a 2 WW?

Answer 7

Vulval lump
Vulval bleeding due to ulceration

Question 8

Which women should have a vulval biopsy?

Answer 8

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

Question 9

What is the most common type of vulval cancer?

Answer 9

Squamous cell carcinoma

Question 10

What are the other types of vulval cancer?

Answer 10

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

Question 11

How does vulval cancer spread?

Answer 11

Local invasion
Lymph - inguinal/femoral
Haematogeonuos

Question 12

FIGO 1a

Answer 12

Size <2cm, stromal invasion ,<1mm

Question 13

FIGO 1b

Answer 13

Size >2cm or stromal invasion >1mm

Question 14

FIGO 2

Answer 14

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

Question 15

FIGO 3

Answer 15

Extension to upper part of adjacent structure +/- LN

Question 16

FIGO 3a

Answer 16

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

Question 17

FIGO 3b

Answer 17

Regional LN >5mm

Question 18

FIGO 3c

Answer 18

Regional LN met + extracapsular spread

Question 19

FIGO 4
4a
4b

Answer 19

Distant met, bone, ulcerated LN

4a Pelvic bone, ulcerated regional LN met

4b Distant met

Question 20

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

Answer 20

> 80%

Question 21

If inguinal nodes involved, 5 year prognosis?

Answer 21

50%

Question 22

If iliac or pelvic nodes involved?

Answer 22

10-15%

Question 23

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

Answer 23

Wide local excision, without groin node dissection

Question 24

When should groin node dissection be considered?

Answer 24

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

ie >1a FIGO

Question 25

When can sensual lymph biopsy be offered?

Answer 25

If squamous <4cm Univocal No evidence of lymph node mets If does not meet this criteria for groin node dissection

Question 26

Which other cancers should not be offered groin node dissection

Answer 26

1a squamous Verrucous tumour Basal cell carcinoma Melanoma

Question 27

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

Answer 27

Radical vulvelectomy + bi-inguinal lymphdenopathy Surgery mainstay for management of vulval cancer. Radioatherpty and chemotherapy considered in advanced cases.