Vulval Cancer

Question 1

Percentage of gynaecological cancers that are vulval

Answer 1

3-5%

Question 2

Type of vulval cancer most common

Answer 2

Squamous (90%)

Question 3

Aetiological factors

Answer 3

VIN
HPV
Chronic inflammation and itch. In ono-neoplasticism vulval dermatitis (LS)

Question 4

HPV types associated with VIN

Answer 4

16

18

Question 5

Symptoms of vulval cancer

Answer 5

Pruritis
Burning
Soreness
Bleeding
Pain
Lump
Ulceration
Discharge
Asymptomatic

Question 6

Concerning features on exam

Answer 6

Genital wart in a PM woman
Ulcers
Fun hating mass
Irregularity f skin contour
Depigmentation
Hyperpigmentation
Groin lympthadenopathy

Question 7

SCC locations

Answer 7

Unifocal
Anterior lesions
Usually on labia majora
(Can be on clitoris or perineum

Question 8

Diagnosis of lesion

Answer 8

Biopsy
Clinical photography
WLE of a small and well circumscribed lesion

Question 9

Figo stage 1 vulva

Answer 9

Tumor confined to vulva

Negative nodes

Question 10

Figo stage II vulval ca

Answer 10

Tumor of any size with extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with negative nodes

Question 11

Figo stage III vulval ca

Answer 11

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

Question 12

Figo Stage IV vulval ca

Answer 12

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

Question 13

Management of Stage II vulva ca or less

Answer 13

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

Question 14

Management of stage III and IV vulval ca

Answer 14

Radical vulvectomy with en bloc resection of bilateral inguinofemoral LNs
Can have pre op adjuvant RT or CT

Question 15

Recurrence rate of vulval cancer

Answer 15

37%

Question 16

Risk factors for recurrence

Answer 16

> stage II
Positive LNs
Vascular space invasion

Question 17

Pathological types

Answer 17

Squamous 90%
Melanoma 3%
BCC 2-4%
Bart 5%
Adenocarcinoma <1%
Verrucous carcinoma <1%
Sarcomas 1-2%

Question 18

Risk of progression of VIN to vulval ca (usually on a background of LS)

Answer 18

30%

Question 19

Risk of progression of HSIL to cancer

Answer 19

9-16%

Question 20

Prognostic factors in vulval ca

Answer 20

Inguinofemoral LN Mets***
FIGO stage
Histological grade of tumor
Depth of invasion
Age
Performance status of patient

Question 21

Risk of complications with groin lymphadenectomy

Answer 21

Wound dehiscence
Infection
Lymphocyte formation
Lymphoedema
Immobility
Prolonged hospitalization

Question 22

Indications for adjuvant therapy

Answer 22

Presence of extracapsular spread in the involved groin node

2 or more positive groin nodes