Vulval cancer Flashcards
SIL
squamous intra-epithelial lesion
prevalence of VIN
uncommon - 1.4/100 000
Increasing incidence of VIN?
recognition of VIN and HPV related disease
Age at VIN presentation
36
2 types of VIN
younger, HPV positive and multi-focal
older, unifocal and HPV negative
Main principle of VIN management
prevent invasive disease
risk of progression to invasive disease in VIN treated/untreated
4% risk in treated
20-40% in untreated
4 risk factors for VIN
smoking
other genital intra-epithelial neoplasia
previous related malignancy
immunosuppression
clinical appearance of VIN
raised popular or plaque lesions erosions, nodules, warty keratotic roughened appearance sharp border discolouration = red, brown, white
Diagnosis of VIN
histology
punch biopsy under LA
Management of VIN
prevent cancer - eliminate severe itch - maintain sexual function - preserve body image - surveillance- surgery - topical treatments - laser ablation
Topical treatment
imiquimod
multiple lesions
photodynamic therapy
5FU, alpha-interferon, cidofivir
Laser treatment
CO2 laser on mucosal skin only
success of laser treatment
75% treated in one session
40-70% recurrence
Most common type of vulval cancer
SCC
Other vulval cancer types
BCC, melanoma, adenocarcinoma
Presentation of vulval cancer
74 (27-97) with pain, itching, bleeding or lump/ulcer
Staging of vulval cancer
surgical-pathological
size of lesions, nodes
Nodes in vulval cancer
inguinal AND upper femoral
pelvic
Stage 1a
microinvasion - less than 2cm
Treating vulval cancer
radical local excision
LN removal
chemo/radiotherapy
Groin node dissection
inguinal and upper femoral
staging and removal of nodes
Morbidity associated with groin node dissection
infection, lymphocysts, nerve damage
