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Vulvar Cancer > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

What HPV subtypes are associated with vulvar cancer?

A

6, 16, 18, 33

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2
Q

Subsites of the vulva?

A 
Labia majora
Labia minora
Mons pubis
Clitoris 
Vaginal Vestibule 
Perineal body 
Posterior forschette
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3
Q

What elements of the history and physical do you need to know?

A

History: pruritis, discomfort pain, dysuria, bleeding, difficulty with defecation, duration, prior exams, pap smears, GYN cancers

Physical: Visulization of external genetalia, Speculum exam, Bimanual exam digitial rectal exam, inguinal nodal exam, pap smear

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4
Q

How is locally advanced vulvar cancer defined? What percentage of patients have it at diagnosis?

A
  1. Cancer that can not be resected without exenterative surgery
  2. 30%
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5
Q

What are the 1st, 2nd and 3rd echelon nodes?

A
  1. Superficial inguinofemoral
  2. Deep inguinofemoral and femoral
  3. External iliac
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6
Q

What are the predictors of nodal disease?

A
  1. Depth of invasion

2. Grade

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7
Q

What is the risk of nodes by depth of invasion?

A
  1. < 1 mm: 5 mm:34%
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8
Q

What are the common histologies?

A
  1. Squamous cell carcinoma: 80-90%
  2. Melanoma
  3. Basal cell carcinoma
  4. Merkel cell
  5. Sarcoma
  6. Adenocarcinomas of the bartholin’s gland
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9
Q

What is the treatment for vulvar CIS or VIN?

A

Superficial local excision
or
If the clitoris or labia minora are involved, laser ablation can be done

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10
Q

How to acquire a tissue diagnosis?

A
  1. Lesions < 1 cm: excisional biopsy with 1 cm margin
  2. Lesions > 1 cm: Wedge biopsy including surrounding skin taken from the edge of the lesion to include the interface between normal skin and the tumor to determine if there is invasion of surrounding skin

Also performed a EUA with colposcopy, and directed biopsy of the cervix, vagina, vulva to rule out primary cervical or vaginal cancer

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11
Q

What labs and imaging are needed for at work up?

A

Imaging: CT scan of the abdomen/pelvis, MRI of primary and CXR. +/- PET/CT scan.

Labs: UA to rule out infection, HIV, CBC

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12
Q

What special studies may be needed at diagnosis?

A
  1. Cystoscopy
  2. Proctoscopy

For locally advanced disease Stage II-IV

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13
Q

FIGO Stage I

A

IA: lesion 2 cm or less, confined to vulva or perineum with stromal invasion < 1 mm, no nodal mets

IB: Lesion > 2 cm or with stromal invasion > 1 mm, confined to vulva or perineum, no nodal mets

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14
Q

FIGO Stage II

A

Stage II: Any size lesion, invades lower 3rd of the urethra, vagina, or anus, no nodal mets

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15
Q

FIGO Stage III

A

A. 1 LN 5 mm or larger or 1-2 LNs < 5 mm
B. 2 LN or more 5 mm or larger, 3 LN or more and each < 5 mm
C. Nodes with ECE

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16
Q

FIGO Stage IVA1

A
  1. Lesion invades upper urethra and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to pelvic bone
17
Q

FIGO Stage IVA2

A

Fixed or ulcerated inguinofemoral LNs

18
Q

FIGO Stage IVB

A

Distant metastasis including pelvic nodes

19
Q

Treatment options for pts with Stage III-IV disease

A
  1. Surgery (if negative margins can be achieved) + PORT
  2. Neoadjuvant CRT followed by surgery
  3. Definitive CRT
20
Q

Indications for PORT to the primary site?

A
  1. Close or positive margins of WLE ( < 8mm in fixed specimen, < 1 cm by frozen)
  2. LVSI
  3. DOI > 5 mm
21
Q

What are the acute toxicities?

A
  1. Dermatitis
  2. Nausea
  3. Vomiting
  4. Diarrhea
  5. Urethritis
  6. Cystitis
  7. Decreased blood counts
22
Q

What are the late RT toxicities?

A
  1. Vaginal atrophy
  2. Itching
  3. Discharge
  4. SBO
  5. Femoral neck fracture
23
Q

5 year OS estimates by Stage?

A
  1. Stage I: 90%
  2. Stage II: 81%
  3. Stage III: 68%
  4. Stage IV: 20%
24
Q

What is the standard regimen for unresectable disease?

A

GOG 101

RT: 47.6 at 1.2 BID
Concurrent 5FU and cisplatin

25
Q

CT simulation

A

Supine
Frog leg
Indexed body mold
Wire LN, vulva, anus and scars

26
Q

Treatment: Stage IA

A

WLE alone

27
Q

Treatment: Stage IB/II

A

WLE with superficial LN dissection (ipsilateral alone if well lateralized, otherwise bilateral)

28
Q

Indications to treat the groins with RT?

A
  1. More than 1 positive inguinal node

2. Nodal ECE

Vulvar Cancer (1 decks)

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