Vulvar Cancer Flashcards
Vulvar Cancer: Etiolgoy
usual v differentiated
risk factors
Etiology
- 4th MC GYN cancer
- cancer of the 60-80s
- non-invasive type: early 50s
- invasive/inflammation: 70s
esstential two main ways
from HPV: HSIL becomes usual type VIN
from chronic inflammation: dVIN (differntiated vulvaur intraepitheial neoplasia
so you have ususal and differentiated
Risk Factors
- smoking
- PHV status and risky sex
- history of vulvar lichen sclerosus (yeast infection/dm/incont = increase risk)
- hx. of melanoma
- HIV/immunocomp.
- low ses
Vulvr Atypias v Vulvar Malginancies
Atypias
- lichen scleroussu risk of devleoping CA
- linchen platus
- psoriasis
- HPV warts: condyloma
- HS
- lymphogranuloms venerum (from chalmydia)
- VIN (vulvar intraepithial neoplasia)
Malignancy
- Melanoma in situs
- squamouse cell carcinoma
- Pagets disease rare but think this if nipple crusts
- Adenomcarcinoma of bartholian
Symptoms/sigsn
Symptoms
- vulvar itching/burning
- changes in color or texture of skin
- texture: scaley, bumpie, rougher
- raised califlower like lesions
- dysuria
- lymphadenopathy
symptoms usually with later disease stages
Diagnosis of vulvar cancer
Diagnosis
- easiest way is to biopsy via punch of the skin in multiple areas
can perform colposcopy to eval area, but PAP not done
what is VIN and stages
VIN: vulvar intraepitheial neoplasia
- precancerous growths
- atypical dysplaisa in squamous epithelium
- vuvlar cancer is very slow growthi, will stay as VIN for years
VIN1: mild dysplasi
VIn II: moderate
VIN III: severe
VIN II: CIS: carcinoma in situs: is VIN III with full thickness invasion
Management of VIN
Diagnosed via punch biopsy
treatment regards…
- symptoms management, preserve the abiltiy to converge to cancer and presever tissue/function
- determine grade, margins, mutlifocal disease and smoking status
VIN options
- oversation: VIN I
- aldara: imiquoid
- cryotherapy
- laser never used in invasive CA
- surgery
(5-FU NOT used)
Vulvar Cancer: Squamous Cell
Vulvar Cancer: Melanoma
Squamous Cell
most common vulvar cancer
- slow growing and rarely metatstized
- only prevention is it prevent HPV
Melanoma
- 2nd type of vuvlar cancer
- only on ciltoris or labia minora
Treatment of Vulvar Cancer
prognosis
recurrance
sqaum or melanoma
surgery
- laser
- excisional: wide with/wihtout nodes
- vulvectomy
radiation and chemo preo-op (although chemo NOT HELPFUL)
prognosis
- with node invovlemd: 40%
- without node involved: 85-95%
recurrance
- usuing radiation alone is rarely used because of risks
- if surgery done and recurrance occurs: chemo/rad. alone cna be done
