Vulval Cancer

Question 1

Epidemiology of vulval cancer

Answer 1

• Age 74 (29-97)
• 75% >60

Question 2

Risk factors for vulval cancer

Answer 2

• Intraepithelial neoplasia at other lower genital tract site
• Lichen sclerosus
• Smoking
• Immunosuppression

Question 3

Presentation of vulval cancer

Answer 3

• Pain
• Itching
• Bleeding
• Lump/ulcer

Question 4

How is vulval cancer staged

Answer 4

• FIGO
  
  • Size
  • lymph node involvement
    
    • Inguinal and upper femoral
    • Pelvic

Question 5

Stages of vulval cancer

Answer 5

Size

Nodes

Survival

1

<2cm

-

97%

2

>2cm

-

85%

3

Local spread

Unilateral nodes

46%

4

Distant or advanced local spread

Pelvic nodes

50%

Question 6

Types of vulval cancer

Answer 6

• HPV related
• Non-HPV related

Question 7

HPV related vulval cancer

Answer 7

• usual type VIN
• Younger women
• Multifocal
• Multizonal
• Immunosuppression
• Past history of intraepithelial neoplasia

Question 8

Presentation of HPV related vulval cancer

Answer 8

• Rough, wartous, white, itch

Question 9

Non-HPV related vulval cancer

Answer 9

• Differntiated VIN
• Older women
• Lichen sclerosus
• Cancer at first presentation
• Shorter natural history

Question 10

Treatment of vulval cancer

Answer 10

• Surgery
  
  • Individualised
  • Local excision
  • unilateral or bilateral node excision
• Radiotherapy/chemotherapy - very similar to anal cancer regimes

Question 11

Groin node dissection in vulval cancer

Answer 11

• Inguinal and upper femoral nodes
• Separate node incisions
• Staging and removal of node disease
• associated with significant morbidity
  
  • Wound infection
  • Lymphocysts
  • Nerve damage

Question 12

Histopathology of vulval cancer

Answer 12

• Punch biopsy or excisional biopsy
• Small piece of tissue which is processed and looked at under microscope
• Possible diagnosis
  
  • Inflammatory, including lichen sclerosus
  • Dysplasia - VIN
  • Malignant - squamous cell carcinoma

Question 13

VIN in vulval cancer

Answer 13

• Abnormal proliferation of squamous epithelium; can progress to carcinoma
• Usual type (aka. classical/warty)
  
  • Associated with HPV infection
  • Low grade (VIN1) or high grade (VIN2/3)
• Differentiated
  
  • In older women, not HPV related
  • Always high grade

Question 14

Squamous cell carcinoma in vulval cancer

Answer 14

• Malignant tumour of squamous cells
• Ability to invade adjacent tissue and spread to distant (metastases)
• Important to measure depth of invasion