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Gyn Onc > Vulva Tidbits > Flashcards

Vulva Tidbits Flashcards

1
Q

What % of Gyn Ca is vulvar Carcinoma

A

~4%

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2
Q

What % of Vulvar carcioma are HPV related

A

43%

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3
Q

What HPV subtypes account for 55.5% of HPV related vulvar cancers

A

HPV 16 + 33

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4
Q

What % of vulvar carcinoma occur in developed countries

A

~60%

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5
Q

What are the 2 main distinct histological patterns of vulvar carcinoma

A

Basaloid/Warty - HPV related in 75-100% Keratinizing vulvar carcinoma - Rarely HPV associated

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6
Q

Name 5 uncommon histologies of vulvar carcinoma

A

Melanoma, Basal cell, Bartholin gland adenocarcinoma, Sarcoma Paget’s disease

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7
Q

RF for vular cancer

A

other genital cancers, chronic inflammatory diseases of the vulva smoking, history of genital warts vulvar intraepithelial neoplasia.

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8
Q

What % of vulvar malignancies are due to paget’s disease

A

Between <1% and 2%

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9
Q

What % of Paget’s disease of the vulva is invasive

A

~ 25%

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10
Q

How is the depth of invasion of vulval cancer defined.

A

from the epithelial-stromal junction of the most superficial adjacent dermal papilla to the deepest point of invasion of the tumor.

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11
Q

Vulva - How are Stage IA lesions managed

A

WLE with a tumour free margin all around of at least 1 cm

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12
Q

What is the risk of groin node metastases with a depth of invasion between 1.1 - 3.0mm (from GOG 37)

A

7%

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13
Q

In a vulval ca, what is the risk of LN metastasis with a depth of invasion of > 3mm

A

26 - 35% (>3 = 30%)

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14
Q

What is the risk of LN metastases in tumours with < 1mm of invasion

A

< 1%. 1mm= 1%

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15
Q

Inthe GROINSS - V trial what was the rate of groin recurrence in unifocal disease with negative SLN over 35 months

A

2.3%

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16
Q

Independent of chosen treatment method what is the risk of recurrence for Vulval HSIL

A

~30 -40%

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17
Q

Aim for surgical margins in Early vulvar cancer of

A

2cm

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18
Q

What % of women with a lesion < 4cm in size and >2cm from the midline with -ve ipsilateral nodes have metastases to the contralateral groin

A

< 1%

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19
Q

What are the indications for pelvic and groin irradiation in patients with +ve groin nodes

A

Presence of Extracapsular spread 2 or more +ve LN.

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20
Q

Histological margins aimed for in Vulvar SCC

A

> 8 mm

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21
Q

According to GOG 37 - How does LVSI affect the likelihood of LN +ve lesion

A

x 3 increased risk

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22
Q

According to GOG 37 - What is the risk of +ve LN with a tumour thickness of = 1mm

A

2.6 % (1 patient in that trial)

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23
Q

According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 1.1 - 2mm

A

8.9 %

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24
Q

Vulva Ca: According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 2.1 - 3mm

A

18.6%

25
Q

According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 3.1 - 4 mm

A

30.9%

26
Q

According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 4.1 - 5mm

A

33.3%

27
Q

What is the rate of LN mets in lesions > 5mm in depth

A

47.9%

28
Q

Is there a correlation between age and LN +ve status for vulvar carcinoma

A

Yes. GOG 37 <55 = 25% 55-64 25.4% 65 -74 36.4% 75+ 46.0 %

29
Q

According to GOG 37 - What is the risk of +ve LN with a tumour diameter of < 1 cm

A

18.0 %

30
Q

According to GOG 37 - is there a difference between LN + status in tumours < 1cm and 1.1 - 2 cm?

A

No signif dif. < 1.0 = 18.0%, 1.1 - 2.0 = 19.4%

31
Q

According to GOG 37 - What is the risk of +ve LN with a diameter of 2.1 - 3.0 cm

A

31.4%

32
Q

According to GOG 37 - What is the risk of +ve LN with a diameter of 3.1 - 4 cm

A

54.3%

33
Q

According to GOG 37 - What is the risk of +ve LN with a diameter of 4.1 - 5.0cm

A

39.6%

34
Q

According to GOG 37 - What is the risk of +ve LN with a diameter of > 5cm

A

51.8%

35
Q

According to GOG 37 - What is likelihood of +ve Groin LN in nodes normal on clinical examination?

A

23.9%

36
Q

What is the risk of recurrence in Paget’s disease with negative margins?

A

~ 33%

37
Q

What % of Vulva SLN are deep to the fascia lata?

