Vulval cancer Flashcards
How does Vulval cancer present?
- Pain
- Itch - doesn’t tend to present on its own
- Bleeding
- Lump/ulcer
Incidence of vulval cancer?
Rare cancer - lower incidence in comparison with other gynae cancers i.e endometrial, cervical or ovarian
75% diagnosed over age of 60
Mean age of presentation is 74 but can see vulval cancer in young women too.
Risk factors for vulval cancers (4)
- Intraepithelial neoplasia or cancer at other lower genital tract site (cervical etc) or perianal/anal
- Lichen sclerosus - chronic dermatosis believed to be autoimmune in origin (not related to HPV)
- Smoking
- Chronic imunosuppression
Stages of vulval cancer
- Stage 1 – the cancer is confined to the vulva
- Stage 2 – the cancer has spread to other nearby parts of the body, such as the lower vagina, anus or lower urethra, but the lymph nodes are unaffected
- Stage 3 – the cancer has spread into nearby lymph nodes
- Stage 4 – the cancer has spread to other parts of the body, including more distant lymph nodes
Which local lymph nodes does vulval cancer tend to spread to?
- Inguinal and upper femoral
- Pelvic
What are the 2 main causes of vulval cancer?
- HPV
- Non-HPV cause such as Lichen Sclerosus (a vulval skin condition) - seen in older women
How does HPV related vulval cancer present?
- Usual type vulvar intraepithelial neoplasia (VIN) - precancerous
- Tend to occur in younger women between the ages of 35+55
- HPV type 16 is the most common type of HPV found in vulval cancer
- However, it is very rare for woman with VIN to develop vulvar cancer
Which staging system is used to stage vulval cancer and other gynaecalogical cancers?
Figo staging - relates to size of lesion
Figo staging of vulval cancer
Stage 1
- Size = less than 2 cm
- No nodes involved
- Survival = 97%
Stage 2
- Size = more than 2 cm
- No nodes involved
- Survival = 85%
Stage 3
- Size = Local spread
- Unilateral nodes
- Survival = 46%
Stage 4
- Distant or advanced local spread
- Pelvic nodes Survival = 50%
How is vulval cancer diagnosed?
Biopsy - punch biopy or excisional biopsy
The sample is then processed in the lab and studied under a microscope. It is important to measure the depth of invasion into the epithelium if there is any as this affects the staging and management of patient.
Possible diagnoses:
- Inflammatory, including lichen sclerosus
- Dysplasia- VIN
- Malignant- squamous cell carcinoma
What is Vulvar Intraepithelial Neoplasia (VIN)?
VIN is an abnormal proliferation of squamous epithelium that can progress to carcinoma. It is pre-cancerous!
2 types:
- Usual or classical type
- Associated with HPV infection
- Low grade (VIN 1) or high grade (VIN 2 or 3)
- Differentiated type
- Usually occurs in older women - not HPV related
- Always high grade
How is Vulval cancer treated?
Surgery
- Individualised surgery
- Local excision of lesion
- Unilateral or bilateral node dissection (depends on location/size of lesion) - this would be done with separate node incisions. Tends to be inguinal and upper femoral nodes.
Radiotherapy/chemotherapy - may be the main treatment or it may be used to downstage disease/reduce it and then have surgery for any residual disease.
Groin node dissection is associated with significant morbidity. Give 3 examples of possible complications.
- Wound infection
- Lymphocysts
- Nerve damage - numbness over the thigh
If there is local spread to lymph nodes i.e inguinal/upper femoral LNs then is surgery still the definitive treatment?
Yes
Give 2 reasons why Groin node dissection is done
- For staging disease - to detect nodal involvement
- To remove nodal disease
