Vulval Cancer Flashcards
Percentage of gynaecological cancers that are vulval
3-5%
Type of vulval cancer most common
Squamous (90%)
Aetiological factors
VIN
HPV
Chronic inflammation and itch. In ono-neoplasticism vulval dermatitis (LS)
HPV types associated with VIN
16
18
Symptoms of vulval cancer
Pruritis Burning Soreness Bleeding Pain Lump Ulceration Discharge Asymptomatic
Concerning features on exam
Genital wart in a PM woman Ulcers Fun hating mass Irregularity f skin contour Depigmentation Hyperpigmentation Groin lympthadenopathy
SCC locations
Unifocal
Anterior lesions
Usually on labia majora
(Can be on clitoris or perineum
Diagnosis of lesion
Biopsy
Clinical photography
WLE of a small and well circumscribed lesion
Figo stage 1 vulva
Tumor confined to vulva
Negative nodes
Figo stage II vulval ca
Tumor of any size with extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with negative nodes
Figo stage III vulval ca
Tumor of any size, with or without extension to adjacent perineal structures, with positive inguino-femoral lymph nodes
IIIA with 1 LN met (> or = 5 mm) or 1-2 LN Mets <5mm
IIIB 2 or more LN met >5 or 3 < 5mm
IIIC positive nodes with extracapsular spread
Figo Stage IV vulval ca
Tumor invading other regional (2/3 upper urethra, 2/3 upper vagina) or distant structures
IVA tumor invades local structures or fixed or ulcerated inguino-femoral nodes
IVB any distant Mets including pelvic LN
Management of Stage II vulva ca or less
Radical WLE If superficially invasive, no need to resect LNs If more than superficial Inuginofemoral lymphadenectomy Ipislateral if >1cm from midline If central —>resect both sides
Management of stage III and IV vulval ca
Radical vulvectomy with en bloc resection of bilateral inguinofemoral LNs
Can have pre op adjuvant RT or CT
Recurrence rate of vulval cancer
37%
Risk factors for recurrence
> stage II
Positive LNs
Vascular space invasion
Pathological types
Squamous 90% Melanoma 3% BCC 2-4% Bart 5% Adenocarcinoma <1% Verrucous carcinoma <1% Sarcomas 1-2%
Risk of progression of VIN to vulval ca (usually on a background of LS)
30%
Risk of progression of HSIL to cancer
9-16%
Prognostic factors in vulval ca
Inguinofemoral LN Mets*** FIGO stage Histological grade of tumor Depth of invasion Age Performance status of patient
Risk of complications with groin lymphadenectomy
Wound dehiscence Infection Lymphocyte formation Lymphoedema Immobility Prolonged hospitalization
Indications for adjuvant therapy
Presence of extracapsular spread in the involved groin node
2 or more positive groin nodes
