Vulval Cancer

Question 1

Stage 1

Answer 1

Tumor confined to the vulva

Question 2

1A

Answer 2

Tumor size ≤2 cm and stromal invasion ≤1 mm

Question 3

1B

Answer 3

Tumor size >2 cm or stromal invasion >1 mm

Question 4

Stage II

Answer 4

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

Question 5

Stage III

Answer 5

Tumor of any size with extension to upper part of adjacent perineal structures, or with any number of nonfixed, nonulcerated lymph node

Question 6

IIIA

Answer 6

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

Question 7

IIIB

Answer 7

Regional lymph node metastases >5 mm

Question 8

IIIC

Answer 8

Regional lymph node metastases with extracapsular spread

Question 9

IV

Answer 9

Tumor of any size fixed to bone, or fixed, ulcerated lymph node metastases, or distant metastases

Question 10

IVA

Answer 10

Disease fixed to pelvic bone, or fixed or ulcerated regional lymph node metastases

Question 11

IVB

Answer 11

Distant metastases

Question 12

Any lesion 2cm OR less in diameter + 1mm or less in depth

Answer 12

RWLE. With NO LN removal. The risk of groin node
metastases in these patients is <1%

Question 13

Any lesion > 2cm or depth > 1mm

Answer 13

RWLE with LN removal ( confined to vulva)
Lateral -Inguinofemoral dissection if possible contralateral dissection
Median lesion - always bilateral LN dissection- triple incision

Question 14

Any lesion > 4 cm anywhere

Answer 14

B/L - LAD, f/b radiotherapy

Question 15

Sentinel LN biopsy

Answer 15

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.

Question 16

Post op RT for nodes positive patients indications:

Answer 16

a. Presence of extracapsular spread.
b. Two or more positive groin nodes.
c. Positive margins

Question 17

No suspicious LN involved both clinically and by imaging

Answer 17

no RT

Question 18

advanced- LN involved revealed by histology

Answer 18

post op RT

Question 19

Advanced stages ( stage ¾) requires

Answer 19

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

Question 20

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

Answer 20

> 80%

Question 21

positive inguinal nodes

Answer 21

5 yr survival <
50%

Question 22

positive iliac or other pelvic
lymph nodes

Answer 22

5 yr survival 10-15 %

Question 23

Recurrent vulval cancer

Answer 23

15-37%

Question 24

Pelvic recurrence-

Answer 24

chemo radio

Question 25

vulval BCC , vulval verrucous cancer

Answer 25

• wide local excision(1cm margins) NO LND

Question 26

Bartholin gland cancer

Answer 26

Radical hemivulvectomy + bilateral inguino-femoral LND + Postop RT

Question 27

Melanoma treatment

Answer 27

surgical excision, primarily resistant to radiotherapy, can be used in close surgical margins, unsuitable for excision