Vulval Cancer – MCQ

1. An 85-year-old woman presents via an urgent referral with a 4-month history of vulval pain. On examination she has a 3-cm irregular exophytic tumour replacing the clitoris and extending to within 17 mm of the urethra. Enlarged lymph nodes are palpable in both groins.
What is the next most appropriate action?

2. A 75-year-old woman was referred with erosive lesion of the vulva. On examination, there is a raised irregular lesion with ulceration and raised ulcer with rolled edges measuring 2 cm in diameter. What would you do next?

3. A 75-year-old lady has been referred to the gynaecology clinic with a raised irregular lesion in the left labia majora measuring 1.5 x 1.5 cm in size. A punch biopsy from this lesion has confirmed a well differentiated squamous cell carcinoma with a depth of invasion of 0.6 mm. What is the most appropriate management for this patient?

4. A 75-year-old has been referred with vulval soreness and a large irregular vulval lesion involving the left labia majora. She has past medical history of heart surgery. On examination, the lesion measures 4.5 x 4.5 cm and has raised, rolled edges with an irregular contour. The lesion involves the left labia majora and minora and is > 1 cm clear of the anus and the urethra. Biopsy confirms a moderately differentiated squamous cell carcinoma with a depth of invasion of 4 mm. MRI pelvis shows no enlarged groin or pelvic lymph nodes.
What is the most appropriate management in this lady?

5. A 75-year-old woman is seen by the GP for routine recall of her lichen sclerosus. She is on treatment for the same, but she mentions the itching has become gradually worse over the year with no relief after using different creams as suggested. She is upset as she has some swelling down below that feels like the size of a 10 pence coin. She is referred to the hospital and on examination, you note a raised ulcer < 2cm with rolled edges. Her general examination is normal with no groin nodes palpable. A biopsy is taken under local anaesthetic in clinic. In anticipation of carcinoma, a pre-op is arranged. What are the appropriate investigations done?

6. What percentage of squamous cell cancers of vulva are associated with high risk HPV subtypes?