Vulval Cancer Flashcards
Stage 1
Tumor confined to the vulva
1A
Tumor size ≤2 cm and stromal invasion ≤1 mm
1B
Tumor size >2 cm or stromal invasion >1 mm
Stage II
Tumor of any size with extension to lower one-third of the urethra, lower one-third of the vagina, lower one-third of the anus with negative nodes
Stage III
Tumor of any size with extension to upper part of adjacent perineal structures, or with any number of nonfixed, nonulcerated lymph node
IIIA
Tumor of any size with disease extension to upper two-thirds of the urethra, upper two-thirds of the vagina, bladder mucosa, rectal mucosa, or regional lymph node metastases ≤5 mm
IIIB
Regional lymph node metastases >5 mm
IIIC
Regional lymph node metastases with extracapsular spread
IV
Tumor of any size fixed to bone, or fixed, ulcerated lymph node metastases, or distant metastases
IVA
Disease fixed to pelvic bone, or fixed or ulcerated regional lymph node metastases
IVB
Distant metastases
Any lesion 2cm OR less in diameter + 1mm or less in depth
RWLE. With NO LN removal. The risk of groin node
metastases in these patients is <1%
Any lesion > 2cm or depth > 1mm
RWLE with LN removal ( confined to vulva)
Lateral -Inguinofemoral dissection if possible contralateral dissection
Median lesion - always bilateral LN dissection- triple incision
Any lesion > 4 cm anywhere
B/L - LAD, f/b radiotherapy
Sentinel LN biopsy
not yet implemented:- still in ongoing clinical studies such as GROINSS-V II
* Indications for sentinel nodes biopsy:-
* Unifocal confined to vulva
* primary SCC
* <4cm in dia
* no safety issues for patent blue/tech 99
* Stromal invasion >1mm
* informed consent and f/u every 2monthly for 1st year.
* Clinically and radiological negative nodes.
Post op RT for nodes positive patients indications:
a. Presence of extracapsular spread.
b. Two or more positive groin nodes.
c. Positive margins
No suspicious LN involved both clinically and by imaging
no RT
advanced- LN involved revealed by histology
post op RT
Advanced stages ( stage ¾) requires
beyond vulva/ bulky positive groin nodes
ultra-radical surgery ( MORTALITY 0-20%)
pre-op CT ( Cisplatin + 5FU)+ radiotherapy f/b Surgery or
neoadjuvant chemo f/b surgery or radiotherapy is an alternative treatment regimen, especially in those
patients who have had perineal radiotherapy previously.
Primary radiotherapy with or without chemotherapy in those patients who are medically unfit for surgery
f groin lymph nodes is the single most important prognostic factor that affects 5-year
survival. Patients with negative groin nodes (all stages) have a 5-year survival of
> 80%
positive inguinal nodes
5 yr survival <
50%
positive iliac or other pelvic
lymph nodes
5 yr survival 10-15 %
Recurrent vulval cancer
15-37%
Pelvic recurrence-
chemo radio