Vulval Cancer Flashcards
Incidence of vulval cancer?
3.7/100,00
RCOG/BGCS 2014
Mortality rate of vulval cancer?
1.3/100,000
RCOG/BGCS 2014
Percentage of lichen sclerosus that develops to squamous cell carcinoma?
4% (TOG & RCOG/BGCS 2014)
<5% (BASHH 2015)
Percentage of vulval cancers which are SCC?
90%
RCOG/BGCS 2014
Vulval cancer:
Which is associated with higher local recurrence: infiltrative growth patterns or pushing patterns?
Infiltrative growth patterns
RCOG/BGCS 2014
Vulval cancer:
Does the presence of fibromyxoid stroma at the invasive edge suggest better or poorer outcome?
Poorer outcome
RCOG/BGCS 2014
Vulval cancer:
Percentage of women with operable disease who have nodal spread?
About 30%
RCOG/BGCS 2014
Vulval cancer:
What is stage I?
What is the 5 year survival?
Tumour confined to the vulva; 98%
FIGO 2018 & StratOG
Vulval cancer:
What is stage I?
What is stage Ia?
What is stage 1b?
Tumour confined to the vulval
- Ia - <2cm size, stromal invasion <1mm
- Ib - >2cm or >1mm invasion
(FIGO 2018)
Vulval cancer:
What is stage II?
What is the 5 year survival?
Tumour of any size with extension to adjacent perineal structures (lower 1/3 urethra, low 1/3 vagina, anus) with negative nodes; 85%
(FIGO 2018 & StratOG)
Vulval cancer:
What is stage III?
What is the 5 year survival?
Tumour of any size with or without extension to adjacent perineal structures (lower 1/3 urethra, low 1/3 vagina, anus) with positive nodes; 74%
(FIGO 2018 & StratOG)
Vulval cancer: What is stage III? What is stage IIIa? What is stage IIIb? What is stage IIIc?
Tumour of any size with or without extension to adjacent perineal structures (lower 1/3 urethra, low 1/3 vagina, anus) with positive nodes
IIIa - one node ≥ 5mm or 1-2 nodes <5mm
IIIb - two nodes ≥ 5mm or 3 nodes <5mm
IIIc - positive nodes with extracapsular spread
(FIGO 2018 & StratOG)
Vulval cancer:
What is stage IV?
What is the 5 year survival?
Tumour invades other regional or distant structures; 31%
FIGO 2018 & StratOG
Vulval cancer:
What is stage IV?
What is stage IVa?
What is stage IVb?
Tumour invades other regional or distant structures
IVa - invades upper urethra, vagina, bladder, rectum or fixed to pelvic bone/ fixed or ulcerated lymph nodes
IVb - any distant mets including pelvic lymph nodes (survival 11%)
(FIGO 2018 & StratOG)
Vulval cancer:
Treatment for lesions <2cm diameter and invasion <1mm?
Radical wide local excision
RCOG/BGCS 2014
Vulval cancer:
Risk of node involvement if lesion <2cm, invasion <1mm?
<1% risk
RCOG/BGCS 2014
Vulval cancer:
Distance from midline for unilateral lymph node dissection only?
> 1cm
(RCOG/BGCS 2014)
2cm
(FIGO 2018)
Vulval cancer:
Adequate surgical margins and risk of recurrence with this?
> 8mm risk of recurrence 0%
<8mm risk of recurrence 47%
(RCOG/BGCS 2014)
Vulval cancer:
Risk of recurrence for SCC?
15-33%
RCOG/BGCS 2014
Vulval cancer:
Commonest site of recurrence?
- Vulva 69.5%
- Groin nodes 24.3%
- Pelvis 15.6%
- Distant metastases 18.5%
(RCOG/BGCS 2014)
What percentage of gynaecological cancers are vulval?
2-5%
FIGO 2018
Lymphatic drainage of vulval?
Inguinal then femoral, then external and internal iliacs. Clitoris can be directly to iliac.
(FIGO 2018)
What subtype of HPV is most commonly associated with vulval cancer?
HPV-16
FIGO 2018
VIN 1 is now called…. and is associated with…?
VIN 1 = low-grade squamous intraepithelial lesions due to HPV
(FIGO 2018)
VIN 2/3 or usual type VIN is now called…
VIN2/3 = high-grade squamous intraepithelial lesions
FIGO 2018
Differentiated VIN is associated with…
Lichen sclerosus
FIGO 2018
Which type of VIN has highest rate of progression to SCC?
DIfferentiated VIN
FIGO 2018
Management of differentiated VIN?
Wide local excision (0.5-1cm margins)
FIGO 2018
Treatment of HSIL (high-grade squamous intraepithelial lesions)?
Simplex excision with 5mm margins and 4mm depth
FIGO 2018
How much distal urethra can be removed without comprimising urinary continence?
Distal 1cm
FIGO 2018
