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
Management of vulval cancer
Surgical
- local disease control and detection of locoregional lymph nodes
- vulvectomy
- with or without inguinal lymphadenectomy
Chemotherapy
Radiotherapy (post-op only)
Reconstruction after vulval surgery
Grafts or flaps are used to reconstruct the external genitalia
- lotus petal flaps are common (developed from butterfly incision)
Sentinel node therapy
The sentinel node is the first node that drains the area affected by cancer, therefore is representative of the nodal basin
- SLN is used to assess whether lymphadenectomy is required
