Vaginal and Vulvar Cancer

Question 1

First sign of disease in VIN

Answer 1

Abnormal papsmear

Question 2

vaginal intraepithelial neoplasia aka

Answer 2

preinvasive disease of vagina

Question 3

how do you diagnose VIN? what must you rule out?

Answer 3

abnormal papsmear, coloscopic examination of vagina with biopsy, coloscopic 3-5% acetic acid whitening of vagina, and lugol’s iodine- identifies borders of lesion. Rule out vaginal cancer

Question 4

what is one of the most common sites for extramammary paget disease?

Answer 4

vulva

Question 5

Patient presents with bloody discharge, hyperplastic, leukoplastic vulvar skin, pruritis, irritation. In 65 year old woman (post menopausal). Has history of genital warts, abnormal papsmears, diabetes, smoking, HSV-2. What do you suspect and how to diagnose?

Answer 5

Biopsy necessary, can do punch biopsy. consider preopertaive colposcopy, pelvic CT or MRI to r/o lymphadenopathy. Vulvar cancer

Question 6

HPV subtypes that are risk factors for vulvar cancer

Answer 6

16, 18, and 31

Question 7

90% of vulvar cancers are…

Answer 7

squamous lesions. Most originate in labia majora and minora, more than one third involve vulva bilaterally

Question 8

VIN is associated with..

Answer 8

HPV infection (vulvar warts common)

Question 9

VIN stages

Answer 9

I- mild, II- moderate dysplasia, III- severe dysplasia

Question 10

vulvar cancer tx

Answer 10

laser, wide or radical local excision, ultrasound surgical aspiration, valvotomy, radiation therapy, chemotherapy, biologic therapy. Refer to gynecologic oncologist

Question 11

if vulvar carcinoma less than 2 cm, what is 5 year survival rate?

Answer 11

85-90%

Question 12

often, the first symptom of vulva involvement (cancer, lichen sclerosis, lichen simplex chronicus_

Answer 12

itching

Question 13

cancer of vagina most common in what age group

Answer 13

older women

Question 14

most common symptom of vaginal cancer

Answer 14

vaginal bleeding, postcoital spotting