Vulval cancer Flashcards
What group of patients most commonly presents with vulva cancer?
> 60s
What are the signs/symptoms of vulval cancer?
Pain
Itch
Bleeding
Lump/ulcer
What are risk factors for vulval cancer?
Intraepithelial neoplasia or cancer at other lower genital tract site Lichen sclerous Smoking Immunosuppression HPV infection
What is lichen sclerosis?
Chronic dermatitis which causes itch and irritation - lesions present as white papules and plaques
What is the staging for vulval cancer?
Surgical-pathological
What is stage 1A of vulva cancer?
‘Micro-invasion’ <1mm
What is used to stage vulva cancer?
Size of lesion
Lymph node involvement: inguinal and upper femoral, pelvic
Which node involvement suggests advanced vulva cancer?
Pelvic nodes
What is VIN?
Vulvar intraepithelial neoplasia
Precancerous lesion caused by dysplasia of squamous cells
What are two types of VIN?
HPV related and non-HPV related
Is differentiated VIN associated with HPV?
No
Who is differentiated VIN usually found in?
Older women
Associated with lichen sclerosus
Which type of VIN has a higher risk of presenting as cancer ?
Differentiated, non-HPV related, VIN
What are the symptoms of VIN?
Itching
Pain
Changes to the vulval skin
Dyspareunia
What is HPV VIN associated with?
Young women Multifocal Multizonal Immunosuppression PHx intraepithelial neoplasia
What are the stages of vulva cancer?
Stage 1-4
What size is a stage 1 vulva cancer?
<2cm
What size is a stage 2 vulva cancer?
> 2cm
What is a stage 3 vulva cancer
Local spread
Unilateral nodes
What is a stage 4 vulva cancer?
Distant or advanced local spread
Pelvic nodes
What is the treatment for vulva cancer?
Surgery
Radiotherapy/chemotherapy
What are the surgery options for vulva cancer?
Individualised surgery - radical vulvectomy
Local excision
Unilateral or bilateral node dissection
Why is groin node dissection associated with significant morbidity?
Wound infection
Lymphocysts
Nerve damage
What nodes are dissected in a groin node dissection?
Inguinal and upper femoral
Overall, what groups does vulva cancer usually affect?
Older women - pain/ulcer
Young women - VIN
What type of cancer are the majority of vulva cancers?
Squamous cell carcinomas
What are the investigations for vulval cancer?
Pelvic exam and colposcopy
Biopsy
