Vulval cancer

Question 1

75% of patients are diagnosed over the age of?

Answer 1

60

Question 2

Typical presentation of vulva cancer (4)

Answer 2

• pain
• itch
• bleeding
• lump/ulcer

Question 3

risk factors for vulval cancer? (4)

Answer 3

• Intraepithelial neoplasia or cancer at other lower genital tract site
• Lichen sclerosus
• Smoking
• Immunosuppression

Question 4

lymph node involvement inclues ?

Answer 4

inguinal and upper femoral

pelvic

Question 5

2 pathways vulval cancer can develop in?

Answer 5

HPV related

Non-HPV related

Question 6

what does multizonal mean in terms of HPV related spread?

Answer 6

can spread to areas like the cervix, the vagina, perinanal skin and anal mucosa

Question 7

HPV related - features

Answer 7

• Usual type VIN
• Younger women
• Multifocal - more than 1 lesion
• immunosupression
• Past history of intra-epithelial neoplasia

Question 8

Non-HPV related disease features (4)

Answer 8

• Differentiated VIN on histology
• Older women
• Lichen Sclerosus
• Often presents as cancer at first diagnosis

Question 9

vulval cancer 97% survival rate if size is?

Answer 9

<2cm

Question 10

vulval cancer 85% survival rate if size is?

Answer 10

> 2cm

Question 11

vulval cancer 46% survival rate if?

Answer 11

local spread - unilateral nodes

Question 12

vulval cancer 50% survival rate if?

Answer 12

distant of advanced local spread, pelvic nodes

Question 13

what biopsy may you do?

Answer 13

Punch biopsy or excisional biopsy

Question 14

possible diagnoses you can get from biopsy? (3)

Answer 14

Inflammatory, including lichen sclerosus

Dysplasia- VIN

Malignant- squamous cell carcinoma

Question 15

Vulvar Intraepithelial Neoplasia is?

Answer 15

Abnormal proliferation of squamous epithelium; can progress to carcinoma

Question 16

the usual the of VIN is?
what is it associated with?
grading?

Answer 16

classical / warty
HPV infection
Low grade VIN1 - high grade VIN 2 or 3

Question 17

differentiated type of VIN is ?

Answer 17

In older women, not HPV related

always high grade

Question 18

squamous cell carcinomas have the ability to?

Answer 18

to invade adjacent tissues and spread to distant sites (metastasis)

Question 19

vulval cancer uses what staging?

Answer 19

FIGO staging

Question 20

what is it important to measure ?

Answer 20

depth of invasion

Question 21

on a histology image of a SSC you will see?

Answer 21

keratinisation

Question 22

what surgeries/ treatments are offered for vulva cancer? (3-4)

Answer 22

• individualised surgery
• Local excision
• Unilateral or bilateral node dissection

Radiotherapy/Chemotherapy

Question 23

groin node dissection is dependent on?

Answer 23

anatomy - lymphatic drainage from the vulva

Question 24

inguinal node and upper femoral nodes - dissection

Answer 24

local dissection of tumour to try preserve some of the anatomy and function of the vulva

Question 25

Groin node dissection is associated with? (3)

Answer 25

significant morbidity

• wound infection
• lymphocysts
• nerve damage - numbness over the thigh

Question 26

structures you come into contact with in femoral node dissection?

Answer 26

femoral artery
femoral vein
long saphenous vein 
inguinal ligament 
sartorius muscle

Question 27

dissection begins with

Answer 27

small incision over the femoral tract

Question 28

vulval cancer - older people key symptoms

Answer 28

pain/ulcer/lump

- precursor VIN