Vulva/Vagina Flashcards
In a patient with a lateralized 3 cm vulvar cancer, what is the most important factor in determining to perform bilateral groin node dissection?
a) DOI >2mm
b) size>2 cm
c) pos groin unilateral groin node
d) LVSI
c) pos groin unilateral groin node
Biopsy shows VIN III with a focus of SCCA w/ 0.8mm invasion, what do you do next?
If this was an excision, you may observe. For this biopsy, you would then excise.
How do you treat a 2cm mid vaginal SCCA?
Radiate
only surgery if <2cm
1cm vulvar lesion with 2 positive LN in the right groin. What is the next step in management?
a) bilateral groin RT
b) bilateral groin RT +Pelvic XRT
c) Systemic chemo
b) bilateral groin RT +Pelvic XRT
NCCN: In both the locally advanced and postoperative settings, especially when there is ≥1 LN clinically suspicious or pathologically positive, the bilateral inguinal and pelvic lymphatic regions are typically included in the CTV
What stage – vulvar lesion with two pos 6 mm LNs
IIIB
What stage – vulvar lesion with 2 positive LN with extracapsular spread?
IIIC (remember: extraCapsular)
Treatment of non-healing vulvar ulcer or radiation induced hemorrhagic cystitis?
Hyperbaric oxygen
In severe cases best choice for cystitis is cysto with fulguration of bleeding vessels, followed by hyperbaric/intravesical instillation of alum or formalin/systemic pentosan polysulfate (elmiron)
Nerve supply to the vulva
Pudendal nerve and genital branch of genfem
8 cm defect between the vulva and the anus, what’s the best flap?
a) Gracilis
b) VRAM
c) rhomboid
a) Gracilis
Order of fascial plane in the inferior dissection of radical vulvectomy
Colle’s facia, inferior then superior fascia of the urogenital diaphragm
Which patients with bartholin’s gland adeno need LND?
All, 20% risk of LN mets
Depth of laser tx in hair bearing areas?
3mm
Laser depth in non hair bearing areas?
1 mm. In hair bearing areas, laser proceudres must ablate hair follicles, which can contain vulvar HSIL(VIN usual type) and extend into the subcutaneous fat or 3mm or more. Consequently large vulvar HSIL lesions over hair bearing areas may be preferentially treated with surgical excision.
Role for LND for vulvar melanoma?
controversial as it’s mostly prognostic
best treatment for a 4 cm vulvar ulcer after radiation therapy?
a) hyperbaric oxygen
b) flap
c) resection
hyperbaric oxygen
Vaginal cancer: 1cm posterior vaginal fornix, hx crohn’s, treatment?
a) radiation
b) radical local excision
c) partial resection +LND
d) rad hyst, LND, vaginectomy
d) Rad hyst, LND, vaginectomy
Upper 1/3 vagina–> external iliac nodes
Middle 1/3–> common and internal iliac nodes
Lower 1/3–> superficial inguinal nodes
How often are hair bearing areas involved with VIN?
50%
what has been associated with decreased infection in groin dissection?
Saphenous vein sparing
Which vessel is not encountered during inguinal LND?
a) deep circumflex femoral artery
b) femoral artery
c) superficial circumflex iliac vein
d) superficial external pudendal
e) superficial epigastric vein
f) saphenous vein
a) deep circumflex femoral artery – NOT encountered
b) femoral artery
c) superficial circumflex iliac vein (lateral)
d) superficial external pudendal (medial)
e) superficial epigastric vein (superior)
f) saphenous vein
deep circumflex iliac artery (or deep iliac circumflex artery) is an artery in the pelvis that travels along the iliac crest of the pelvic bone
lateral circumflex femoral artery is a short branch of the deep femoral artery. The artery courses laterally separating the femoral nerve into anterior and posterior divisions in the femoral triangle.
medial circumflex femoral artery usually arises from the deep femoral artery
What is best way to decrease wound infection after inguinal dissection?
a) prolonged prophylactic abx
b)tissel spray
c) sparing the saphenous
c) sparing the saphenous
1 week s/p vulvectomy. Presents with hypotension, fevers, crepitus. Failed drainage. Next step?
a) ICU and abx
b) abx and ID consult
c) abx and CT scan
d) operative management
d) operative management
What are the stages of vulvar cancer?
What is a tumor marker for Melanoma?
Serum LDH
Melanomas express S-100 protein, HMB-45, and Melan-A on tumor tissue
Micrometastasis in a sentinel inguinal LN - what is the next step in treatment?
Radiation - don’t need to do full LND since it is micromet and needs RT anyway. BULKY inguinal disease could be debulked first.
