Vulval Cancer Flashcards
Aetiology of vulval cancer
405 deaths in 2012 Smoking VIN Chronic skin conditions - e.g. Lichen sclerosis HPV Squamous metaplasia Altered immune system/suppression Increasing age
histopathological subtypes of vulval cancer
Squamous cell carcinoma (most common) Adenocarcinoma Melanoma BCC Sarcoma Metastatic
Vulval intraepithelial neoplasia subtypes
VIN1 - not a precursor of VIN2 and 3
VIN 2 and 3
- both managed as high grade disease
- they can be differentiated, warty, basaloid or the usual type
‘usual type’ pathology in VIN
Thickened
Disorganised keratinocytes
High nuclear:cytoplasmic ratio
Nuclear atypic abnormal mitotic figures
‘Warty’ pathology in VIN
Papillary configuration
Multinucleate cells, koliocytes and dyskeratotic cells
‘Basaloid’ pathology of VIN
Flat surface
Less differentiated cells with a high nuclear:cytoplasmic ratio
‘Differentiated’ pathology of VIN
Thicken epidermis
Surface parakeratosis
Not well documented as a disease
Clinical presentation of VIN
Pruritis Pain Ulceration Leukoplakia Wart Asymptomatic - noticed during smear due to increased awareness in smear takers
Common VIN locations
Labia Majora Labia minora Mins pubis Clitoris Perineal Perinanal
Appearance of VIN
Variable Red/white plaques Papules Polypoid Verruciform
Diagnosis of VIN
Biopsy
- incisional (original lesions remains)
- excisional
Management of high grade VIN
Eradication of HPV and symptom relief Excision (local excision must be employed, not negative margins) - surgery - laser Ablation - chemical e.g. Imiquimod - laser - photodynamic therapy
What is imiquimod?
A topical immune response modifier, can be used to treat high grade VIN or genital warts
- works by chemical ablation
Signs and symptoms of vulval cancer
Vulval/groin lump Bleeding/discharge Swollen leg Ulceration Colour changes An elevated and irregular surface Lower limb oedema Inguinal lymphadenopathy
Diagnosing vulval cancer
Biopsy
- incisional (preferred) or excisional
Assess locoregional lymph nodes
- CT, MRI, USS
