Gynaecological Oncology & Screening - Vulval Cancer

Question 1

Epidemiology of Vulval Cancer.

Answer 1

1. Rarer than Other Gynaecological Cancers.

2. 90% SCC; can be Malignant Melanomas.

Question 2

Risk Factors of Vulval Cancer (4).

Answer 2

1. Advanced Age (75+).
2. Immunosuppression.
3. HPV Infection.
4. Lichen Sclerosis (5%).

Question 3

What is VIN?

Answer 3

Vulval Intraepithelial Neoplasia - premalignant condition affecting squamous epithelium of the skin that can precede vulval cancer (like CIN).

Question 4

What is High-Grade Squamous Intraepithelial Lesion?

Answer 4

A type of VIN associated with HPV infection and occurs in younger women (35-50).

Question 5

What is Differentiated VIN?

Answer 5

A type of VIN associated with Lichen Sclerosis and occurs in older women (50-60).

Question 6

Clinical Presentation of Vulval Cancer.

Answer 6

1. Incidental Finding.
2. Vulval Lump, Ulceration, Bleeding, Pain, Itching.
3. Groin Lymphadenopathy.
4. Irregular Mass, Fungating Lesion.

Question 7

Which part of the vulva is most frequently affected by Vulval Cancer?

Answer 7

Labia Majora.

Question 8

Investigations of VIN (3).

Answer 8

1. Biopsy - Diagnostic.
2. Sentinel Node Biopsy - Lymph Node Spread.
3. CT AP - Staging.

Question 9

Grading of Vulval Cancer.

Answer 9

FIGO System.

Question 10

Management of Vulval Cancer (4).

Answer 10

1. Wide Local Excision to remove cancer.
2. Groin Lymph Node Dissection.
3. Chemotherapy and Radiotherapy.
4. VIN - Laser Ablation, Watch and Wait, Imiquimod Cream.