Vulvar and Cervical Cancer 3 Flashcards
Identify and describe the following vulvar lesions: lichen sclerosis, vulvar carcinoma, vulvar intraepithelial neoplasia, vulvar condyloma, dermatitis, melanoma.
What are the two groups of people who have vulvar cancer?
- HPV Assoc → HSIL (VIN-2/3), Younger age (<55y/o), smoking, low SES, high-risk sexual behaviors, HIV
- Non-HPV Assoc → Chronic inflammatory disease-30% assoc. with Lichen Sclerosis
What is the most important procedure if there is any question about vulvar lesion/pathologic process?
BIOPSY - full thickness, including underlying dermis
What is the etiology, symptoms, PE, evaluation, and treatment of contact vulvar dermatitis?
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Etiology:
- allergen that produces an immune response (delayed)
- irritant that directly damages vulvar skin (immediate)
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Symptoms:
- severe pruritus (most common), rawness, stinging, burning, and pain
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PE:
- mild-to-severe erythema
- scaling and fissures
- excoriation
- lichenification of the skin (simplex chronicus)
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Eval:
- consider Biopsy
- infection/STD
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Treatment:
- behavioral modification: break itch/scratch cycle
- eliminate offending allergen/irritant
- consider topical steroid
What is the etiology, symptoms, PE, evaluation, and treatment of lichen sclerosis?
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Etiology:
- complex chronic inflammatory skin condition
- exact etiology is unknown
- considered an autoimmune disease
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Symptoms:
- Severe pruritus (most common), vulvar irritation, pain, and dyspareunia
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PE:
- porcelain white (hypopigmentation) papules and plaques, often with areas of ecchymosis, purpura, and excoriation.
- shiny, waxy, thinned, whitened, and crinkling- “cigarette paper.”
- changes in vulva: loss of the labial contours and fusion of the labia minora into the labial fat pad
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Eval:
- consider biopsy
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Treatment:
- ultrapotent steroids
What is the treatment of vulvar/perianal condylomas?
Laser therapy if severe
What are vulvar lymphatics and why are they important?
- Vulva & distal third of vagina to ipsilateral superficial inguinal groin
- Lymph channels then perforate cribiform fascia to deep inguinal/femoral LN
- cloquet node: superiormost deep femoral LN
- Drainage from midline structures (urethra, clitoris, perineum) likely bilateral
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Lymph Node Dissection:
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superficial borders:
- sartorius,
- adductor longus,
- inguinal ligament
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deep borders:
- beneath cribiform fascia medial to femoral vein
- beneath the borders of the fossa ovalis
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superficial borders:
What are treatments for vulvar carcinoma?
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Current Surgical Management: Triple Incision Vulvectomy/Wide Local Excision
- >1-2cm margin around primary lesion, separate incision for groin.
- lymph node dissection: ipsilateral only, unless ≤2cm of midline
- partial radical vulvectomy for lesions >2cm
- Radical vulvectomy: depth of the perineal membrane
- Previously: Radical Vulvectomy
- butterfly vs. longhorn
- For advanced disease: Consider Neoadjuvant chemoradiation primary concern adequate XRT with minimal damage to femoral heads
What is the basic structure of staging for carcinoma of the vulva?
- Stage I = tumor confined to the vulva
- Stage II = tumor of any sizes with extension to adjacent perineal structures with negative nodes
- Stage III = tumor of any size with or without extension to adjacent perineal structures with positive inguino-femoral lymph nodes
- Stage IV = tumor invades other regional or distant structures
What is the treatment and most important prognostic factor for carcinoma of the vulva?
- Treatment = inguinofemoral LND performed for allstages except IA
- Positive LN is single most important prognostic factor
- 5 year survival with positve LN is 50% of similar size with negative LN
Describe the findings of melanoma of the female reproductive tract.
- 5-10% of vulvar CA, Mean age 55y/o
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Typical Presentation:
- Caucasian with pigmented lesion or bleeding/painful mass
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risk factors:
- fair
- sun
- UV
- fam Hx
- atypical nevi (ABCDEs)
- Staging: Tumor Thickness/Depth of Invasion
- Breslow: Best predictor of outcome
- Spread: Groin Mets/Distant Metastasis Frequent
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Rx: Surgical RLE include B/L Groin LND
- the thicker the tumor, the larger margin
- recurrence: Consider XRT
- Nodular is worst subtype