Vulval carcinoma Flashcards
What is vulval carcinoma?
A very rare form of malignancy affecting the vulva
Risk factors for vulval carcinoma?
Highest incidence in older women.
Vulval intraepithelial neoplasia (VIN) is considered as the pre-malignant state
- For young women is often multifocal, recurrent or persistent causing treatment problems.
- For older women greater risk of progression to invasive squamous carcinoma
HPV infection
Paget’s disease of the vulva
Lichen sclerosus
What is the main histological type of vulva carcinoma?
Squamous cell carcinomas (85% of cases)
Remaining cases are of various other histological types including melanomas.
Main precursor for HPV-driven SCC?
VIN (vulvar intraepithelial neoplasia)
Main precursor of HPV independant vulva SCC?
Differentiated VIN (dVIN)
Differentiated VIN results in a higher risk of malignancy than HPV-driven VIN. True/false?
True
HPV driven VIN often has an association with background inflammatory dermatoses such as lichen sclerosus. True/false?
False
Differentiated VIN is associated with background inflammatory dermatoses.
Clinical features of vulva cancer?
May present with
- a vulval lump
- vulval bleeding due to ulceration
- pruritus (itch) or pain
75% of growths are found on the labia
Investigations for vulva cancer?
Examination and biopsy
Other investigations may include:
- Cystoscopy
- Proctoscopy
- CXR and MRI scans can be used for staging purposes
Management of vulva cancer?
Wide local excision of the vulval lesion
- If depth of invasion > 1mm, surgery includes inguinal lymphadenectomy.
Radiotherapy +/- is often used in the treatment of advanced vulval cancer
What is an important prognostic factor for vulval cancer?
Inguinal lymph node spread
What is Paget’s disease of the vulva?
Very rare malignancy originating in the vulvar-apocrine gland bearing skin cells (primary disease)
Manifestation of adjacent primary anal, rectal or bladder adenocarcinoma (secondary disease).
Who is usually affected with Paget’s disease of the vulva?
Only post-menopausal women are usually affected.
Pathophysiology of Paget’s disease of the vulva?
Tumour cells in the epidermis, contains mucin (protects and lubricates epithelial surfaces).
Clinical presentation of Paget’s disease of the vulva?
Crusting rash, often sharp demarcation
Pruritic/painful
