Vulval cancer Flashcards
1
Q
Types of vulva CA
A
- Sq cell carcinoma - 90%
- Vulva melanoma/basal cell/adenocarcinoma etc 10%
2
Q
Age group
A
> 65yo
3
Q
Cause of SCC
A
- HPV 16
- VIN
- Smoking
- Lichen scelrosus (5%)
4
Q
Symptoms
A
- Vulval itching/irritation/pain
- Bleeding
- ulceration
- Fungating lesion
- Palpable groin nodes
ALWAYS BIOPSY!
5
Q
Biopsy
A
- Punch or wedge, avoid excisional biopsy
- Avoid central ulcer- might not be diagnostic
- Good depth >1mm
6
Q
How does Vulva CA spread
A
Lymph nodes
7
Q
Imaging
A
- CT TAP or MRI to visualise nodes/ mets
8
Q
FIGO staging
A
add image
9
Q
Mx of SCC
A
- MDT and staging
- Excision biopsy once confirmed SCC - 1cm margin macroscopically
- Consider reconstruction for large excisions
- On slide, if margins are clear, >2mm microscopic clearance is fine.
10
Q
If anal margins are involved
A
- Use adj chemo-radio (within 6w) to shrink the tumour then excise to prevent faecal incontinence.
- Temp/premanent stoma
11
Q
Groin nodes mx
A
- Preoperative lymphoscintigraphy is recommended.
- SLNB if tumour <4cm
- Use fluorescent dyes +radioactive tracer
- DO NOT do SLNB if nodes + on scan.
- Groin node removal if >stage 1a. or tumour >4cm
12
Q
When to use post op radiotherapy
A
- Positive excision margins
- > 1 metastatic node
13
Q
Grading for SCC (linked to 5 year survival)
A
- Grade 1- Well differentiated
- Grade 2- Mod diff
- Grade 3- Poorly diff
Based on deg of keratinisation, intercellular bridges and pleomorphisms.
14
Q
Management by stages
A
Stage 1a- Excision, no nodes
Stage 1b- Large local excision +nodes
Stage II and III- Same as above.
Stage IV- Palliative procedues- defunctioning stomas, urinary diversion (if fistulas form)
15
Q
Mx of pt who cannot have surgery
A
- Radical chemoradiotherapy
- Map rx using CT
