Vulval Cancer Flashcards

1
Q

Firstly we’re going to explore VIN

A

Vulval Intraepithelial neoplasia

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2
Q

Who gets VIN?

A

Mean age is 36yrs (older than CIN)

Younger women tend to be HPV +ve & have multi-focal VIN

Older women tend to be uni-focal and unrelated to HPV

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3
Q

How does VIN look?

A

Raised papular or plaque lesions with a keratotic appearance (potentially like warts)

They have a sharp border and may be discoloured (red, white or brown)

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4
Q

How can we diagnose VIN?

A

With a punch biopsy under LA. It’s a histological diagnosis

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5
Q

When we detect a case of VIN what are our goals?

A

Firstly to prevent cancer
Control symptoms
Preserve body image and sexual function

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6
Q

What treatments do we have for VIN?

A

Surgery is gold standard
Laser Ablation e.g. CO2 laser
Topical Treatments e.g. Imiquimod

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7
Q

Pros & cons of laser ablation

A

Not as effective as surgery & missed occult invasion

But it has a better cosmetic result and can be used on mucosal skin

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8
Q

Pros and cons of Topical treatments?

A

Not as effective as surgery but preserves the tissue and is better for multiple lesions

Imiquimod, it’s mainly a treatment for genital warts

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9
Q

What risk factors lead to VIN?

A

Smoking
Other genital IN including anal
Previous related malignancy
Immunosuppression

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10
Q

If we don’t catch or treat VIN it can lead to vulval cancer, what is the major type?

A

SCC

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11
Q

How does Vulval cancer present?

A

Mostly >60yrs

A sustained pain, intractable itch and a bleeding lump or ulcer

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12
Q

How treatable is vulval cancer?

A

Stage 1 has a 97% cure rate

Late stage is more like 50%

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13
Q

How can we treat vulval cancer?

A

Surgery +/- node dissection

RT & Chemo

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14
Q

What nodes are removed when treating vulval canceR?

A

Inguinal and upper femoral

Either unilateral or bilateral

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15
Q

When do we use RT & Chemo for vulval cancer?

A

Either neo-adjuvantly or if they arn’t suitable for surgery

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16
Q

What are the risk of vulval cancer surgery?

A

Wound infection
Lymphocysts
Nerve damage