Flashcards in Vulval and vaginal cancer Deck (23):
What is Lichen simplex?
Chronic inflammatory skin condition of the vulva, presents with severe intractable pruritis, especially at night
What causes a bartholin's gland cysts? When does an abscess form?
*Blockage of the duct causes cyst formation
*If infection occurs (commonly staph or E.coli) abscess forms
Presentation of a barthlin's gland cysts?
Acutely painful and large tender red swelling is evident
Treatment of bartholin's gland cysts?
*Incision and drainage
*Marsupialization =incision is sutured open to reduce risk of re-formation
What is Vaginismus? Presents how? Caused by?
*Involuntary muscle spasm prevent vaginal penetration
*often results in pain with attempts at sex
*generally a fear that penetration will hurt
What is vulval intraepithelial neoplasia (VIN)? How is is divided?
Presence of atypical cells in the vulval epithelium, considered premalignant stage
*Usualy type VIN
*Differentiated type VIN
What is usual type VIN present with? Associated with?
Clinically it may be multifocal and appearances vary widely: red, white or pigmented, plaques, papules or patches
*can be warty, basaloid or mixed
*common in 35-55years old
What is differentiated type VIN?
*lesion unifocal, ulcer or plaque
*linked to kertinizing sqaumous cell carcinomas
*risk of progression to cancer higher
How does VIN present?
*pruritis of the vulva
*pain of the vulva
Treatment of VIN?
*mild topical steroid
*gold standard is local surgical excision to reliev symptoms, confirm histology and exclude invasive disease
What is the epidemiology of vulval carcinoma?
*5% of genital tract cancers
*Most common after the age of 60
What is the histology of vulval carcinomas?
*95% are sqaumous cell carcinomas
*Other types: melanomas, basal cell carcinomas, adenocarcinomas
What is vulval carcinoma risk factors?
*Paget's disease of the vulva
What is Paget's disease of the vulva?
Adenocarcinoma in situ
*risk of malignancy and invasion high
What is the clinical presentation of vulval carcinoma?
*Ulcer or mass most commonly on the labia majora or clitoris
*inguinal lymph nodes may be enlarged, hard and immobile
What is the staging of vulval carcinoma?
Tumour confined to vulva/perineum
Tumour of any size with adjacent spread (lower urethra/vagina or anus), negative nodes
Tumour of any size with positive inguinofemoral nodes
Tumour invades upper urethra/vagina, rectum, bladder, bone or distant metastases
What justifies referral if suspician of vulval cancer is present?
Urgent 2 week referral if:
*Woman presenting with unexplained vaginal lump
*Woman with unexplained vulval bleeding or ulceration
For a woman who presents with vulval puritis or pain, how should they be managed?
*Treat, watch and wait
*However if persistent symptoms then they should be referred for gynae opinion
What investigations are completed if vulval carcinoma is suspected?
*biopsy to allow diagnosis
*assessment of fitness for surgery
What is the treatment of vulval carcinoma?
*Stage 1a, wide local excision is adequate, without inguinal lymphadenectomy
*Other stages, injection of blue dye injected around tumour and any sentinel node identified biopsied to assess presence of metastasis
*radiotherapy with or without chemo
*reconstructive surgery often undertaken
What are the complications of surgery for vulval carcinoma?
*wound break down and infection
What is the epidemiology of vaginal carcinoma?
*affects older women