Vulva

Question 1

is it rare or common

Answer 1

rare found in 70+

Question 2

are incidence rates increasing or decreasing

Answer 2

increasing

Question 3

what are the risk factors

Answer 3

smoking
HPV
genital warts, immunosuppression lichen sclerosis
lichen sclerosis is an itchy skin condition, which is when there’s white patches on the vulva, skin becomes fragile and breaks down

Question 4

presentation

Answer 4

lump on vulva, may ulcerate, odorous
pain
mass on groin + lymphoedema in the leg

Question 5

what is the main pathology

Answer 5

SCC (90%)

Question 6

what are the other pathology types

Answer 6

BCC, melanoma or adenocarcinoma

Question 7

what does FIGO relate to

Answer 7

the local spread and involvement of inguinal nodes, distant mets are rare (IVB)

Question 8

how can tumour recurrence be treated

Answer 8

interstitial brachytherapy (HDR)

Question 9

why can direct DXR or electron field be used

Answer 9

groin node: inguinal are superficial

Question 10

what is VIN

Answer 10

pre-invasive vulval intraepithelial neoplasia
can become malignant

Question 11

what is the treatment for VIN

Answer 11

watch and wait

Question 12

what is the treatment for radical invasive

Answer 12

radical or hemi vulvectomy
risks: highly vascular region, risk of haemorrhage post surgery
excision of groin nodes
risks: parathesia of lower limb due to femoral nerve damage and lymphodema
if nodes are unresectable adjuvant EBRT can be offered

Question 13

what is the treatment for palliative

Answer 13

Palliative EBRT
tissues in the vulva are intolerant to EBRT leading to MDS
POP
max 1.8Gy per fraction, with a max total of 40-45Gy