Vulval cancer Flashcards
what is the incidence of vulval cancer
75% diagnosed over age 60
what is the typical presentation for vulval cancer
pain
itch
bleeding
lump/ulcer
what are risk factors for vulval cancer
Intraepithelial neoplasia or cancer at other lower genital tract site
Lichen sclerosus
Smoking
Immunosuppression
how is vulva cancer staged
Staging surgical-pathological
Stage 1a ‘micro-invasion’ < 1mm
Size of lesion
Lymph node involvement
inguinal and upper femoral
pelvic
HPV related vulva cancer who does this affect
Usual type VIN
Younger women
Multifocal
Multizonal
Immunosuppression
Past history of intra-epithelial neoplasia
non HPV vulva cancer who does this affect
Differentiated VIN
Older women
Lichen Sclerosus
Often presents as cancer at first diagnosis
how do we identify the histopathology of vulva cancer
Punch biopsy or excisional biopsy
Small piece of tissue which we process and look at under the microscope
what are Possible diagnosis for vulval cancer after histopathology comes back
Inflammatory, including lichen sclerosus
Dysplasia- VIN
Malignant- squamous cell carcinoma
Vulvar Intraepithelial Neoplasia
Abnormal proliferation of squamous epithelium; can progress to carcinoma
Usual type (aka classical / warty)
Associated with HPV infection
Low grade (VIN 1) or high grade (VIN 2 and 3)
Differentiated type
In older women, not HPV related
always high grade
Squamous cell carcinoma
Malignant tumour of squamous cells
Ability to invade adjacent tissues and spread to distant sites (metastasis)
Grade= How bad is it ( Mild, Moderate, Poor)
Staging system = how far tumour has spread
Vulval cancer = FIGO staging
On a biopsy very important to measure depth of invasion
how is vulva cancer treated
Surgery
individualised surgery
Local excision
Unilateral or bilateral node dissection
Radiotherapy/Chemotherapy
Groin node dissection
Inguinal and upper femoral nodes
Separate node incisions
Staging and remove nodal disease
Associated with significant morbidity
Wound infection
Lymphocysts
Nerve damage
