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Reproductive System > Vulval Cancer and Precancer > Flashcards

Vulval Cancer and Precancer Flashcards

1
Q

What are the features of lower genital tract intra-epithelial neoplasia?

A

Stratified squamous epithelium - no transition zone, natural history from infection to neoplasia is longer than in CIN
Decreasing age at presentation - around 36 years
Younger women with multi-focal disease, HPV +ve, more susceptible to multi-zonal disease
Older women with uni-focal disease, HPV -ve

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2
Q

How many women are affected by vulva intraepithelial neoplasia?

A

1.4 cases per 100,000 women

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3
Q

What are the reasons for the increasing incidence of vulva intraepithelial neoplasia?

A

Recognition of VIN - people more aware and less likely to put up with symptoms for as long
HPV related diseases - increasing infection resulting in increasing vaginal, vulva and anal disease

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4
Q

What is the management of vulva intraepithelial neoplasia?

A 
Prevent invasive disease 
Eliminate symptoms 
Preserve sexual function 
Preserve body image
Surveillane - lower genital tract, emollients
Surgery 
Topical treatments 
Laser ablation
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5
Q

What is the risk of invasive disease in vulva intraepithelial neoplasia?

A

4% risk of invasion in treated women

20-40% risk in untreated women

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6
Q

What are the risk factors for vulva intraepithelial neoplasia?

A

Smoking
Other genital intra-epithelial neoplasia
Previous related malignancy
Immunosuppression e.g. HIV +ve, autoimmune disease, immunosuppression for transplantation

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7
Q

What is the clinical appearance of vulva intraepithelial neoplasia?

A

Raised papular lesions or plaques - can be seen without colposcopy
Erosions, nodules, warts
Keratotic roughened appearance
Sharp border
Differentiated VIN tends to be uni-focal ulcer or plaque, generally seen in older women
Discolouration - red, white, brown, pigmented

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8
Q

How is VIN diagnosed?

A

Histological diagnosis
VIN/SIL
Punch biopsy under local anaesthetic

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9
Q

The pathology of VIN looks identical to CIN, how can you differentiate?

A

Biopsy site

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10
Q

What are the functions of topical treatments for VIN?

A

Tissue preservation

Multiple lesions

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11
Q

What are the topical treatments used for VIN?

A 
Imiquimod 
Photodynamic therapy 
5FU
Alpha interferon
Cidofivir
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12
Q

What is the effect of topical treatment on sexual function, long-term recurrence rates and risk of cancer?

A

Unknown

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13
Q

What are the features of laser ablation for treatment of VIN?

A

CO2 laser

Improved cosmetic results, more minor procedure

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14
Q

What percentage of laser ablation for VIN will miss occult invasion?

A

12%

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15
Q

What percentage of VIN can be treated in one session of laser ablation?

A

75%

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16
Q

What is the recurrence rate of VIN following laser ablation?

A

40-70%

17
Q

What is the follow up for VIN?

A

Dedicated clinic
Role of colposcopy
Frequency and duration of follow up depend on uni-focal or multi-focal disease

18
Q

What percentage of gynaecological cancers are accounted for by vulva cancer?

A

3%

19
Q

How many cases per year of vulva cancer are there in Scotland?

A

130

20
Q

How many women are affected by vulva cancer?

A

4.6/100,000 women

21
Q

What are the histological types of vulva cancer?

A

Most commonly squamous cell carcinoma

Also basal cell carcinoma, melanoma and Bartholin’s gland adenocarcinoma

22
Q

What is squamous cell carcinoma of the vulva related to?

A

VIN

Lichen sclerosus

23
Q

At what age does vulva cancer typically occur?

A

Age 74

Range 27-97

24
Q

What percentage of vulva cancer is diagnosed in women > 60 years?

A

75%

25
Q

What is the presentation of vulva cancer?

A

Pain
Itching - may be related to VIN or lichen sclerosus
Bleeding
Lump/ulcer

26
Q

How is vulva cancer staged?

A

Surgical-pathological staging

27
Q

What factors are involved in staging vulva cancer?

A

Size of lesion
Lymph node involvement
Metastases

28
Q

What is stage 1a of vulva cancer?

A

Micro-invasion < 1mm, no node involvement

29
Q

What is stage 1 of vulva cancer?

A

< 2mm lesion

No node involvement

30
Q

What is stage 2 of vulva cancer?

A

> 2mm lesion

No node involvement

31
Q

What is stage 3 of vulva cancer?

A

Local spread

Unilateral node involvement

32
Q

What is stage 4 of vulva cancer?

A

Distant or advanced local spread

Pelvic node involvement

33
Q

What is the survival of stage 1 vulva cancer?

A

97%

34
Q

What is the survival of stage 2 vulva cancer?

A

85%

35
Q

What is the survival of stage 3 vulva cancer?

A

46%

36
Q

What is the survival of stage 4 vulva cancer?

A

50%

37
Q

What is the treatment of vulva cancer?

A

Surgery

  • individualised for each patient, need to consider urinary, bowel and sexual function
  • radical local excision
  • unilateral or bilateral node dissection (bilateral if central tumour as it could metastasise to either side)

Radiotherapy
Cemotherapy

38
Q

What is the process of groin node dissection?

A

Inguinal and upper femoral nodes dissected
Separate node incisions
Staging and removal of nodal disease

39
Q

Groin node dissection is associated with significant morbidity, such as

A

Wound infection
Lymphocysts
Nerve damage

Reproductive System (33 decks)

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