Vulvar and Cervical Cancer 3 Flashcards

Identify and describe the following vulvar lesions: lichen sclerosis, vulvar carcinoma, vulvar intraepithelial neoplasia, vulvar condyloma, dermatitis, melanoma.

1
Q

What are the two groups of people who have vulvar cancer?

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

What is the most important procedure if there is any question about vulvar lesion/pathologic process?

A

BIOPSY - full thickness, including underlying dermis

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

What is the etiology, symptoms, PE, evaluation, and treatment of contact vulvar dermatitis?

A
  • Etiology:
    • allergen that produces an immune response (delayed)
    • irritant that directly damages vulvar skin (immediate)
  • Symptoms:
    • severe pruritus (most common), rawness, stinging, burning, and pain
  • PE:
    • mild-to-severe erythema
    • scaling and fissures
    • excoriation
    • lichenification of the skin (simplex chronicus)
  • Eval:
    • consider Biopsy
    • infection/STD
  • Treatment:
    • behavioral modification: break itch/scratch cycle
    • eliminate offending allergen/irritant
    • consider topical steroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the etiology, symptoms, PE, evaluation, and treatment of lichen sclerosis?

A
  • Etiology:
    • complex chronic inflammatory skin condition
    • exact etiology is unknown
    • considered an autoimmune disease
  • Symptoms:
    • Severe pruritus (most common), vulvar irritation, pain, and dyspareunia
  • 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
  • Eval:
    • consider biopsy
  • Treatment:
    • ultrapotent steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the treatment of vulvar/perianal condylomas?

A

Laser therapy if severe

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

What are vulvar lymphatics and why are they important?

A
  • 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
  • Lymph Node Dissection:
    • superficial borders:
      • sartorius,
      • adductor longus,
      • inguinal ligament
    • deep borders:
      • beneath cribiform fascia medial to femoral vein
      • beneath the borders of the fossa ovalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are treatments for vulvar carcinoma?

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

What is the basic structure of staging for carcinoma of the vulva?

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

What is the treatment and most important prognostic factor for carcinoma of the vulva?

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

Describe the findings of melanoma of the female reproductive tract.

A
  • 5-10% of vulvar CA, Mean age 55y/o
  • Typical Presentation:
    • Caucasian with pigmented lesion or bleeding/painful mass
    • 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
  • Rx: Surgical RLE include B/L Groin LND
    • the thicker the tumor, the larger margin
    • recurrence: Consider XRT
  • Nodular is worst subtype
How well did you know this?
1
Not at all
2
3
4
5
Perfectly