Nowadays, incidents of gynaecological malignancies are increasing. Out of various types of malignancies one is vulval cancer that affects the vulva and which is the fourth most common gynaecological cancer. It normally occurs after menopause with an average diagnostic age is 70 years. Most frequent histological subtype of vulvar cancer is squamous cell cancer.
Aetiology: It can be of two distinct types on the basis of predisposing factors.
I. Vulvar intraepithelial neoplasia (VIN) caused by human papillomavirus (HPV) infection
II. Vular cancer not related to HPV infection.
Various aetiological factors which are associated with vulvar cancer includes:
• Precancerous dysplastic changes
• Infection with human papilloma virus
• Molecular biology events
Diagnosis: Various symptoms that indicate vulval cancer are:
• Lump or a mass along with a long-standing history of pruritus and vulvar soreness
• Bleeding
• Swelling
• Ulceration
• Pain or burning
• Discharge
• Appearance of raised ulcer
Staging: The vulval cancer is classified into various stages.
- I: Tumour confined to the vulva
- IA: Tumour ≤ 2 cm in size, confined to the vulva or perineum and with stromal invasion ≤1.0 mm and no nodal metastasis
- IB: Lesions >2 cm in size with stromal invasion >1.0 mm confined to the vulva or perineum with negative nodes
- II: Tumour of any size with extension to the adjacent perineal structures (1/3rd lower urethra, 1/3rd lower vagina, anus) with negative nodes
- III: Tumour of any size with extension to the adjacent perineal structures (1/3rd lower urethra, 1/3rd lower vagina, anus) with positive inguinofemoral lymph nodes
- IIIA: Either with 1 lymph node metastasis ≥ 5 mm or 1–2 lymph node metastasis(<5 mm)
- IIIB: With 2 or more lymph node metastasis (≥5 mm) or 3 or more lymph node metastasis (<5 mm)
- IIIC:Having positive nodes with extracapsular spread
- IV: Tumour invades other regional (two-thirds upper urethra, two thirds upper vagina) or distant structures
- IVA: Tumour invades any of the following: Upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa or the tumour is fixed to the pelvic bone or there are fixed or ulcerated inguinofemoral lymph nodes
- IVB: Any distant metastasis including pelvic lymphadenopathy
Treatment: Treatment in cases of vulvar carcinoma needs to be individualised on the basis of extent of tumour spread and lymph node involvement and treatment is mainly done by surgical approaches. Some of them are as: wide local excision, simple partial vulvectomy, radical partial vulvectomy. en block radical vulvectomy, radical complete vulvectomy.
Jaypee Brothers Medical Publishers organises a course regarding MRCOG exam. The course includes webinars on various significant topics. The upcoming webinar is on the “Vulvar Cancer” that will be organized on February 16, 2019.
For further information regarding the course, please visit our website www.crackingmrcog.com
For More Information:
Email: crackingmrcog@jaypeebrothers.com
Whatsapp: +91-9873886225
Website: www.crackingmrcog.com
© Jaypee Brothers Medical Publishers
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