Vulval Cancer

Question 1

Firstly we’re going to explore VIN

Answer 1

Vulval Intraepithelial neoplasia

Question 2

Who gets VIN?

Answer 2

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

Question 3

How does VIN look?

Answer 3

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)

Question 4

How can we diagnose VIN?

Answer 4

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

Question 5

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

Answer 5

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

Question 6

What treatments do we have for VIN?

Answer 6

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

Question 7

Pros & cons of laser ablation

Answer 7

Not as effective as surgery & missed occult invasion

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

Question 8

Pros and cons of Topical treatments?

Answer 8

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

Imiquimod, it’s mainly a treatment for genital warts

Question 9

What risk factors lead to VIN?

Answer 9

Smoking
Other genital IN including anal
Previous related malignancy
Immunosuppression

Question 10

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

Answer 10

SCC

Question 11

How does Vulval cancer present?

Answer 11

Mostly >60yrs

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

Question 12

How treatable is vulval cancer?

Answer 12

Stage 1 has a 97% cure rate

Late stage is more like 50%

Question 13

How can we treat vulval cancer?

Answer 13

Surgery +/- node dissection

RT & Chemo

Question 14

What nodes are removed when treating vulval canceR?

Answer 14

Inguinal and upper femoral

Either unilateral or bilateral

Question 15

When do we use RT & Chemo for vulval cancer?

Answer 15

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

Question 16

What are the risk of vulval cancer surgery?

Answer 16

Wound infection
Lymphocysts
Nerve damage

Question 17

Staging of Vulval cancer ?

Answer 17

FIGO staging 
1- <2cm 
2->2cm 
3- local spread: unilateral nodes 
4- extensive spread: pelvic nodes

Question 18

Differences between VIN and Vulval cancer?

Answer 18

VIN

• common in younger women
• Non differentiated epithelium
• multi-focal
• HPV related

Vulval cancer

• Common in older women
• Differentiated epithelium
• Uni-focal
• Non -HPV related
• Lichen sclerosis