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MRCOG Part 2 > Vulval Cancer > Flashcards

Vulval Cancer Flashcards

1
Q

Incidence of vulval cancer?

A

3.7/100,00

RCOG/BGCS 2014

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2
Q

Mortality rate of vulval cancer?

A

1.3/100,000

RCOG/BGCS 2014

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3
Q

Percentage of lichen sclerosus that develops to squamous cell carcinoma?

A

4% (TOG & RCOG/BGCS 2014)

<5% (BASHH 2015)

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4
Q

Percentage of vulval cancers which are SCC?

A

90%

RCOG/BGCS 2014

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5
Q

Vulval cancer:

Which is associated with higher local recurrence: infiltrative growth patterns or pushing patterns?

A

Infiltrative growth patterns

RCOG/BGCS 2014

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6
Q

Vulval cancer:

Does the presence of fibromyxoid stroma at the invasive edge suggest better or poorer outcome?

A

Poorer outcome

RCOG/BGCS 2014

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7
Q

Vulval cancer:

Percentage of women with operable disease who have nodal spread?

A

About 30%

RCOG/BGCS 2014

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8
Q

Vulval cancer:
What is stage I?
What is the 5 year survival?

A

Tumour confined to the vulva; 98%

FIGO 2018 & StratOG

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9
Q

Vulval cancer:
What is stage I?
What is stage Ia?
What is stage 1b?

A

Tumour confined to the vulval
- Ia - <2cm size, stromal invasion <1mm
- Ib - >2cm or >1mm invasion
(FIGO 2018)

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10
Q

Vulval cancer:
What is stage II?
What is the 5 year survival?

A

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)

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11
Q

Vulval cancer:
What is stage III?
What is the 5 year survival?

A

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)

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12
Q 
Vulval cancer: 
What is stage III?
What is stage IIIa?
What is stage IIIb?
What is stage IIIc?
A

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)

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13
Q

Vulval cancer:
What is stage IV?
What is the 5 year survival?

A

Tumour invades other regional or distant structures; 31%

FIGO 2018 & StratOG

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14
Q

Vulval cancer:
What is stage IV?
What is stage IVa?
What is stage IVb?

A

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)

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15
Q

Vulval cancer:

Treatment for lesions <2cm diameter and invasion <1mm?

A

Radical wide local excision

RCOG/BGCS 2014

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16
Q

Vulval cancer:

Risk of node involvement if lesion <2cm, invasion <1mm?

A

<1% risk

RCOG/BGCS 2014

17
Q

Vulval cancer:

Distance from midline for unilateral lymph node dissection only?

A

> 1cm
(RCOG/BGCS 2014)
2cm
(FIGO 2018)

18
Q

Vulval cancer:

Adequate surgical margins and risk of recurrence with this?

A

> 8mm risk of recurrence 0%
<8mm risk of recurrence 47%
(RCOG/BGCS 2014)

19
Q

Vulval cancer:

Risk of recurrence for SCC?

A

15-33%

RCOG/BGCS 2014

20
Q

Vulval cancer:

Commonest site of recurrence?

A
  • Vulva 69.5%
  • Groin nodes 24.3%
  • Pelvis 15.6%
  • Distant metastases 18.5%
    (RCOG/BGCS 2014)
21
Q

What percentage of gynaecological cancers are vulval?

A

2-5%

FIGO 2018

22
Q

Lymphatic drainage of vulval?

A

Inguinal then femoral, then external and internal iliacs. Clitoris can be directly to iliac.
(FIGO 2018)

23
Q

What subtype of HPV is most commonly associated with vulval cancer?

A

HPV-16

FIGO 2018

24
Q

VIN 1 is now called…. and is associated with…?

A

VIN 1 = low-grade squamous intraepithelial lesions due to HPV
(FIGO 2018)

25
Q

VIN 2/3 or usual type VIN is now called…

A

VIN2/3 = high-grade squamous intraepithelial lesions

FIGO 2018

26
Q

Differentiated VIN is associated with…

A

Lichen sclerosus

FIGO 2018

27
Q

Which type of VIN has highest rate of progression to SCC?

A

DIfferentiated VIN

FIGO 2018

28
Q

Management of differentiated VIN?

A

Wide local excision (0.5-1cm margins)

FIGO 2018

29
Q

Treatment of HSIL (high-grade squamous intraepithelial lesions)?

A

Simplex excision with 5mm margins and 4mm depth

FIGO 2018

30
Q

How much distal urethra can be removed without comprimising urinary continence?

A

Distal 1cm

FIGO 2018

MRCOG Part 2 (4 decks)

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