Vulval Cancer CPC Flashcards
Case:
78 year old P3
- Many years (?) vulva itch and irritation
- Has used lots of different creams with some benefit
- Now complaining of pain and burning
on examination:
marked changes to vulval architeture
absent labia minroa as they have became reabsorbed
smooth flat skin and whitening in some areas
some inflammation and redness
who tends to get vulva cancer?
not a common cancer and lower incidence than other gynacological cancers (ovarian, uterine, cervical)
tends to be in older women but can be in younger women
- Mean Age 74 (Range 27-97)
- 75% diagnosed over age 60
how does vulva cancer present?
pain
itch
bleeding
lump/ulcer
what are the risk factors of vulva cancer?
- Intraepithelial neoplasia or cancer at other lower genital tract site
- Lichen sclerosus (in this patient, chronic dermatoses, belived to be autoimmune in origin, not related to HPV, causes itchy white patches on the vagina, penis or bottom)
- Smoking
- Immunosuppression
how is the prognosis of Vulva Cancer determiend?
- Staging surgical-pathological
- Stage 1a ‘micro-invasion’ < 1mm
- Size of lesion
- Lymph node involvement
- inguinal and upper femoral
- pelvic
what are the two different pathways of VIN and Vulva Cancer developing?
(Vulval intraepithelial neoplasia (VIN) is a pre-cancerous condition)
HPV and non-HPV related
VIN and Vulva Cancer:
what are the features of HPV related
- Usual type VIN
- Younger women
- Multifocal (more than one lesion)
- Multizonal (more than one anatomical site)
- Immunosuppression
- Past history of intra-epithelial neoplasia
VIN and Vulva Cancer:
what are the features of non-HPV related
- Differentiated VIN
- Older women
- Lichen Sclerosus (can be a predisposing factor but is a rare complication of it to develop into a cancer)
- Often presents as cancer at first diagnosis
what is the staging and survival of vulva cancer?
use figo staging rather than TNM classification
relates to size of the lesion
how is Histopathology done?
- Punch biopsy or excisional biopsy
- Small piece of tissue which we process and look at under the microscope
- Possible diagnosis?
- Inflammatory, including lichen sclerosus
- Dysplasia - VIN
- Malignant - squamous cell carcinoma
what is Vulvar Intraepithelial Neoplasia?
•Abnormal proliferation of squamous epithelium; can progress to carcinoma
Vulval intraepithelial neoplasia (VIN) is a skin condition of the vulva
whata re the 2 types of Vulvar Intraepithelial Neoplasia?
• Usual type (aka classical/warty)
- Associated with HPV infection
- Low grade (VIN 1) or high grade (VIN 2 and 3)
• Differentiated type
- In older women, not HPV related
- always high grade
what is a Squamous cell carcinoma?
- Malignant tumour of squamous cells
- Ability to invade adjacent tissues and spread to distant sites (metastasis)
- Grade= How bad is it (Mild, Moderate, Poor)
- Staging system = how far tumour has spread
- Vulval cancer = FIGO staging
- On a biopsy very important to measure depth of invasion
vulva cancer is staged using what system?
figo
what is the treamtent of vulva cancer?
• Surgery
- individualised surgery
- Local excision
- Unilateral or bilateral node dissection (depend son location or size of lesion)
• Radiotherapy/Chemotherapy
what is the femoral triangle?
