Vulval Cancer

Question 1

Presentation

Answer 1

• ITCH!! - often long-standing + refractive to usual topical rx (e.g. thrush medication)
  
  • PAIN
  • BLEEDING
  • LUMP/ULCER

Question 2

Risk factors

Answer 2

• INTRA-EPITHELIAL NEOPLASIA/CANCER at OTHER LOWER GENITAL TRACT SITE (CERVICAL, ANAL, VAGINAL etc.)
  
  • LICHEN SCLEROSUS
  • SMOKING
  • IMMUNOSUPPRESSION (CHRONIC)
  • HPV (some cases)
  • WELL-CONTROLLED HIV w/ ART = NO INCREASED INCIDENCE of VULVAL CANCER

Question 3

Investigations

Answer 3

• CLINICAL DIAGNOSIS + BIOPSY (determine depth of invasion)

Question 4

Management

Answer 4

SURGERY:
• INDIVIDUALISED SURGERY

• LOCAL EXCISION - TAKING MARGIN of HEALTHY SKIN ~ CANCEROUS TISSUE
• UNILATERAL/BILATERAL NODE DISSECTION

RT/CHEMOTHERAPY:
• If UNFIT FOR SURGERY

• For LARGE TUMOURS - downstage tumours to allow them to be surgically dissected

Question 5

Epidemiology

Answer 5

• MAJORITY = OLDER WOMEN ~ 74YRS (can be any age i.e. 27 - 97yrs)

75% DIAGNOSED > 60YRS

Question 6

Staging

Answer 6

• SURGICAL-PATHOLOGICAL - FIGO STAGING
  
  • STAGE 1a = MICROINVASION, < 1 mm
  • SIZE of LESION
  • LYMPH NODE INVOLVEMENT○ INGUINAL + UPPER FEMORAL (both have to be involved)
    ○ PELVIC = quite ADVANCED, spread is via inguinal canal