Vulva/Vagina Flashcards

1
Q

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

A

c) pos groin unilateral groin node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Biopsy shows VIN III with a focus of SCCA w/ 0.8mm invasion, what do you do next?

A

If this was an excision, you may observe. For this biopsy, you would then excise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you treat a 2cm mid vaginal SCCA?

A

Radiate
only surgery if <2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What stage – vulvar lesion with two pos 6 mm LNs

A

IIIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What stage – vulvar lesion with 2 positive LN with extracapsular spread?

A

IIIC (remember: extraCapsular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of non-healing vulvar ulcer or radiation induced hemorrhagic cystitis?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nerve supply to the vulva

A

Pudendal nerve and genital branch of genfem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

8 cm defect between the vulva and the anus, what’s the best flap?
a) Gracilis
b) VRAM
c) rhomboid

A

a) Gracilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Order of fascial plane in the inferior dissection of radical vulvectomy

A

Colle’s facia, inferior then superior fascia of the urogenital diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which patients with bartholin’s gland adeno need LND?

A

All, 20% risk of LN mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Depth of laser tx in hair bearing areas?

A

3mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Laser depth in non hair bearing areas?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Role for LND for vulvar melanoma?

A

controversial as it’s mostly prognostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

best treatment for a 4 cm vulvar ulcer after radiation therapy?
a) hyperbaric oxygen
b) flap
c) resection

A

hyperbaric oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

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

17
Q

How often are hair bearing areas involved with VIN?

A

50%

18
Q

what has been associated with decreased infection in groin dissection?

A

Saphenous vein sparing

19
Q

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

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

20
Q

What is best way to decrease wound infection after inguinal dissection?
a) prolonged prophylactic abx
b)tissel spray
c) sparing the saphenous

A

c) sparing the saphenous

21
Q

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

A

d) operative management

22
Q

What are the stages of vulvar cancer?

A
23
Q

What is a tumor marker for Melanoma?

A

Serum LDH

Melanomas express S-100 protein, HMB-45, and Melan-A on tumor tissue

24
Q

Micrometastasis in a sentinel inguinal LN - what is the next step in treatment?

A

Radiation - don’t need to do full LND since it is micromet and needs RT anyway. BULKY inguinal disease could be debulked first.