Vulval Cancer and Precancer

Question 1

lower genital tract intra-epithelial neoplasia age

Answer 1

• Decreasing age at presentation:
o 36 years
o Younger women/multi-focal/HPV +
o Older women/unifocal/HPV –

Question 2

management of VIN

Answer 2

o Prevent invasive disease
§ 4% risk of invasion in treated women
§ 20-40% in untreated women

Question 3

risk factors for VIN

Answer 3

o Smoking
o Other genital intra-epithelial neoplasia
o Previous related malignancy
o Immunosuppression

Question 4

clinical appearance of VIN

Answer 4

• Raised popular or plaques lesions
• Erosions, nodules, warty
• Keratotic roughened appearance
• Sharp border
• Differentiated VIN tends to be unifocal ulcer or plaque
• Discoloration
o Red
o White
o Brown/pigmented

Question 5

diagnosis of VIN

Answer 5

Histological diagnosis
• VIN = VIN2/VIN3 = SIL
• Punch biopsy (dermatology) under local anaesthetic

Question 6

management of VIN

Answer 6

• Prevent cancer
• Eliminate symptoms
• Preserve sexual function
• Preserve body image
• Surveillance
o Lower genital tract
o Emollients
• Surgery
• Topical treatments
• Laser ablation

Question 7

topical treatments for VIN

Answer 7

o Tissue preservation
o Multiple lesions
o Effect on sexual function not known
o Long term recurrence rates and risk of cancer are not known
o Imiquimod
o Photodynamic therapy
o 5FU, alpha-interferon, cidofovir

Question 8

laser ablation for VIN

Answer 8

o CO2 laser
o Improved cosmetic results
o Miss occult invasion (12%)
o 75% can be treated at one session
o Suitable for mucosal skin not hairy
o 40-70% recurrence rate

Question 9

follow up for VIN

Answer 9

• Dedicated clinic
• Role of colposcopy (other LGT sites)
• Frequency of follow up
• Duration of follow up
o Unifocal vs multi focal disease

Question 10

most common types of vulval cancer

Answer 10

Squamous cell - VIN, lichen sclerosus
basal cell
melanoma
bartholin’s gland

Question 11

average age for vulval cancer

Answer 11

74 (27-87)

Question 12

presentation of vulval cancer

Answer 12

o Pain
o Itch
o Bleeding
o Lump/ulcer

Question 13

how is vulval cancer staged?

Answer 13

surgical-pathological

Question 14

lymph node spread of vulval cancer

Answer 14

inguinal and upper femoral

pelvic

Question 15

treatment for vulval cancer

Answer 15

• Surgery
o Individualised surgery
o Radical local excision
o Unilateral or bilateral node dissection
• Radiotherapy
• Chemotherapy

Question 16

groin node dissection in vulval cancer

Answer 16

• Inguinal and upper femoral nodes
• Separate node incisions
• Staging and remove nodal disease
• Associated with significant morbidity
o Wound infection
o Lymphocysts
o Nerve damage