Vaginal and vulval cancer

Question 1

What are the 2 main aetiologies of vulval cancer?

Answer 1

1. HPV

• younger women
• associated with smoking and HPV
• develops warts.
  2. Non-HPV (most common type: 90%)
• older women (post menopausal, over 70)
• not associated with smoking or HPV
• Usually form into SCC

Question 2

What are the different types of vulval cancer?

Answer 2

1. SCC (90%)
2. BCC
3. Melanoma
4. Adenocarcinoma (originates from Bartholins gland)
5. Sarcoma (originates from adipose tissue)

Pre-cancerous = vulval intraepithelial neoplasia “VIN”

Differentiates into:

1. SCC
   - mean age 45 years
   - itching is the most common symptoms (half pts are asymptomatic)
   - lesions are usually raised, different colour to skin

Investigation: colposcopy with acetic acid.

2. Pagets Disease of the vulva
   - adenocarcinoma, derived from apocrine sweat glands of the vulva.
   - slow growing, non invasive.

Question 3

What are the RF for vaginal compared to vulval cancer?

Answer 3

BOTH

• HPV infection
• smoking
• multiple sexual partners/STI history
• age (vulval, now getting lower).

Vulval cancer:

• chronic vulval itching
• lichen sclerosus (chronic skin condition of vulva and anus)
• genital warts
• nullparity

Vaginal cancer:

• hx of gyn cancers/dysplastic cells
• prenatal exposure to DES/vaginal adenosis.

Question 4

What are the clinical features of vulval compared to vaginal cancer?

Answer 4

Both

• early stages often symptomless.
• bleeding/discharge coming from the vagina.
• lymph node swelling in the groin.
• problems passing urine or bowel motions (spread to bowel or bladder).

Vulval

• lump with chronic itch
• lump grows in size, progression to ulcerated sore that doesn’t heal, gets larger with time.

Vaginal

• PAINLESS abnormal/post coital/post menopausal bleeding
• Purulent discharge
• Constant pelvic pain.

Question 5

What are the different types of vaginal cancers?

Answer 5

1. SCC (95%)
2. Adenocarcinoma - almost all clear cell carcinomas (from DES)
3. melanoma
4. sarcoma.

Question 6

What are the investigations for vulval and vaginal cancer?

Answer 6

1. Colposcopy with acetic acid.
2. bx and staging
3. CXR to rule out mets

MX

• surgical
• radiation
• chemo.