Vulval & Vaginal Malignancy MCQs

Vulval Cancer Vulval cancer accounts for 2%-4% of all malignancies of the female genital tract. The women are generally elderly, in the sixth or seventh decade of life. Thirty per cent of cases are older than 70 years, and 40% of cases are between the age of 60 and 70 years. M/C variety- Squamous cell carcinoma Most common symptom of vulval cancer - pruritis Most common site: Labia majora and minora Most common type of spread: Lymphatics( First lympnode involved-Superficial Inguinal lymphnode, and then Deep inguinal LN and femoral group of lymphnodes). For lateral tumors only ipsilateral lympnodes involved whereas for midline leisons, B/L lymphnodes are involved Sentinel lymphnode biopsy is helpful in vulval cancer Most important prognostic factor- Lymph node status.

Painless well-defined ulcers with a firm base should raise the suspicion of a chancre. Chancre is the primary lesion of primary syphilis. It is most commonly found on the labium majus, labium minus, fourchette, clitoris, urethral orifice, or cervix, but can be found anywhere on the lower genital tract. In 10% cases, more than one primary lesion is present. The first manifestation is a small papule which breaks to form an ulcer. Ulcer is firm, painless with raised edges and a granulomatous base. In fact, any sort of discrete, relatively painless ulceration on the vulva may be a primary syphilitic lesion. Inguinal glands enlarge when the primary is on the vulva or lower vagina. Lymph nodes are hard, painless, and do not suppurate. Reference: Williams Gynaecology, 1st Edition, Page Number-58.

Chancre is the primary lesion of primary syphilis. It is most commonly found on the labium majus, labium minus, fourchette, clitoris, urethral orifice or cervix but can be found anywhere on the lower genital tract. In 10% cases more than one primary lesion is present. The first manifestation is a small papule which breaks to form an ulcer. Ulcer is firm, painless with raised edges and granulomatous base. In fact any sort of discrete relatively painless ulceration on the vulva may be primary syphilitic lesion. Inguinal glands enlarge when the primary is on the vulva or lower vagina. Lymph nodes are hard, short, painless, and do not suppurate. Reference: Harrison 17th/ed p 1040; William’s Gynae 1st/ed p 58-9 Current diagnosis and treatment of STDs p 21

Painless well-defined ulcers with firm base should raise the suspicion of chancre. Chancre is the primary lesion of primary syphilis. It is most commonly found on the labium majus, labium minus, fourchette, clitoris, urethral orifice or cervix but can be found anywhere on the lower genital tract. In 10% cases more than one primary lesion is present. The first manifestation is a small papule which breaks to form an ulcer. Ulcer is firm, painless with raised edges and granulomatous base. In fact any sort of discrete relatively painless ulceration on the vulva may be primary syphilitic lesion. Inguinal glands enlarge when the primary is on the vulva or lower vagina. Lymph nodes are hard, shotty, painless, and do not suppurate Reference: William's Gynae 1st/ed p 58.