Vulva Tidbits Flashcards
What % of Gyn Ca is vulvar Carcinoma
~4%
What % of Vulvar carcioma are HPV related
43%
What HPV subtypes account for 55.5% of HPV related vulvar cancers
HPV 16 + 33
What % of vulvar carcinoma occur in developed countries
~60%
What are the 2 main distinct histological patterns of vulvar carcinoma
Basaloid/Warty - HPV related in 75-100% Keratinizing vulvar carcinoma - Rarely HPV associated
Name 5 uncommon histologies of vulvar carcinoma
Melanoma, Basal cell, Bartholin gland adenocarcinoma, Sarcoma Paget’s disease
RF for vular cancer
other genital cancers, chronic inflammatory diseases of the vulva smoking, history of genital warts vulvar intraepithelial neoplasia.
What % of vulvar malignancies are due to paget’s disease
Between <1% and 2%
What % of Paget’s disease of the vulva is invasive
~ 25%
How is the depth of invasion of vulval cancer defined.
from the epithelial-stromal junction of the most superficial adjacent dermal papilla to the deepest point of invasion of the tumor.
Vulva - How are Stage IA lesions managed
WLE with a tumour free margin all around of at least 1 cm
What is the risk of groin node metastases with a depth of invasion between 1.1 - 3.0mm (from GOG 37)
7%
In a vulval ca, what is the risk of LN metastasis with a depth of invasion of > 3mm
26 - 35% (>3 = 30%)
What is the risk of LN metastases in tumours with < 1mm of invasion
< 1%. 1mm= 1%
Inthe GROINSS - V trial what was the rate of groin recurrence in unifocal disease with negative SLN over 35 months
2.3%
Independent of chosen treatment method what is the risk of recurrence for Vulval HSIL
~30 -40%
Aim for surgical margins in Early vulvar cancer of
2cm
What % of women with a lesion < 4cm in size and >2cm from the midline with -ve ipsilateral nodes have metastases to the contralateral groin
< 1%
What are the indications for pelvic and groin irradiation in patients with +ve groin nodes
Presence of Extracapsular spread 2 or more +ve LN.
Histological margins aimed for in Vulvar SCC
> 8 mm
According to GOG 37 - How does LVSI affect the likelihood of LN +ve lesion
x 3 increased risk
According to GOG 37 - What is the risk of +ve LN with a tumour thickness of = 1mm
2.6 % (1 patient in that trial)
According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 1.1 - 2mm
8.9 %
Vulva Ca: According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 2.1 - 3mm
18.6%
According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 3.1 - 4 mm
30.9%
According to GOG 37 - What is the risk of +ve LN with a tumour thickness of 4.1 - 5mm
33.3%
What is the rate of LN mets in lesions > 5mm in depth
47.9%
Is there a correlation between age and LN +ve status for vulvar carcinoma
Yes. GOG 37 <55 = 25% 55-64 25.4% 65 -74 36.4% 75+ 46.0 %
According to GOG 37 - What is the risk of +ve LN with a tumour diameter of < 1 cm
18.0 %
According to GOG 37 - is there a difference between LN + status in tumours < 1cm and 1.1 - 2 cm?
No signif dif. < 1.0 = 18.0%, 1.1 - 2.0 = 19.4%
According to GOG 37 - What is the risk of +ve LN with a diameter of 2.1 - 3.0 cm
31.4%
According to GOG 37 - What is the risk of +ve LN with a diameter of 3.1 - 4 cm
54.3%
According to GOG 37 - What is the risk of +ve LN with a diameter of 4.1 - 5.0cm
39.6%
According to GOG 37 - What is the risk of +ve LN with a diameter of > 5cm
51.8%
According to GOG 37 - What is likelihood of +ve Groin LN in nodes normal on clinical examination?
23.9%
What is the risk of recurrence in Paget’s disease with negative margins?
~ 33%
What % of Vulva SLN are deep to the fascia lata?
In Rob et al., J Gynecol Cancer . Jan-Feb 2007 of 118 women 16.1% were deep femoral.
What % of mucosal (vulvo/vaginal) melanoma have a BRAF and KIT mutation?
10% and 25% respectively Consider BRAF inhibitors e.g. deBRAFenib and KIT inhibitor e.g. imatinib (Glivec)
When was DES removed from the marker?
1971
What was the risk of CCC in an offspring of a woman exposed to DES?
1: 1000 - vaginal adenosis common as well as structural abnormalities
What % of women with +ve groin nodes will have normal examination
23.9% - Homesly et al 1992
In ESGO guidelines to pooled sensitivity and specificity of clinical examination for the detection of +ve groin nodes in vulval cancer was?
Sensitivity - 35%
Specificity 94.3%
In ESGO guidelines to pooled sensitivity and specificity of MRI for the detection of +ve groin nodes in vulval cancer was?
Sensitivity 86%
Specificity 87%
In ESGO guidelines to pooled sensitivity and specificity of PET scan for the detection of +ve groin nodes in vulval cancer was?
Sensitivity 71%
Specificity 72%
In a review of 6 studies, Zhang et al found that preservation of the saphenous vein was associated with a decreased risk of? (4)
Less cellulitis (18 v 39%)
SHort term lower extremity lymphoedema (32 v 70%)
Wound breakdown ( 13 v 38%)
Chronic oedema (3 v 32%)
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?
39 - 18%
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?
70 % to 32 %
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?
38% - 13%
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?
32% to 3%
In a review of 6 studies, Zhang et al found that preservation of the saphenous vein lead to no complications in ?
No complications in 56% of those with saphenous vein preserved compared with 23% of those who had the vein ligated.
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?
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%.
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.
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%.
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.
Both groins need treating as per the size of the mets as per GROINS 2.
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?
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%.
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?
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%
In a MIDLINE tumour with unilateral lymph flow on SLN how do you manage this intra operatively?
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.
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?
Treat the +ve groins as per GROINS V2.
