Vulval Cancer

Question 1

What is vulval cancer?

Answer 1

Malignant neoplasm of vulva.

Question 2

What is the aetiology of vulval cancer?

Answer 2

Progression of vulval dermatoses, or progression of VIN (HPV related). Related to VIN, lichn sclerosis, smoking.

Question 3

What is the epidemiology of vulval cancer?

Answer 3

800/yr in UK, rare.

Question 4

What is the Hx and Exam of vulval cancer?

Answer 4

Vulval swelling an pain, ulcer, pruritus, pain, bleeding, discharge.

Nodule or ulcer visible on vulva (labia majora usually). Inguinal lymphadenopathy.

Question 5

What is the pathology of vulval cancer?

Answer 5

Histology: mostly SCC, melanoma or BCC (rare), Adenocarcinoma very rare.

Spread: Direct and lymph.

Staging: FIGO 2009L I-IV

· Ia: vulva/perineum, negative nodes, <2cm, stromal invasion <1mm.

· I: vulva/perineum, negative nodes, >2cm, stromal invasion >1mm.

· II: extends to lower 1/3 of urethra, lower 1/3 if V or An, nodes –

· III: pisitive nodes or distant spread.

· IV upper urethral or vaginal mucosa, ulcerated nodes, distant mets.

Question 6

What are the Ix of vulval cancer?

Answer 6

Tissue diagnosis: full thickness biopsy, sentinel node biopsy.

Cervical smear if CIN or VIN associated.

Blood: FBC, UE, Image with CT/MRI if suspect spread, CXR for mets, Stage by cystoscopy.

Question 7

What is the management of vulval cancer?

Answer 7

· Surgery if early stage – wide local excision. Ipsilateral or bilateral femoral nodectomy. Radical vulvectomy if large.

· Radiotherapy: external beam radiation if advanced disease.

Question 8

What are the complications/ prognosis of vulval cancer?

Answer 8

Psychosexual, surgical morbidity, LL lymphodema. 5y survival stage I 95%, with node involvement 50%