vulval cancer Flashcards
What are the types of vulval cancer?
> 90% is squamous cell carcinoma
Malignant melanoma
Adenocarcinoma
Paget’s disease (rare)
what are the types of SQUAMOUS cell vulval premalignant changes?
Vulval Intraepithelial Neoplasm:
- Differentiated intraepithelial neoplasm - associated with lichen sclerosis
- High grade squamous intraepithelial lesion - associated with high risk HPV
- Low grade squamous intraepithelial lesion - associated with low risk HPV
what is vulval intraepithelial neoplasia
abnormal proliferation of squamous epithelium
what are features of HPV associated/warty/classical vulval cancer
higher grade
effects ages 35-50
what are features of differentiates VIN
associated with lichen sclerosus
effects older women
what are risk factors for vulval cancer
advanced age immunosuppressed HPV infection lichen sclerosus smoking intraepithelial neoplasia at another lower genital tract site
how does vulval cancer present
vulval lump ulceration itch bleeding itch lymphadenopathy irregular mass fungating lesion Lump usually painless
what investigations could you do for vulval cancer
biopsy (core or excision) of mass +/- nodes
CT for staging if needed
what staging system is used in vulval cancer
FIGO
how do you manage vulval cancer
surgical excision of tumour +/- lymph nodes
chemo/radio in stages 3/4 to treat or shrink before surgery
imiquimod cream for DVIN
laser ablation
what are complications of lymph node removal
infection
lymphocysts
nerve damage
Where is vulvar cancer mostly seen?
On the labia major.
What is lichen sclerosis?
An autoimmune condition causing white patchy skin usually near the genitals that’s thinner than normal.
What is the treatment for Vulval intraepithelial neoplasia?
Watch and wait
wide and local excision
Imiquimod
Laser ablation
