Vulvar Cancer

Knowledge Check

Exam-style MCQs aligned with these notes. Available to Hyperexcision Scholar members.

Last updated: June 24, 2026Bookmark

Vulvar carcinoma is a malignant neoplasm that can arise from anywhere between the mons pubis and the perianal region. 90% of vulvar cancers are squamous cell carcinomas. Other histological subtypes include melanoma and Bartholin’s gland adenocarcinoma.

Vulvar intraepithelial neoplasia (VIN) is a premalignant change (cellular atypia) in the vulvar epithelium.

It is a rare cancer, peaking at 65 years of age.

Vin is a premalignant change in the vulvar epithelium characterised by cellular atypia.

1986 ISSVD Classification of vulvar intraepithelial neoplasia (VIN)

Classification	Description
VIN-1	Atypia in the deep 1/3 of the epithelium
VIN-2	Atypia in the deep 1/2 of the epithelium
VIN-3	Atypia in the deep 2/3 of the epithelium
VCIS	Full-thickness atypia confined to the basement membrane

2002 ISSVD Classification of vulvar intraepithelial neoplasia

VIN-1 was eliminated because it was confirmed not to progress to vulvar carcinoma

VIN, usual type is strongly associated with HPV and smoking

VIN, differentiated type is less common. It occurs in older women and is associated with lichen sclerosis and squamous cell hyperplasia. It is more likely to progress to SCC

Classification	Description
VIN-1	(Eliminated)
VIN/VCIS	VIN, usual type (warty, basaloid, mixed)
	VIN, differentiated type
	VIN, unclassified type (Paget’s)

Risk factors
- Vulvar intraepithelial neoplasia – especially the differentiated type
- High-risk HPV infection
- HSV infection
- Lichen sclerosis
- Smoking
- Chronic immunosuppression (especially HIV/AIDS)
Signs and symptoms
- 4 P’s
  - Papule formation – Raised lesion +/- erosion and bleeding
  - Pruritic
  - Patriotic – Red, white, and blue in colour (similar to melanoma)
  - Parakeratosis – retention of nuclei in the stratum corneum
Investigation
- Biopsy is performed for:
  - Pigmented lesion
  - Genital warts in an immunocompromised or post-menopausal woman
  - Genital warts that persist despite topical therapy (Podophyllin)
  - Evolving lesion
Treatment
- Laser ablation for VIN
- Wide local excision for stage IA
- Partial radical vulvectomy including ipsilateral inguinofemoral lymphadenectomy for stage IB and II
  - Bilateral lymphadenectomy should be performed if the tumor crosses midline)
- Radical vulvectomy including inguinofemoral lymphadenectomy for stage III and IV
  - Followed by pelvic-groin irradiation +/- chemotherapy
  - Pelvic exenteration may be done for stage IV

Staging of Vulvar Cancer (TNM and Surgical)

Stage	Description	Treatment
Stage I	Tumor confined to the vulva. Negative nodes
Stage IA	≤ 2cm in size and ≤ 1 mm of stromal invasion	Wide local excision
Stage IB	> 2cm in size or > 1 mm of stromal invasion	Partial radical vulvectomy including ipsilateral inguinofemoral lymphadenectomy
Stage II	Extension to adjacent perineal structures. Negative nodes	Partial radical vulvectomy including ipsilateral inguinofemoral lymphadenectomy
Stage III	Extension to adjacent perineal structures. Positive nodes	Radical vulvectomy including inguinofemoral lymphadenectomy. Followed by pelvic-groin irradiation +/- chemotherapy
Stage IV	Invasion of other regional or distant structures	Radical vulvectomy including inguinofemoral lymphadenectomy. Occasional pelvic exenteration is done. Followed by chemoradiation

