Vulval Cancer Flashcards
What is the peak age for vulvar cancer?
- 27-97
* 75% diagnosed over age 60
How does vulvar cancer present?
- Pain
- Itch
- Bleeding
- Lump/ulcer
What are the risk factors for vulvar cancer?
- Intraepithelial neoplasia or cancer at other lower genital tract site
- Lichen sclerosus
- Smoking
- Immunosuppression
How is vulvar cancer staged?
- Staging surgical-pathological
- Stage 1a ‘micro-invasion’ < 1mm
- Size of lesion
- Lymph node involvement - inguinal and upper femoral, pelvic
Describe HPV-related vulvar cancer?
- Usual type VIN - vulvar intraepithelial neoplasia
- Younger women
- Multifocal
- Multizonal - cervix, vagina, perianal skin, anal mucosa
- Immunosuppression
- Past history of intra-epithelial neoplasia
Describe non-HPV-related vulvar cancer?
- Differentiated VIN
- Older women
- Lichen sclerous
- Often present as cancer at first diagnosis
What is stage 1 of vulvar cancer?
- <2cm
* Survival - 97%
What is stage 2 of vulvar cancer?
- > 2cm
* Survival - 85%
What is stage 3 of vulvar cancer?
- Local spread
- Unilateral lymph nodes
- Survival - 46%
What is stage 4 of vulvar cancer?
- Distant or advanced local spread
- Pelvic lymph nodes
- Survival - 50%
How is a biopsy taken in vulvar cancer?
Punch biopsy or excisional biopsy
What is the histopathology of vulvar cancer?
- Inflammatory, including lichen sclerosus
- Dysplasia - VIN
- Malignant - squamous cell carcinoma
What is vulvar intraepithelial neoplasia?
Abnormal proliferation of squamous epithelium; can progress to carcinoma
What is usual type VIN?
- Associated with HPV infection
* Low grade (VIN 1) or high grade (VIN 2 and 3)
What is differentiated type VIN?
- In older women, not HPV related
* Always high grade
What staging is used in vulvar cancer?
FIGO
What is squamous cell carcinoma?
- Malignant tumour of squamous cells
* Ability to invade adjacent tissues and spread to distant sites (metastasis)
How is vulvar cancer treated?
•Surgery
- individualised surgery
- local excision
- unilateral or bilateral node dissection
•Radiotherapy/Chemotherapy
What is groin node dissection used for?
- Inguinal and upper femoral nodes
- Separate node incisions
- Staging and remove nodal disease
What are the risks associated with groin node dissection?
- Associated with significant morbidity
- Wound infection
- Lymphocysts
- Nerve damage
Summary
- Rare cancer
- Older women with pain/ulcer/lump
- Young women with VIN
- Treatment is surgery
- Prognosis is good
