Vulvar cancer

Question 1

Is vulvar cancer common in the UK?

Answer 1

• no
• around 1300/year

Question 2

What age is most commonly affected by vulvar cancer?

1 - 20-30
2 - 30-40
3 - 40-50
4 - >60

Answer 2

4 - >60

Question 3

Which type of vulvar cancer accounts for aprox 80% of all vulvar cancers?

1 - Vulval melanoma
2 - Paget’s disease of the vulva
3 - Squamous cell carcinoma
4 - Basal cell carcinoma

Answer 3

3 - Squamous cell carcinoma
- from most outer layers of the vulva
- same cells as those in skin elsewhere in the body

Question 4

Although the exact cause of vulvar cancer is unknown, there are risk factors associated with it. Which of the following is NOT a risk factors for vulvar cancers?

1 - HPV (16 and 18)
2 - Cervical intraepithelial neoplasia (CIN)
3 - Vulval intraepithelial neoplasia (VIN)
4 - Nulliparity
5 - Lichen sclerosis
6 - History of other genital cancer
7 - Smoking

Answer 4

4 - Nulliparity

Question 5

Vulvar cancers can occur anywhere on the vulva, but which of the following is the most common sight?

1 - labia majora and minora
2 - clitoris
3 - bartholin’s glands
4 - perineum

Answer 5

1 - labia majora and minora

Question 6

Patients can present with a number of symptoms if they have vulvar cancer. Other than a mass on the vulvar, which of the following ma be present?

1 - lichen sclerosis
2 - pruritus
3 - active bleeding
4 - discharge
5 - dysuria
6 - dyspareunia
7 - all of the above

Answer 6

7 - all of the above

• lichen sclerosis = itchy white patches on the vagina
• generalised itching

Question 7

To confirm a diagnosis of vulvar cancer what test needs to be performed?

1 - lymph biopsy
2 - cytology based on biopsy from lump
3 - MRI
4 - CT

Answer 7

2 - cytology based on biopsy from lump

• lymph biopsy, CT and MRI may be done if the patient is suspected of having metastasis, but the first investigation to confirm should be a biopsy

Question 8

If a patient presents with a mass on the vulvar, which of the following would not be a typical differential?

1 - Vulvar cancer
2 - Vulval intraepithelial neoplasia (VIN)
3 - Cervical cancer
4 - Lichen sclerosis
5 -

Answer 8

3 - Cervical cancer

• VIN could be benign or early signs of cancer, depends on the stage of the VIN as per the image

Question 9

Which of the following is stage 1 of vulva cancer according to the FIGO classification?

1 - cancer has spread to nearby tissue, such as the vagina, anus, or urethra, and to the groin lymph nodes. There are no distant metastases.
2 - tumor is only in the vulva or the vulva and perineum. It has not spread.
3 - cancer has spread to the upper part of the vagina or upper part of the urethra, or it has spread to a distant part of the body.
4 - tumor is of any size and has spread to nearby structures, including the lower part of the urethra, vagina, or anus

Answer 9

2 - tumor is only in the vulva or the vulva and perineum. It has not spread.

Question 10

Which of the following is stage 2 of vulva cancer according to the FIGO classification?

1 - cancer has spread to nearby tissue, such as the vagina, anus, or urethra, and to the groin lymph nodes. There are no distant metastases.
2 - tumor is only in the vulva or the vulva and perineum. It has not spread.
3 - cancer has spread to the upper part of the vagina or upper part of the urethra, or it has spread to a distant part of the body.
4 - tumor is of any size and has spread to nearby structures, including the lower part of the urethra, vagina, or anus

Answer 10

4 - tumor is of any size and has spread to nearby structures, including the lower part of the urethra, vagina, or anus

Question 11

Which of the following is stage 3 of vulva cancer according to the FIGO classification?

1 - cancer has spread to nearby tissue, such as the vagina, anus, or urethra, and to the groin lymph nodes. There are no distant metastases.
2 - tumor is only in the vulva or the vulva and perineum. It has not spread.
3 - cancer has spread to the upper part of the vagina or upper part of the urethra, or it has spread to a distant part of the body.
4 - tumor is of any size and has spread to nearby structures, including the lower part of the urethra, vagina, or anus

Answer 11

1 - cancer has spread to nearby tissue, such as the vagina, anus, or urethra, and to the groin lymph nodes. There are no distant metastases.

Question 12

Which of the following is stage 4 of vulva cancer according to the FIGO classification?

1 - cancer has spread to nearby tissue, such as the vagina, anus, or urethra, and to the groin lymph nodes. There are no distant metastases.
2 - tumor is only in the vulva or the vulva and perineum. It has not spread.
3 - cancer has spread to the upper part of the vagina or upper part of the urethra, or it has spread to a distant part of the body.
4 - tumor is of any size and has spread to nearby structures, including the lower part of the urethra, vagina, or anus

Answer 12

3 - cancer has spread to the upper part of the vagina or upper part of the urethra, or it has spread to a distant part of the body.

Question 13

In a patient who has confirmed vulvar cancer, which 2 of the following are typically the firs treatment options?

1 - radiotherapy
2 - chemotherapy
3 - vulvectomy
4 - anti-immune medication

Answer 13

1 - radiotherapy
3 - vulvectomy