Reference Intervals ›

Biochemistry

ACTH	P: <80 ng/L
ALT	P: 5–35 U/L
Albumin	P: 35–50 g/L
Aldosterone	P: 100–500 pmol/L
Alk. phosphatase	P: 30–130 U/L
α-Amylase	P: 0–180 IU/dL
α-Fetoprotein	S: <10 kU/L
Angiotensin II	P: 5–35 pmol/L
ADH	P: 0.9–4.6 pmol/L
AST	P: 5–35 U/L
Bicarbonate	P: 24–30 mmol/L
Bilirubin	P: 3–17 μmol/L
BNP	P: <50 ng/L
CRP	P: <10 mg/L
Calcitonin	P: <0.1 mcg/L
Calcium (ionized)	P: 1.0–1.25 mmol/L
Calcium (total)	P: 2.12–2.60 mmol/L
Chloride	P: 95–105 mmol/L
Cholesterol	P: <5.0 mmol/L
VLDL	P: 0.128–0.645 mmol/L
LDL	P: <2.0 mmol/L
HDL	P: 0.9–1.93 mmol/L
Cortisol AM	P: 450–700 nmol/L
Cortisol Midnight	P: 80–280 nmol/L
CK ♂	P: 25–195 U/L
CK ♀	P: 25–170 U/L
Creatinine	P: 70–100 μmol/L
Ferritin	P: 12–200 mcg/L
Folate	S: 2.1 mcg/L
FSH	P: 2–8 U/L ♂; >25 menopause
GGT ♂	P: 11–51 U/L
GGT ♀	P: 7–33 U/L
Glucose (fasting)	P: 3.5–5.5 mmol/L
Growth hormone	P: <20 mu/L
HbA1C (DCCT)	B: 4–6%
HbA1C (IFCC)	B: 20–42 mmol/mol
Iron ♂	S: 14–31 μmol/L
Iron ♀	S: 11–30 μmol/L
Lactate (venous)	P: 0.6–2.4 mmol/L
Lactate (arterial)	P: 0.6–1.8 mmol/L
LDH	P: 70–250 U/L
LH	P: 3–16 U/L
Magnesium	P: 0.75–1.05 mmol/L
Osmolality	P: 278–305 mosmol/kg
PTH	P: 0.8–8.5 pmol/L
Potassium	P: 3.5–5.3 mmol/L
Prolactin ♂	P: <450 U/L
Prolactin ♀	P: <600 U/L
PSA	P: 0–4 mcg/mL
Protein (total)	P: 60–80 g/L
Red cell folate	B: 0.36–1.44 μmol/L
Renin (erect)	P: 2.8–4.5 pmol/mL/h
Renin (recumbent)	P: 1.1–2.7 pmol/mL/h
Sodium	P: 135–145 mmol/L
TBG	P: 7–17 mg/L
TSH	P: 0.5–4.2 mU/L
T4	P: 70–140 nmol/L
Free T4	P: 9–22 pmol/L
TIBC	S: 54–75 μmol/L
Triglycerides	P: 0.50–2.3 mmol/L
T3	P: 1.2–3.0 nmol/L
Troponin T	P: <0.1 mcg/L
Urate ♂	P: 210–480 μmol/L
Urate ♀	P: 150–390 μmol/L
Urea	P: 2.5–6.7 mmol/L
Vitamin B12	S: 0.13–0.68 nmol/L
Vitamin D	S: 50 nmol/L

Arterial Blood Gases

pH	7.35–7.45
PaCO₂	4.7–6.0 kPa
PaO₂	>10.6 kPa
Base excess	±2 mmol/L

Urine

Cortisol (free)	<280 nmol/24h
Hydroxyindole acetic acid	16–73 μmol/24h
Hydroxymethylmandelic acid	16–48 μmol/24h
Metanephrines	0.03–0.69 μmol/mmol cr.
Osmolality	350–1000 mosmol/kg
17-Oxogenic steroids ♂	28–30 μmol/24h
17-Oxogenic steroids ♀	21–66 μmol/24h
17-Oxosteroids ♂	17–76 μmol/24h
17-Oxosteroids ♀	14–59 μmol/24h
Phosphate (inorganic)	15–50 mmol/24h
Potassium	14–120 mmol/24h
Protein	<150 mg/24h
Protein/creatinine ratio	<3 mg/mmol
Sodium	100–250 mmol/24h

Haematology

WCC	4.0–11.0 ×10⁹/L
RBC ♂	4.5–6.5 ×10¹²/L
RBC ♀	3.9–5.6 ×10¹²/L
Hb ♂	130–180 g/L
Hb ♀	115–160 g/L
PCV ♂	0.4–0.54 L/L
PCV ♀	0.37–0.47 L/L
MCV	76–96 fL
MCH	27–32 pg
MCHC	300–360 g/L
RDW	11.6–14.6%
Neutrophils	2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes	1.0–4.5 ×10⁹/L (20–45%)
Eosinophils	0.04–0.44 ×10⁹/L (1–6%)
Basophils	0–0.10 ×10⁹/L (0–1%)
Monocytes	0.2–0.8 ×10⁹/L (2–10%)
Platelets	150–400 ×10⁹/L
Reticulocytes	0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time	10–14 s
APTT	35–45 s

Paediatric

Pulse Rate (bpm)
Neonate	140–160
Infant <1yr	120–140
1–5 years	110–130
5–12 years	80–120
>12 years	70–100
Respiratory Rate (tachypnoea)
0–2 months	≥60/min
2–12 months	≥50/min
1–5 years	≥40/min
>5 years	≥30/min
Blood Pressure (mmHg)
Term	65/45
1 year	75/50
4 years	85/60
8 years	95/65
10 years	100/70
Weight Formulas
3–12 months	(a + 9)/2 kg
1–6 years	2a + 8 kg
>6 years	(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn	13–20
1 month	11–18
2 months	10–15
1–2 years	10–13
>2 years	11–14
MUAC (6 months–5 years)
Obese	>17.5 cm
Normal	13.5–17.4 cm
At risk	12.5–13.4 cm
Moderate malnutrition	11.5–12.4 cm
Severe malnutrition	<11.5 cm
Developmental Milestones
Social smile	1.5 months
Head control	4 months
Sits unsupported	7 months
Crawls	10 months
Stands unsupported	10–12 months
Walks	12–13 months
Talks	18 months
CSF WBC (/mm³)
Term newborn	0–25
>2 weeks	0–5

Calculator ›

Leave a ReplyCancel Reply