Neoplastic disease of vulva/vagina Flashcards
VIN
Cellular atypia confined in the epithelium
Can VIN have coexisting invasive carcinoma?
YES. 20% of the time it has penetrated the basement membrane somewhere.
VIN is correlated with what?
HPV 16, 18 (as is CIN)
Risk factors for VIN besides that?
Smoking, immunocompromised
The two types of VIN
Differ by PATIENT AGE
1) Younger, more aggressive, multifocal, HPV 75-100% of the time
2) Older postmenopausal, focal slow growing not HPV associated
What percent with VIN are asymptomatic?
What are the symptoms when present?
What should you do?
50%
Vulvar pruritis, palpable abnormality, perinial or perianal burning, or dysuria
Biopsy!
Risk of progression?
Possibly 100% for women over 40!!
Do you treat VIN? How?
Wide local incision with free margin of at least 5-10cm.
Younger patients can have topical 5-FU and imiquimod.
Other: split-thickness skin grafts to replace lesion, laser vaporization for multifocal
Recurrence rates? Any follow up?
18-55% (quite variable, and concerning).
F/u colposcopy of the entire genital tract every 6 months for 2 years THEN every year.
Paget disease of vulva?
CHRONIC INFLAMMATORY CHANGES. Pruritis and velvety red lesions that SCAR into white plaques.
Intraepithelial disease that tends to recur locally and rarely invades.
50-80 year old Caucasian women.
How often is there coexisting carcinoma with Paget?
20%
What sx are precursors to Paget’s of vulva?
Vulvar pruritis and vulvodynia can precede by YEARS!
Rx of Paget’s?
Wide local excision; HIGH RECURRENCE RATE
How bad is underlying adenocarcinoma with Pagets?
ALMOST ALWAYS FATAL
Vulvar cancer risk factors?
Menopausal status, smoking, VIN, CIN, HPV, immunocompromised, hx of cervical cancer
It’s <5% of gynecologic cancers.
Avg age for vulvar cancer
65
Presentation of vulvar cancer
vulvar pruritis, pain, bleeding
Vulvar cancer staging?
Rx?
Surgically staged.
Radical local excision w/ inguino-femoral lymph node dissection (the lymph nodes are NEEDED for staging bc it does tend to spread to them)
Melanoma that has metastasized prognosis?
Near 100%
What raises the suspicion of VAIN?
Persistently abnormal pap smears but no cervical neoplasia on colpo or cervical biopsy
When can you stop screening someone who had hysterectomy for CIN?
3 consecutive normal paps
Rx of VAIN?
Local excision
Laser ablation
5-FU intravaginally for ppl with multifocal lesions and immunosuppresion
Stage 1 vaginal cancer?
Confined to vaginal wall
Stage 2 vaginal cancer?
Subvaginal tissue
Stage 3 vaginal cancer?
Extended to pelvic wall
Stage IV vaginal cancer?
Beyond true pelvis OR involves mucosa of bladder or rectum
Presentation of vaginal cancer?
Often asymptomatic.
Pruritis, discharge, bleeding.
