Vulval Cancer

Question 1

vulva cancer presentation

Answer 1

• age range (27-97)
• 75% diagnosed over age 60
• pain
• itch
• bleeding
• lump/ulcer

Question 2

vulval cancer risk factors

Answer 2

• intaepithelial neoplasia or cancer at other lower genital tract sight
• lichen sclerosis
• smoking
• immunosuppression

Question 3

features of HPV related Vulval cancer

Answer 3

• usually type VIN
• younger women
• multifocal
• multizonal
• immunosuppression
• PMH of intraepithelial neoplasia

Question 4

features of non-HPV related vulval cancer

Answer 4

• differentiated VIN
• older women
• lichen sclerosus
• often presents as cancer at first diagnosis

Question 5

describe vulva cancer from stage 1-4 based on size and node involvement

Answer 5

Question 6

describe vulvar intraepithelial neoplasia (VIN)

Answer 6

• abnormal proliferation of squamous epithelium; can progress to carcinoma
• usual type (aka classical/warty): associated with HPV infection, low-grade (VIN1) or high-grade (VIN2/3)
• OR differentiated type: in older women, not HPV related, always high-grade

Question 7

what staging system is used for vulval cancer?

Answer 7

FIGO

Question 8

vulval cancer treatment

Answer 8

Surgery is mainstay of treatment:
- individualised surgery
- local excision of lesion
- unilateral or bilateral node dissection if larger than microinvasive cancer > 1mm

• Radiotherapy/chemotherapy

Question 9

Groin node dissection (inguinal and upper femoral nodes) are associated with significant morbidity such as:

Answer 9

• wound infection
• lymphocysts
• nerve damage