Vaginal and Vulval Disorders

Question 1

Clinical features of vulval cancer

Answer 1

Vulval bleeding

Vulval lump or ulceration

Question 2

Epidemiology of vulval cancer

Answer 2

Very rare – 3.7 per 100,000 women-years
85% are squamous
Labium majorum most common site

Question 3

Risk factors for vulval cancer

Answer 3

• Vulval Intraepitherlial Neoplasia (VIN)
• Lichen sclerosus
• HPV infection
• Paget’s disease of the vulva (adenoma in situ)

Question 4

Define VIN

Answer 4

Vulval Intraepithelial Neoplasia
Considered a pre-malignant state – due to dysplasia
Two types
Usual/undifferentiated – usually affects women under 50, associated with HPV infection
Differentiated – rarer, usually affects women over 60, associated with lichen sclerosus

Question 5

Features of VIN

Answer 5

Most women have pruritis but may also by asymptomatic

White, grey or red raised lesions

Question 6

Management of VIN

Answer 6

Biopsy performed to ensure not malignant

1st line management is wide local excision

Question 7

Presentation of vulval carcinoma

Answer 7

Vulval lump,
Vulval bleeding due to ulceration
Pruritis 
Pain
Spread to adjacent organs or via lymphatics to inguinal and femoral nodes

Question 8

Managment of vulval carcinoma

Answer 8

Diagnosis made by examination and biopsy
Standard management is radical/wide local resection
With multifocal disease a radical vulvectomy may be needed
Reconstructive surgery can be performed
Radiotherapy used in advanced vulval cancer