Vulvar cancer

Question 1

List two risk factors for vulval cancer

Answer 1

smoking
HPV
immunosuppressed 
VIN
Lichen sclerosus
Squamous metaplasia

Question 2

Which is the most common vulval cancer?

Answer 2

90% squamous cell carcinoma

Question 3

What are the three types of VIN?

Answer 3

VIN1,2,3

Question 4

Patient has VIN 2. Do they have cancer?

Answer 4

VIN 2 and 3 are high grade disease and may well have underlying cancer (unlike in CIN which is a precursor condition)

Question 5

List two VIN subtypes

Answer 5

1. usual type
2. warty
3. basaloid
4. differentiated

Question 6

Name two other sites involved in vulval cancer

Answer 6

vagina
cervix
perianal
anal
natal cleft

Question 7

List three signs and symptoms of vulval cancer

Answer 7

pruritis
pain
ulceration
leukoplakia
lump
swollen leg
groin lump

Question 8

Name two common sites of VIN

Answer 8

labia majora
labia minora
posterior fourchette
mons pubis
clitoris

Question 9

Define vulva

Answer 9

female external genitalia

Question 10

How is a diagnosis of VIN made?

Answer 10

biopsy

Question 11

What is the management of high grade VIN?

Answer 11

surgery
laser
chemical
photodynamic therapy

Question 12

Name a chemical agent in the treatment of VIN

Answer 12

imiquimod

Question 13

Name one negative aspect of imiquimod

Answer 13

difficult compliance due to cream stinging/burning

Question 14

Why might vulvar cancer present with groin lump?

Answer 14

lymphatic drainage of vulva= pelvic lymph nodes (inguinal)

Question 15

What is the main lifestyle factor modification for vulval cancer?

Answer 15

STOP smoking

Question 16

List two signs of vulval cancer

Answer 16

mass
ulceration
colour changes
inguinal lymphadenopathy
lower limb lymphoedema

Question 17

List three modalities of chemo in vulval cancer

Answer 17

Neoadjuvant- shrink tumour
primary- prior to radiotherapy
adjuvant

Question 18

Name one surgical technique of vulval cancer

Answer 18

triple incision

Question 19

When do you need to perform a lymphadenectopy?

Answer 19

if the sential lymph node is negative!