This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
True about carcinoma vulva 
Select and explain. 
A. Spreads to superficial inguinal nodes and Radiotherapy given, B. Spreads to iliac nodes, C. Seen after menopause and Viral predisposition, D. All
D: All
Answer: D: All 
Explanation: Ans. is a, b and c i.e. Spreads to superficial inguinal nodes: Spreads to iliac nodes: Seen after menopause; Viral predisposition; and Radiotherapy given Vulva) cancer : 2 - 4% of all malignancies of female genital tract. Age : occurs in 6" or 7" decade. Most common histologic type is epidermoid cancer (squamous cell CA) Nulliparous, women of low parity are predisposed to vulva, CA. The etiology is same as of carcinoma in situ cervix (that is viral predisposition by viurses - HIV, HPV, HSV-I1). Most common site - Labium majora followed by clitorus and labium minora. Associated with cervical and ovarian CA in 20% case. Presents with pruritus, vulva! swelling, lump or ulcer. Spread of tumor - mainly by direct spread and lymphatics. First superficial inguinal nodes are involved and then spreads to deep nodes and glands of Cloquet to external iliac nodes, obturator and common iliac nodes in late stages. Treatment : - Early stages : vulvectomy with inguinal nodes dissection. - Late stages : chemotherapy and radiotherapy.