Vulval Cancer Flashcards
Firstly we’re going to explore VIN
Vulval Intraepithelial neoplasia
Who gets VIN?
Mean age is 36yrs (older than CIN)
Younger women tend to be HPV +ve & have multi-focal VIN
Older women tend to be uni-focal and unrelated to HPV
How does VIN look?
Raised papular or plaque lesions with a keratotic appearance (potentially like warts)
They have a sharp border and may be discoloured (red, white or brown)
How can we diagnose VIN?
With a punch biopsy under LA. It’s a histological diagnosis
When we detect a case of VIN what are our goals?
Firstly to prevent cancer
Control symptoms
Preserve body image and sexual function
What treatments do we have for VIN?
Surgery is gold standard
Laser Ablation e.g. CO2 laser
Topical Treatments e.g. Imiquimod
Pros & cons of laser ablation
Not as effective as surgery & missed occult invasion
But it has a better cosmetic result and can be used on mucosal skin
Pros and cons of Topical treatments?
Not as effective as surgery but preserves the tissue and is better for multiple lesions
Imiquimod, it’s mainly a treatment for genital warts
What risk factors lead to VIN?
Smoking
Other genital IN including anal
Previous related malignancy
Immunosuppression
If we don’t catch or treat VIN it can lead to vulval cancer, what is the major type?
SCC
How does Vulval cancer present?
Mostly >60yrs
A sustained pain, intractable itch and a bleeding lump or ulcer
How treatable is vulval cancer?
Stage 1 has a 97% cure rate
Late stage is more like 50%
How can we treat vulval cancer?
Surgery +/- node dissection
RT & Chemo
What nodes are removed when treating vulval canceR?
Inguinal and upper femoral
Either unilateral or bilateral
When do we use RT & Chemo for vulval cancer?
Either neo-adjuvantly or if they arn’t suitable for surgery
