Vulval cancer (VIN)

Question 1

What is vulval cancer/ vaginal intraepithelial neoplasm

Answer 1

Malignant neoplasm of the vulva
95% are SCC&raquo_space;» melanoma&raquo_space;>adeno

RF- 
usual types (warty SCC)- VIN (from HPV type 16), immunosupress, smoke
Differentiated type (keratine SCC) - lichen scloeris

Aetiology -
VIN split into 3 groups on how deep it is
Low, high grade. when invasive its vulval cancer

Use FIGO staging again

Question 2

sx and ix of vulval cancer/ vaginal intraepithelial neoplasm

Answer 2

Sx - vulval swelling/ulcer, pruritis, pain, bleed, discharge
Nodule/ulcer visible on vulva- usually labia majora
INGUINAL lymphadenopathy

Ix -
Tissue diagnosis + LN biopsy
Cervical smeal - exclude CIN
Imagine - CT for stagine
cytoscopy/proctoscopy

Question 3

Mx of vulval cancer/ vaginal intraepithelial neoplasm

Answer 3

Depends on FIGO stage
1a- tumour confined/VIN - wide local excision (10mm magins)

> 1a - radical vulvectomy and bilateral inginal lymphadenectomy (15% are metastased)

surgery used as neoadjuvant or if surgery not valid