Vulval cancer Flashcards
75% of patients are diagnosed over the age of?
60
Typical presentation of vulva cancer (4)
- pain
- itch
- bleeding
- lump/ulcer
risk factors for vulval cancer? (4)
- Intraepithelial neoplasia or cancer at other lower genital tract site
- Lichen sclerosus
- Smoking
- Immunosuppression
lymph node involvement inclues ?
inguinal and upper femoral
pelvic
2 pathways vulval cancer can develop in?
HPV related
Non-HPV related
what does multizonal mean in terms of HPV related spread?
can spread to areas like the cervix, the vagina, perinanal skin and anal mucosa
HPV related - features
- Usual type VIN
- Younger women
- Multifocal - more than 1 lesion
- immunosupression
- Past history of intra-epithelial neoplasia
Non-HPV related disease features (4)
- Differentiated VIN on histology
- Older women
- Lichen Sclerosus
- Often presents as cancer at first diagnosis
vulval cancer 97% survival rate if size is?
<2cm
vulval cancer 85% survival rate if size is?
> 2cm
vulval cancer 46% survival rate if?
local spread - unilateral nodes
vulval cancer 50% survival rate if?
distant of advanced local spread, pelvic nodes
what biopsy may you do?
Punch biopsy or excisional biopsy
possible diagnoses you can get from biopsy? (3)
Inflammatory, including lichen sclerosus
Dysplasia- VIN
Malignant- squamous cell carcinoma
Vulvar Intraepithelial Neoplasia is?
Abnormal proliferation of squamous epithelium; can progress to carcinoma
the usual the of VIN is?
what is it associated with?
grading?
classical / warty
HPV infection
Low grade VIN1 - high grade VIN 2 or 3
differentiated type of VIN is ?
In older women, not HPV related
always high grade
squamous cell carcinomas have the ability to?
to invade adjacent tissues and spread to distant sites (metastasis)
vulval cancer uses what staging?
FIGO staging
what is it important to measure ?
depth of invasion
on a histology image of a SSC you will see?
keratinisation
what surgeries/ treatments are offered for vulva cancer? (3-4)
- individualised surgery
- Local excision
- Unilateral or bilateral node dissection
Radiotherapy/Chemotherapy
groin node dissection is dependent on?
anatomy - lymphatic drainage from the vulva
inguinal node and upper femoral nodes - dissection
local dissection of tumour to try preserve some of the anatomy and function of the vulva
Groin node dissection is associated with? (3)
significant morbidity
- wound infection
- lymphocysts
- nerve damage - numbness over the thigh
structures you come into contact with in femoral node dissection?
femoral artery femoral vein long saphenous vein inguinal ligament sartorius muscle
dissection begins with
small incision over the femoral tract
vulval cancer - older people key symptoms
pain/ulcer/lump
- precursor VIN