A

In Rob et al., J Gynecol Cancer . Jan-Feb 2007 of 118 women 16.1% were deep femoral.

38
Q

What % of mucosal (vulvo/vaginal) melanoma have a BRAF and KIT mutation?

A

10% and 25% respectively Consider BRAF inhibitors e.g. deBRAFenib and KIT inhibitor e.g. imatinib (Glivec)

39
Q

When was DES removed from the marker?

A

1971

40
Q

What was the risk of CCC in an offspring of a woman exposed to DES?

A

1: 1000 - vaginal adenosis common as well as structural abnormalities

41
Q

What % of women with +ve groin nodes will have normal examination

A

23.9% - Homesly et al 1992

42
Q

In ESGO guidelines to pooled sensitivity and specificity of clinical examination for the detection of +ve groin nodes in vulval cancer was?

A

Sensitivity - 35%

Specificity 94.3%

43
Q

In ESGO guidelines to pooled sensitivity and specificity of MRI for the detection of +ve groin nodes in vulval cancer was?

A

Sensitivity 86%

Specificity 87%

44
Q

In ESGO guidelines to pooled sensitivity and specificity of PET scan for the detection of +ve groin nodes in vulval cancer was?

A

Sensitivity 71%

Specificity 72%

45
Q

In a review of 6 studies, Zhang et al found that preservation of the saphenous vein was associated with a decreased risk of? (4)

A

Less cellulitis (18 v 39%)

SHort term lower extremity lymphoedema (32 v 70%)

Wound breakdown ( 13 v 38%)

Chronic oedema (3 v 32%)

46
Q

In a review of 6 studyies, Zhang et al found that preservation of the saphenous vein was associated with a decreased risk of cellulitis from?

A

39 - 18%

47
Q

In a review of 6 studies, Zhang et al found that preservation of the saphenous vein was associated with a decreased risk of short term lower extremity lymphedema from?

A

70 % to 32 %

48
Q

In a review of 6 studies, Zhang et al found that preservation of the saphenous vein was associated with a decreased risk of wound breakdown from?

A

38% - 13%

49
Q

In a review of 6 studies, Zhang et al found that preservation of the saphenous vein was associated with a decreased risk of chronic oedema from?

A

32% to 3%

50
Q

In a review of 6 studies, Zhang et al found that preservation of the saphenous vein lead to no complications in ?

A

No complications in 56% of those with saphenous vein preserved compared with 23% of those who had the vein ligated.

51
Q

In a vulval cancer with a lateralized tumour undergoing a SLN procedure, if there is a unilateral SLN that is metastatic what is the recommended action and what is the contralateral groin recurrence risk?

A

Treat the ipsilateral groin with LND or RT as per groins V2. No further action needed on contralateral groin. Recurrence risk in contalateral groin is 2%.

52
Q

In a vulval cancer with a lateralised tumour undergoing a SLN procedure, if there is a Bilateral SLN mapping and one side is metastatic and the other negative what is the recommended treatment and what is the recurrence risk in the contralateral groin.

A

Treat the +ve groin as per GROINS V2 and no further action in the contralateral groin. The risk of recurrence int eh contralateral groin is 6.1%.

53
Q

In a cancer with a lateralised tumour undergoing a SLN procedure, if there is a Bilateral SLN mapping and both sides are +ve what is the recommended action.

A

Both groins need treating as per the size of the mets as per GROINS 2.

54
Q

IN a vulval cancer with a near midline tumour (within 1cm of the mid-line) if there is unilateral flow and the LN was +ve what is the recommended action and what is the contralateral recurrence rate?

A

The +ve groin is treated as per GROINS V2 with no treatment of the non-mapping groin. The risk of recurrence in that groin is 2.2%.

55
Q

IN a vulval cancer with a near midline tumour (within 1cm of the mid-line) if there is bilateral flow and one side is +ve and the other -ve. What is the recommended treatment and what is the recurrence risk in the other groin?

A

Treat the +ve groin as per GROINS V2 with no further treatment for the -ve groin. The risk of recurrence in the contralateral groin is 3.3%

56
Q

In a MIDLINE tumour with unilateral lymph flow on SLN how do you manage this intra operatively?

A

Undertake a SLN on the mapping side and do a complete LND on the non-mapping side. This is in accordance with the ESGO 2023 guideline.

57
Q

IN a vulval cancer with a near midline tumour (within 1cm of the mid-line) if there is bilateral flow and both sides are positive What is the recommended treatment?

A

Treat the +ve groins as per GROINS V2.

58
Q
A

Gyn Onc (23 decks)

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