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GYN > Vulvar cancer > Flashcards

Vulvar cancer Flashcards

1
Q

Incidence and mortality

A

Very rare

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2
Q

Anatomy

A

MLC

M-Mons Pubis
L-Labia Majora
L-Labia Minora
C-Clitoris

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3
Q

Anatomy

A

Innervation: Pudendal nerve S2-S4
Lymphatic drinage: Superficial inguinal nodes ~ deep nodes
Clitoris -> pelvic nodes

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4
Q

Symptoms

A

Persistent itching
Bleeding
Soreness
Lump/Mass

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5
Q

Compare Gyn cancers and symptoms

A
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6
Q

Risk factors

A

Vulvar dystrophy
Lichen sclerosis
Age
HPV
HIV
Family history of Melanoma

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7
Q

HPV Infection risk factors

A

Young age @ intercourse
# of sexual partners
genital warts

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8
Q

HPV Strains

A

16
18
33

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9
Q

Histology

A

Verrucous carcinoma = SCCa variant = rarely mets

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10
Q

Patterns of SCCa

A

1) Spray
2) Diffuse

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11
Q

Spray SCCa

A

Finger like tumor = extending to deeper and into dermis

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12
Q

Diffuse SCCa

A

Connected tumor >1mm
Deeply invasive = Stromal desmoplasia

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13
Q

Risk of lichen sclerosis transforming into malignancy

A

5%

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14
Q

Risk of VIN III transforming into malignancy

A

80%

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15
Q

Cloquet’s node
Rosenmuller node

A

Most superficial deep inguinal node = Pelvic mets

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16
Q

Risk of Groin nodes depends on??

A

Thickness of tumor ~ DOI

(GOG 36)

2-5mm = 33%
>5 mm = 47% risk

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17
Q

Pelvic Nodes +ve

A

FIGO Stage IV B
Poor prognosis = GOG 37

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18
Q

What is the risk of contralateral disease

A

8%

(GOG 36)

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19
Q

Labs + Imaging

A

H&P
Pelvic examination
Rectal Examination
CBC, LFT
HPV Test
PREGNANCY TEST
EUA with proctoscopy/sigmoidoscopy = Biopsy
If Mets = Chest X-ray
MRI Pelvis
Node +ve = PET CT

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20
Q

Staging

A

FIGO Staging 2009

21
Q

Prognostic factors

A

LN +ve
Margins
DOI
ECE
Grade
LVSI
Size
PNI
P16 status

22
Q

RX STD of care

A

Surgery

we know the size, location better

23
Q

Types of Surgery

A

Modified radical vulvectomy
Hemi vulvectomy

24
Q

What is considered as negative margins

A

1 cm free of tumor/ 8mm pathologic margins

25
Q

NCCN Rx paradigm

A
26
Q

Positive margins

A
27
Q

Nodes RX

A
28
Q

Summary of RX

A
29
Q

Evaluation of response

A
30
Q

Summary

A

Very rare
White women > black/hispanic women
mostly SCCa
Older Women (7th decade)
H/o HPV or Lichen SClerosis
Primary RT: SX
Adjuvant RT as needed
IMRT PORT
CHT only neoadjuvant if needed.

31
Q

Radiation therapy

A

PORT
.
.
Neg margins
4500-5040 cGy
.
.
Close margins: <8mm - 56Gy
Positive margins: 63Gy
5400-5990 cGy
.
.
Residual/Gross Disease
6500-7000 cGy

32
Q

Radiation therapy, LN volumes/dose

A

@ risk: 4500-5000 cGy
_+ve gross Nodes: 6000-7000cGy
ECE: 5400-6400 cGy

33
Q

CRT

A

Neoadjuvant RT + CHT = Tumor > 4cm
.
Nodes: 4500 cGy
Boost to tumor 5760 in 2 fx
.
.
CHT
Cisplatin/ 5-FU
5-FU MMC
.
.
.
.
Adjuvant CRT = T1b-T2 , Nmi

34
Q

Side Effects from XRT

A

Skin
Cystitis
Proctitis
fibrosis
bowel obstruction
lymphedema
Pelvic insufficiency #

35
Q

Outcomes

A

5 year DSS based on Stage
I = 85%
II = 80%
III = 60%

36
Q

GOG 37

A

Indications for post op LN RT
1) Clinically matted nodes
2) >2 path nodes
3) ECE
4) LN +ve ratio >20%

37
Q

GOG 88

A
38
Q

GOG 173

A
39
Q

GROINSS -V

A
40
Q

GROINSS - VI

A
41
Q

GROINSS - VII

A
42
Q

GROINSS - VIII

A
43
Q

GOG 205

A
44
Q

UCLA HEAPS

A

strongest factor for PORT: Positive/close margins <8mm

45
Q

Studies Summary

A
46
Q

How to sim

A

Supine
arms on chest
frog leg (to reduce skin toxicity)

47
Q

PORT indications for vulvar carcinoma HEAPS

A

1) Close margins <8mm
2) LVSI
3) DOI >9mm

48
Q

Patients with IA disease chance of LN involvement at surgery

A

<8%

49
Q

T-Staging

A

GYN (6 decks)

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