vulval cancer

Question 1

mean age diagnosis

Answer 1

74

Question 2

presentation

Answer 2

pain 
itch 
bleeding 
lump, bump 
rough area 
ulcer

Question 3

risk factors

Answer 3

intraepithelial neoplasia or cancer of another lower genital tract site or (peri) anal
chronic immunosuppresion
smoking
lichen sclerosus

Question 4

HPV related

Answer 4

usual type vulval intraepithelial neoplasia, squamous cell vulval cancer
younger woman
can have more than one lesion
can be at more than one site e.g. cervix, vagina
linked to immunosuppresion
PHx intraepithelial neoplasia (often cervical)

Question 5

non-HPV related

Answer 5

differentiated VIN
older women
lichen sclerosus predisposes

Question 6

histopathology: VIN

Answer 6

usual type: classical, warty, assoc w HPV, VIN1 (low grade) or VIN 2,3 (high grade)

differentiated type: older women, always high grade

Question 7

FIGO stage 1

Answer 7

<2cm

Question 8

FIGO stage 2

Answer 8

> 2cm

Question 9

FIGO stage 3

Answer 9

local spread

unilateral nodes

Question 10

FIGO stage 4

Answer 10

distant or advanced local spread

pelvic nodes

Question 11

management

Answer 11

surgical: mainstay Rx, local excision, unilateral/bilateral node dissection

chemo/radiotherpay (themselves or before surgery)

Question 12

groin node dissection

Answer 12

inguinal and upper femoral nodes

assoc w significant morbidity: wound infection, lymphocysts, nerve damage