Vulval cancer

Question 1

Definition

Answer 1

• Around 90% are squamous cell carcinomas.
• Less commonly, they can be malignant melanomas.

Question 2

Risk factors

Answer 2

• Advanced age (over 75 yrs)
• Immunosuppression
• Human papillomavirus (HPV) infection
• Around 5% of women with lichen sclerosus get vulval cancer.

Question 3

Vulval Intraepithelial Neoplasia

Answer 3

Premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer.

Question 4

High grade squamous intraepithelial lesion

Answer 4

• Type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.

Question 5

Differentiated VIN

Answer 5

type of VIN associated with lichen sclerosus and typically occurs in older women (aged 50 – 60 years).

Question 6

Signs and symptoms

Answer 6

• Vulval lump
• Ulceration
• Bleeding
• Pain
• Itching
• Lymphadenopathy in the groin

Question 7

Where does vulval cancer affect the most

Answer 7

labia majora, giving an appearance of:
- Irregular mass
- Fungating lesion
- Ulceration
- Bleeding

Question 8

Diagnosis

Answer 8

• Suspected vulval cancer = 2-week-wait urgent cancer referral.
• Diagnosis and staging:
  = Biopsy of the lesion
  = Sentinel node biopsy to demonstrate lymph node spread
  = Further imaging for staging (e.g. CT abdomen and pelvis)

Question 9

Staging

Answer 9

International Federation of Gynaecology and Obstetrics (FIGO)

Question 10

Treatment

Answer 10

• Wide local excision to remove the cancer
• Groin lymph node dissection
• Chemotherapy
• Radiotherapy