Vulval Cancer and Precancer Flashcards
who is usually affected by vulval cancer?
average age 74 (27-97)
- 75% diagnosed over age 60
how does vulval cancer present?
- Pain
- Itch
- Bleeding
- Lump/ulcer
what are the risk factors for vulval cancer
- intraepithelial neoplasia (or cancer at any other lower genital tract site)
- lichen sclerosus
- smoking
- immunosuppression
How is vulva cancer staged?
staging is surgical-pathological
- stage 1a is micro-invasion <1mm
depends on size of lesion and lymph node involvement
(inguinal & upper femoral, pelvic)
describe HPV related vulval cancer
- usual type VIN
- younger women
- multifocal, multizonal
- immunosuppression
- past history of intra-epithelial neoplasia
describe non HPV related vulval cancer
- differentiated VIN
- older women
- lichen sclerosus
- often present as cancer at first diagnosis
what is histopathology of vulval cancer
- punch biopsy or excisional biopsy
- small tissue processed under microscope
- possible diagnosis (inflammatory, dysplasia, malignant)
what is vulvar intraepithelial neoplasia
abnormal proliferation of squamous epithelium; can progress to carcinoma
- classical type: HPV related, low or high grade
- differentiated type: older women, not HPV related, high grade
describe squamous cell carcinoma
malignant tumour of squamous cells
- able to spread to distant sites (metastasis)
- grade: mild, moderate, poor
- stage: to see how far tumour has spread
- biopsy: measure depth of invasion
How is vulval cancer treated?
surgery
- individualised
- local excision
- unilateral/bilateral node dissection)
radiotherapy/chemotherapy
How is groin node dissection for vulval cancer performed?
inguinal and upper femoral nodes
- separate node incisions
- stage and remove nodal disease
- associated with significant morbidity (wound infection, lymphocytes, nerve damage)
