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Reproduction > Vulval Cancer and Precancer > Flashcards

Vulval Cancer and Precancer Flashcards

1
Q

Why is the incidence of vulval intraepithelial neoplasia increasing?

A
  • Recognition of VIN

- HPV related diseases

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2
Q

What is the incidence of vulval intraepithelial neoplasia?

A

Uncommon vulval skin disorder

-1.4 cases per 100,000 women

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3
Q

What is vulval intraepithelial neoplasia?

A

A squamous intraepithelial lesion

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4
Q

Who is usually affected by lower genital tract intra-epithelial neoplasia?

A

Decreasing age at presentation

  • Average 36 years
  • Younger women more likely to be multi-focal and HPV positive
  • Older women more likely to be uni-focal and HPV negative
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5
Q

How is the main goal in the management of vulva intra-epithelial neoplasia?

A

Prevention of invasive disease

  • 4% risk of invasion in treated women
  • 20-40% in untreated women
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6
Q

What are the risk factors for vulval intraepithelial neoplasia?

A
  • Smoking
  • Other genital intra-epithelial neoplasia
  • Previous related malignancy
  • Immunosuppression
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7
Q

What is the clinical appearance of VIN?

A
  • Raised papular or plaques lesions
  • Erosions, nodules, warty
  • Keratotic roughened appearance
  • Sharp border
  • Differentiated VIN tends to be unifocal ulcer or plaque
  • Discoloration (red/white/brown/pigemented)
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8
Q

How is VIN diagnosed?

A

Histological diagnosis via punch biopsy under local anaesthetic

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9
Q

Why is VIN managed?

A
  • Prevent cancer
  • Eliminate symptoms
  • Preserve sexual function
  • Preserve body image
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10
Q

How is VIN managed?

A
  • Surveillance of lower genital tract and use of emollients
  • Surgery
  • Topical treatments
  • Laser ablation
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11
Q

What topical treatments are available for VIN?

A
  • Imiquimod
  • Photodynmaic therapy
  • 5FU, alpha-interferon, cidofivir
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12
Q

What are the features of topical treatments in VIN?

A
  • Tissue preservation
  • Multiple lesions
  • Effect on sexual function not known
  • Long term recurrence rates and risk of cancer are not known
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13
Q

What are the features of laser as a treatment in VIN?

A
  • CO2 laser
  • Improved cosmetic results
  • Miss occult invasion (12%)
  • 75% can be treated at one session
  • Suitable for mucosal skin
  • 40-70% recurrence rate
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14
Q

How is VIN followed up?

A
  • Dedicated clinic
  • Role of colposcopy (other LGT sites)
  • Frequency of follow-up
  • Duration of follow-up dependent if unifocal or multi-focal disease
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15
Q

What types of vulval cancer are there?

A
  • Mostly squamous cell carcinoma (VIN, Lichen sclerosus)

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

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16
Q

What is the incidence of vulval cancer?

A
  • Uncommon cancer in UK
  • 3% of gynaecological cancers
  • 97 cases per year in Scotland
  • 3.7/100,000 women
17
Q

Who is usually affected by vulval cancer?

A
  • Average age 74 (27-97)

- 75% diagnosed over age 60

18
Q

How does vulval cancer present?

A
  • Pain
  • Itch
  • Bleeding
  • Lump/ulcer
19
Q

How is vulva cancer staged?

A
  • Staging is surgical-pathological
  • Stage 1a is micro-invasion <1mm
  • Depends on size of lesion
  • Depends on lymph node involvement (inguinal, upper femoral and pelvic)
20
Q

What are the features of stage 1 vulval cancer?

A
  • Size <2cm

- Survival 97%

21
Q

What are the features of stage 2 vulval cancer?

A
  • Size >2cm

- Survival 85%

22
Q

What are the features of stage 3 vulval cancer?

A
  • Local spread
  • Unilateral nodes
  • Survival 46%
23
Q

What are the features of stage 4 vulval cancer?

A
  • Distant or advanced local spread
  • Pelvic nodes
  • Survival 50%
24
Q

How is vulval cancer treated?

A
  • Surgery (individualised, radical local excision and unilateral/bilateral node dissection)
  • Radiotherapy
  • Chemotherapy
25
Q

How is groin node dissection for vulval cancer performed?

A
  • Inguinal and upper femoral nodes
  • Separate node incisions
  • Staging and remove nodal disease
  • Associated with significant morbidity
26
Q

Why is groin node dissection associated with significant morbidity?

A
  • Wound infection
  • Lymphocysts
  • Nerve damage

Reproduction (34 decks)

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