Vulvar CA Flashcards
vulvar cancer risk factors
age, HPV, tobacco use, immunosuppression, lichen sclerosis
age and vulvar cancer
median age of diagnosis 68
SEER data indicates that 26.6% of patients < 55
5 year survival and node status
0-1 unilateral groin nodes = 80%
3+ unilateral nodal mets = 30%
Rate of distant microscopic metastasis at 6 years
11-12%
Kunos et al Ratiation therapy compared with pelvic node resection for node positive vulvar cancer. Obstetrics and Gynecology 2009;114(3):537-46
GOG 101
chemo dosing: cisplatin 50mg/m2 D#1+ 5-FU 1000mg/m2 D#1-4 as a 24 hour infusion
radiation dosing: 170 cGY BID D#1-4
170cGY Qday D#5 and 8-12 (days #6 & 7 are the weekend)
1.5-2.5 week break between cycles
2 cycles of above then surgery in 3-8 weeks
management of fixed or ulcerated IFLN
attempts to ressect ulcerated or fixed IFLN is not recommended. Tassing et al AJOG 1940;164(40):79
rate of LN metastasis in all vulvar cancer
SEER data indicate 61% of all SCCa of the vulva confined to the vulva
FIGO vulvar melanoma staging
FIGO - appropriate but limited by weak predictor of survival/poor assistance in treatment planning
AJCC vulvar melanoma staging
AJCC - uses TNM; revised in 2010 to highlight prognostic factors including mitotic rate, presence of microtumor burden in lymph nodes and levels of lactate dehydrogenase in patients with distant metastases
Clark melanoma staging
considered a microstaging system and used for cutaneous melanoma; based on depth of invasion into dermis
Breslow melanoma staging
Breslow - used in cutaneous melanoma; focuses on tumor thickness
Chung melanoma staging
Chung - modified Clark criteria specifically for vaginal and vulvar melanoma and reflects the absence of a keratin or granular layer in much of the vulvar vestibule
Surgical management of vulvar melanoma
Traditionally managed with radical surgery; recent date indicates more radical surgery is not associated with better survival - 1cm deep surgical margin should be obtained; lateral surgical margins depend on DOI: 1mm = 2 cm. IFLND remains contriversial. Irvin et al Vulvar melanoma: a retrospective analysis and literature review. Gynecol Oncol 2001;83:457-65
Adjuvant treatment for vulvar melanoma
High risk resected cutaneous melanoma high dose alpha interferon demonstrated strong evidence for improved RFS and moderate improvement in OS in 2 studies; pool data from 4 studies showed only improvement in RFS. Irikwood et al. A pooled analysis of ECOG and intergroup trials of high dose interferon for melanoma. Clin Cancer Res 2004;10:1670-7
superficial spreading melanoma
radial growth of > or = 4 retia lateral to the vertical or infiltrative growth
