Vulvar Cancer

Question 1

Vulvar Cancer: Etiolgoy
usual v differentiated

risk factors

Answer 1

Etiology
- 4th MC GYN cancer
- cancer of the 60-80s
- non-invasive type: early 50s
- invasive/inflammation: 70s

esstential two main ways

from HPV: HSIL becomes usual type VIN
from chronic inflammation: dVIN (differntiated vulvaur intraepitheial neoplasia

so you have ususal and differentiated

Risk Factors
- smoking
- PHV status and risky sex
- history of vulvar lichen sclerosus (yeast infection/dm/incont = increase risk)
- hx. of melanoma
- HIV/immunocomp.
- low ses

Question 2

Vulvr Atypias v Vulvar Malginancies

Answer 2

Atypias
- lichen scleroussu risk of devleoping CA
- linchen platus
- psoriasis
- HPV warts: condyloma
- HS
- lymphogranuloms venerum (from chalmydia)
- VIN (vulvar intraepithial neoplasia)

Malignancy
- Melanoma in situs
- squamouse cell carcinoma
- Pagets disease rare but think this if nipple crusts
- Adenomcarcinoma of bartholian

Question 3

Symptoms/sigsn

Answer 3

Symptoms
- vulvar itching/burning
- changes in color or texture of skin
- texture: scaley, bumpie, rougher
- raised califlower like lesions
- dysuria
- lymphadenopathy

symptoms usually with later disease stages

Question 4

Diagnosis of vulvar cancer

Answer 4

Diagnosis
- easiest way is to biopsy via punch of the skin in multiple areas

can perform colposcopy to eval area, but PAP not done

Question 5

what is VIN and stages

Answer 5

VIN: vulvar intraepitheial neoplasia
- precancerous growths
- atypical dysplaisa in squamous epithelium
- vuvlar cancer is very slow growthi, will stay as VIN for years

VIN1: mild dysplasi
VIn II: moderate
VIN III: severe
VIN II: CIS: carcinoma in situs: is VIN III with full thickness invasion

Question 6

Management of VIN

Answer 6

Diagnosed via punch biopsy

treatment regards…
- symptoms management, preserve the abiltiy to converge to cancer and presever tissue/function
- determine grade, margins, mutlifocal disease and smoking status

VIN options
- oversation: VIN I
- aldara: imiquoid
- cryotherapy
- laser never used in invasive CA
- surgery
(5-FU NOT used)

Question 7

Vulvar Cancer: Squamous Cell

Vulvar Cancer: Melanoma

Answer 7

Squamous Cell
most common vulvar cancer
- slow growing and rarely metatstized
- only prevention is it prevent HPV

Melanoma
- 2nd type of vuvlar cancer
- only on ciltoris or labia minora

Question 8

Treatment of Vulvar Cancer

prognosis
recurrance

Answer 8

sqaum or melanoma

surgery
- laser
- excisional: wide with/wihtout nodes
- vulvectomy

radiation and chemo preo-op (although chemo NOT HELPFUL)

prognosis
- with node invovlemd: 40%
- without node involved: 85-95%

recurrance
- usuing radiation alone is rarely used because of risks
- if surgery done and recurrance occurs: chemo/rad. alone cna be done