Vulva inna-epithelial neoplasia and cancer

Question 1

Aetiology of vulvar carcinoma?

Answer 1

May be HPV related or non-HPV related (In which case think about long standing lichen sclerosis)

Question 2

How is vuvlar intra-epithelial neoplasia managed?

Answer 2

1) Prevent invasive disease
2) Prevent cancer
3) Eliminate symptoms
4) Preserve sexual function
5) Preserve body image
6) Surveillance
- lower genital tract
- Emolliants
7) Surgery
8) Topical treatments
9) Laser ablation

Question 3

What are the risk factors of vuvlar intra-epithelial neoplasia?

Answer 3

> Smoking
Other genital intra-epithelial neoplasia
Previous related malignancy
Immunosuppression

Question 4

Clinical appearance of vuvlar intra-epithelial neoplasia?

Answer 4

> Raised papular or plaques lesions

> Erosions, nodules, warty

> Keratotic roughened appearance

> Sharp border

> Differentiated VIN tends to be unifocal ulcer or plaque

> Discoloration

• red
• white
• brown/pigmented

Question 5

How is vuvlar intra-epithelial neoplasia diagnosed?

Answer 5

Punched biopsy under local anaesthetic and histology

Question 6

Topical treatments for vuvlar intra-epithelial neoplasia?

Answer 6

> Imiquimod

> Photodynmaic therapy

> 5FU, alpha-interferon, cidofivir

Question 7

Treatment for intra-epithelial neoplasia?

Answer 7

1) Topical:
- Imiquimod
- Photodynmaic therapy
- 5FU, alpha-interferon, cidofivir

2) Laser ablation
3) Surgery

Question 8

What is the incidence of vulva cancer?

Answer 8

Uncommon:

• 3% of gynaecological cancers
• 97 cases per year in Scotland

Question 9

Most common type of vulva cancer?

Answer 9

Squamous cell carcinoma:

• VIN
• Long-standing lichen sclerosis (Older women)

Question 10

How can Vulvar intre-epithelial neoplasia be characterised?

Answer 10

Koilocytic change, disordered maturation, nuclear atypic and increased mitotic activity

Question 11

What is the age vulva carcinoma most likely to present?

Answer 11

Age 74 (27-97)

75% diagnosed over the age of 60

Question 12

How does vulva cancer present generally?

Answer 12

> Pain
> Itch
> Bleeding
> Lump/ulcer
> Leukoplakia

Question 13

How is vulva carcinoma staged?

Answer 13

1) Size of lesion
2) Invasion
3) Lymph node involvement

Question 14

What is classified as stage 1a vulva cancer?

Answer 14

Stage 1a ‘micro-invasion’ < 1mm

Question 15

What is classified as stage 1 vulva cancer?

Answer 15

1) <2cm
2) Little/No invasion
3) No lymph node involvement

Survival = 97%

Question 16

What is classified as stage 2 vulva cancer?

Answer 16

1) <2cm
2) Little invasion
3) No lymph node involvement

Survival = 85%

Question 17

What is classified as stage 3 vulva cancer?

Answer 17

1) >2cm
2) Local spread
3) Unilateral nodal involvement

Survival = 46%

Question 18

What is classified as stage 4 vulva cancer?

Answer 18

1) >2cm
2) Distant or advanced local spread
3) Pelvic lymph node involvement

Question 19

How is vulva cancer treated?

Answer 19

1) Surgery:
- Individualised surgery
- Radical local excision
- Unilateral or bilateral node dissection

2) Radiotherapy
3) Chemotherapy

4) Groin node dissection:
- Inguinal and upper femoral nodes