Vulval cancer

Question 1

What are the types of VIN that a patient can have?

Answer 1

VIN usual type

VIN differentiated type

Question 2

What is VIN usual type?

Answer 2

This is the most common form of VIN - accounts for >90%

- risk factors include HPV infection, cigarette smoking and immunodeficiency

Question 3

What is dVIN (VIN differentiated type)

Answer 3

• type of VIN not caused by HPV
• associated with lichen sclerosus
• older age groyp

Question 4

List 3 management options for VIN3

Answer 4

Wide local excision
Medical - imiquimod
C02 Laser

Question 5

List 2 advantages of WLE for treatment of VIN3

Answer 5

Most likely to be curative

diagnostic of occult invasive disease

Question 6

List 2 advantages of Medical treatment or Imiquimod for treatment of VIN3

Answer 6

Avoid surgery (with it the high risk of infection and sexual dysfunction)
Similar outcome to surgical at 6 months
Preserves anatomy

Question 7

List 2 advantages of C02 ablation for VIN3 treatment

Answer 7

Better preserves anatomy (although destructive)

Acceptable for immunocompromised women

Question 8

What are the advantages of sentinel node biopsy over full groin node dissection in the context of Vulval cancer?

Answer 8

• may avoid more invasive surgery
• shorter operating time
• preservation of anatomy
• lower risk of lymphedema
• shorter recovery time

Question 9

What are 2 disadvantages of Sentinel node biopsy over formal groin node dissection?

Answer 9

• false negative biopsy

- false positive

Question 10

List FIGO stage 1a and 1b for vulval cancer

Answer 10

1a - <2cm max dimensions, <= 1mm invasion

1b - >2cm, >1mm invasion

Question 11

Describe FIGO stage 2 Vulval cancer

Answer 11

Spread to adjacent perineal structures but no nodes (1/3 lower urethra, 1/3 lower vagina, anus)

Question 12

Describe stage 3 Vulval cancer

Answer 12

Inguinofemoral node spread

Question 13

Describe stage 4 vulval cancer

Answer 13

More proximal urethra, vagina invasion
bladder invasion
bone invasion
pelvic nodes 
distant mets

Question 14

How should you manage stage 1a Vulval cancer?

Answer 14

Wide local excision

Question 15

How should you manage stage 1b vulval cancer?

Answer 15

WLE + ipsilateral groin node dissection if >1cm from midline, and no LVSI or nodes clinically
Contralateral groin node dissection if LVSI or +ve nodes
Pelvic radiotherapy if >2 nodes positive

** could consider sentinel node biopsy

Question 16

How should you manage stage 2+ vulval cancer?

Answer 16

WLE + bilateral groin node dissection
Radiotherapy if 2+ positive nodes
chemotherapy reserved for palliation

Question 17

What are the side effects of treatment for vulval cancer? (WLE +/- groin dissection)

Answer 17

Lymphedema (30-80%)
Wound breakdown/infection 30%
Numbness
Sexual dysfunction
Cellulitis
Bleeding
Incontinence
Bladder/bowel dysfunction