Gynaecological cancers - Vulval cancer

Question 1

vulval cancer

Answer 1

rare compared with other gynaecological cancers

90% squamous cel carcinomas
less common- malignant melanoma

Question 2

vulval cancer risk factors

Answer 2

advanced age >75 y/o
immunosupression
HPV infection
Lichen sclerosus

Question 3

VIN

Answer 3

Vulval intraepithelial neoplasia

premalignant condition that affects squamous epithelium of the skin which can precede vulval cancer

High grade squamous intraepithelial lesion is a type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.

Differentiated VIN is an alternative type of VIN associated with lichen sclerosus and typically occurs in older women (aged 50 – 60 years).

Question 4

VIN treatment options

Answer 4

biopsy to diagnose

Watch and wait with close followup
Wide local excision (surgery) to remove the lesion
Imiquimod cream
Laser ablation

Question 5

vulval cancer presentation

Answer 5

Vulval lump
Ulceration
Bleeding
Pain
Itching
Lymphadenopathy in the groin

mainly affects the labia majora
Irregular mass
Fungating lesion
Ulceration
Bleeding

Question 6

investigations of vulval cancer

Answer 6

suspected- 2 week wait

diagnosis with:
Biopsy of the lesion
Sentinel node biopsy to demonstrate lymph node spread
Further imaging for staging (e.g. CT abdomen and pelvis)

Question 7

management of vulval cancer

Answer 7

Management depends on the stage, and may involve:

Wide local excision to remove the cancer
Groin lymph node dissection
Chemotherapy
Radiotherapy