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Reproduction > Vulval Cancer and Pre-Cancer > Flashcards

Vulval Cancer and Pre-Cancer Flashcards

1
Q

Define vulva cancer

A

Malignancy of outer female genitalia (labia minor/majora, clitoris, Bartholins glands)

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2
Q

What is VIN?

A

Vulvar intraepithelial neoplasia
Precancerous lesion caused by dysplasia of the squamous cells

Intra-epithelial = abnormal cells contained within top layer of epidermis that covers the vulva

Neoplasia = the cells are abnormal

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3
Q

What is the mean age for VIN?

A

36y

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4
Q

What are the two types of VIN and how do they differ?

A

Younger females - HPV related & multifocal

Older females - related to lichen sclerosus, tends to be unifocal

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5
Q

What is lichen sclerosus?

A

Chronic inflammatory disease with characteristic white, atrophic plaques

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6
Q

What are the symptoms of VIN?

A 
Can be asymptomatic
Itching 
Pain 
Changes to vulval skin 
Discomfort/pain during sex/dysuria
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7
Q

What can be the appearance of a VIN?

A

Leukoplasia (white laques on mucosal surfaces as a result of overgrowth of keratin)
Can be v. red and ulcerated
Raised papular/plaque lesions
Nodules, warty
Keratotic roughened appearance
Sharp border
Differentiated VIN tends to be unifocal ulcer/plaque & tends to be discoloured (white, red, brown)

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8
Q

What does a VIN look like histologically?

A

Similar to normal vulval cells but there is keritanisation

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9
Q

What are risk factors for vulval cancer/VIN?

A 
HPV infection 
Smoking
Other genital intra-epithelial neoplasia (check anal canal too) 
Prev related malignancy
Immunosupression
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10
Q

How do you diagnose VIN?

A

Speculum & colposcope to see inside vagina
Colposcope allows you to see abnormalities too small for the naked eye
Histological diagnosis (from punch biopsy taken under LA)

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11
Q

How do you categorise VIN?

A

VIN 1, 2, 3 based on how deeply the abnormal cells go into the dermis but now VIN 1 - not precancerous VIN 2/3 grouped together (VIN 2/3 = VIN = SIL)

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12
Q

How do you manage VIN?

A

Prevent cancer - surveillance & emollients
Surgery - wide, local excision, topical Rx, laser ablation
Eliminate symptoms (REMEMBER these woman have a severe, irretractable itch which is not helped by creams)
Preserve sexual function & body image)

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13
Q

What are the topical Rx for VIN?

A

Imiquimoid - topical cream that stimulates body to destroy HPV virus in hope cells will return to normal
Photodynamic therapy - lights/drugs to kill cancer
5FU, alpha-interferon, cidofivir

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14
Q

When would you use topical Rx for VIN?

A

Tissue preservation, if multiple lesiosn

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15
Q

When would you use laser Rx for VIN?

A

Suitable for mucosal skin

Improved cosmetic results

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16
Q

What kind of laser is used to Rx VIN?

A

CO2 laser
Burns abnormal cells away and re-epithelisation occurs within a few weeks
Can’t be done on hair baring skin!

17
Q

What is involved in the follow up of VIN?

A

Dedicated clinical
Colposcopy used
Duration of follow up depends on unifocal vs multifocal dx

18
Q

How common is vulval cancer?

A

Not very

19
Q

What are the most common vulval cancers?

A

SCC (squamous cell carcinoma) developing from VIN/lichen sclerosus

20
Q

What are the less common vulval cancers?

A

Basal cell carcinoma, melanoma, Bartholin’s gland

21
Q

Why is vulval cancer incidence increasing?

A

People are living longer

22
Q

At what rate does vulval cancer tend to progress?

A

Sowly

23
Q

What chronic skin condition is associated with vulval cancer?

A

Lichen sclerosus

24
Q

What is lichen sclerosus?

A

Skin condition that causes itchy white plaques on the genitals (mostly vulva) & anus of older women

25
Q

What is the average age of presentation of vulval cancer?

A

74

Mostly over 60

26
Q

What are the symptoms of vulval cancer?

A

Pain
Itch/burning
Bleeding
Lump/ulcer

27
Q

What is the staging of vulval cancer?

A

1A - 2cm or less in size, only grow 1mm or less into skin/tissue underneath, no LN involvement

1B - >2cm in size, >1mm into skin/tissue underneath unlikely to have spread to LNs

2 - spread to nearby tissues (e.g. lower vagina, urethra, anus), no cancer in LNs

3A/B/C - any size, may have spread to nearby tissues, involves lymph nodes on one side

4A/B - distant spread or advanced local spread/spread to pelvic LNs

28
Q

How do you Rx vulval cancer?

A

Surgery - radical local excision +/- unilateral/bilateral node dissection
Radiotherapy
Chemotherapy

29
Q

What nodes may need to be resected in vulval cancer?

A

Inguinal & upper femoral

30
Q

What are the complications of groin node dissection?

A

Wound infection
Lymphocysts (=accumulation of lymph fluid)
Nerve damage (e.g. damage to branch of femoral n)

31
Q

What woman do we want to have surveillance for vulval cancer?

A

Those with lichen sclerosis & VIN

Reproduction (28 decks)

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