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Skin Radiation therapy > Vulvar cancer > Flashcards

Vulvar cancer Flashcards

1
Q

is vulvar cancer common or uncommon

A

its rare

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2
Q

risk for vulvar cancer

A

Associated w/ HPV 16 & 18
Previous CIN or invasive cervical cancer (increase risk by 10x)
STIs like herpes and HIV
Immunosuppression groups after renal transplant (100 fold increase in risk)
Smoking
Multiple sexual partners
Sex at a young age

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3
Q

parts of the vulva

A

labia, clitoris, urethral and vaginal openings

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4
Q

site of distant mets

A

lung

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5
Q

natural history of vulvar cancer

A

Local invasion to surrounding soft tissues and pubic bone

Distant mets to lungs

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6
Q

most common age for vulvar cancer

A

most common in women >70y.o.

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7
Q

disease progression of vulvar cancer

A

most start out as VIN (Vulvar intraepithelial neoplasia) and progress to SCC

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8
Q

Most vulvar cancer are diagnosed in ____stage. Why?

A

early stages, this is because the disease is palpable in early stages, however 35% are still diagnosed late

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9
Q

most common parts of the vulva for vulvar cancer

A

most commonly in labia minor and labia majora

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10
Q

most common risk factor in younger its

A

HPV infections

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11
Q

most common risk factor in older patients

A

chronic vulvar inflammation or lichen sclerosis (patchy white skin that appears thinner than normal in the gene area)

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12
Q

S&S of vulvar cancer

A 
No symptoms in the VIN stage 
palpable mass
history of pruritis 
painful urination 
bleeding vaginally
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13
Q

most common spread

A

Most common spread is through direct extension to adjacent LN and organs

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14
Q

LN spread in vulvar cancer

A

SUPERFICIAL inguinal LN —Pelvic LN

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15
Q

Diagnosis of vulvar cancer

A

Physical exam and local biopsy

FNA used for more advanced local disease

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16
Q

most common pathology of vulvar cancer

A

SCC

Other pathologies: BCC, melanoma, Sarcoma

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17
Q

Staging of vulvar cancer

A

FIGO and TNM can be used
TNM-
TNM:
T1: Confined to the vulva =/< 2cm in diameter
T2: Confined to the vulva > 2cm in diameter
T3: Involves the urethra, vagina, perineum or anus
T4: Invades rectal or bladder mucosa, urethral mucosa or bone
N1: Mobile l/n in groin- not clinically suspicious
N2: Mobile l/n in groin- clinically suspicious
N3: Fixed or ulcerated l/n
M1: Distant mets
Staging:
Stage I: T1
Stage II: T2
Stage III: T3 or N1
Stage IV: T4, N2 or M1

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18
Q

surgery in vulvar cancer

A

Surgery is the primary tx
Radical local excision is preferred to a radical vulvectomy as there is a lower mortality rate
Stage I: Radical local excision
Stage II & III: Radical vulvectomy & bilateral groin dissection b/c of increased risk of l/n involvement

19
Q

use of chemo in vulvar cancer and timing

A

used concurrently with XRT

Is used with advanced, recurrent or inoperable disease

20
Q

chemo agents for vulvar cancer

A

5FU and cispltinum

21
Q

indications for XRT in vulvar cancer

A

Post op XRT is used for pts with 2+ nodal mets
preop xrt can be used for pts with tumours close to critical structures
XRT can be used for very large tumours where surgery is not an option
palliation

22
Q

CT scanning limits

A

canning Limits:
Sup Border – L3/L4
Inf Border – 5cm inf from ischial tuberosities

23
Q

phases for AP/PA POP

A

Phase I: AP/PA photons w/ a dose of 45-50Gy at 160-180cGy/fraction
Phase II: Electron boost to the groin bringing dose to 60-65Gy
Phase III: Electron boost to positive l/n bringing dose to 65-70Gy

24
Q

field borders for large vulvar cancer

A 
Sup= Top of L4
Inf= Cover vulva to allow fall off
Lat= ASIS to cover inguinofemoral l/n
25
Q

field borders for small vulvar cancer

A

Sup=Above pubis
Inf= Cover vulva to allow fall off
Lat= 3cm on each side of the lesion

26
Q

patient positioning for photon vs electron tx

A

photon- pt in typical gyne set-up: FDLI, pillow hands on chest holding ring
electron- pt should be in stirrups - lithotomy position

27
Q

treatment considerations for vulvar cancer

A

patients may require a 3-4 week break if they get moist desquamation
patients should have bolus if the skin is involved

28
Q

most important prognostic factor for vulvar cancer

A

inguinal + =worse prognosis therefore LN involvement is most important

29
Q

stage 1 treatment

A

Radical local excision which may be followed by XRT if there are positive margins or l/n involvement

30
Q

stage 2 and 3 treatment

A

Radical vulvectomy

31
Q

lymphatics of the labia perineum and prepuce

A

superficial inguinal- femoral- pelvic (external and common iliac)

32
Q

drainage of the glans clitoris

A

inguinal and deep femoral LN but can also bypass the femoral nodes and go from the inguinal LN to the external iliac nodes

33
Q

Vulvar LN spread typically

A

typically follows a predictable route

superficial inguinofemoral LN,–deep inguinofemoral LN—contralateral inguinal and pelvic LN involvement is rare

34
Q

most common sites of distant mets

A

lung liver and bone, but mets is uncommon

35
Q

pre invasive vukvar cancers

A

carcinoma in situ ( Bowen’s disease) erythoplasia of Queyrat and Paget’s disease (like the precancerous breast lesion of the nipple)

36
Q

2 subtypes of SCC of the vulva

A

SCC is the most common type, subtypes are: adenosquamous and basaxoid carcinoma

37
Q

XRT dose for LN- vulvar cancer, - margins and + margins

A

if the patient has a simple vulvectomy: 50Gy with 6-18Mv and bolus
if the patient has wide local excision - margins 50Gy with 6-18MV and perineal electron boost bringing the excision site to a dose of 60Gy
if there is + margins after 60Gy boost to + margins or +LN (5Gy) with electrons

38
Q

indications for post op XRT in stage 3 vulvar cancer and dose

A

primary tumour >4cm
+ surgical margins
3 or more +LN
DOSE: 50Gy to vulva and inguinal areas, boost to + margins (10-15Gy) via perineal portal or interstitial implant boost to inguinal LN via AP field (10-15Gy)

39
Q

treatment for stage 4 vulvar cancer

A

pelvic exenteration which is the removal of all organs in the pelvic cavity
first neoadjuvant XRT to 45Gy is given to pelvis and inguinal areas with radical vulvectomy and complete inguinal LN dissection
Post op boost of 10-15Gy is given with interstitial intracavitiary or electrons if the patient has palpable LN

40
Q

treatment of its with + LN

A

patients with + LN can benefit from prep XRT 45-50gY OR XRT +chemo
XRT is better than Sx for LN + patients

41
Q

dose for patients with palpable LN

A

for palpable inguinal LN the dose should be 65-70Gy

42
Q

postion for simulation

A

frog leg position knees apart feet together

43
Q

when is preop XRT used

A

for patients with advanced primary lesions involving surrounding structures which are unresectable (45-50Gy for 5-6 weeks should be used)

44
Q

treatment after recurrence

A
  • could be treated with surgery

- for prior surgery extensive XRT of 65-70Gy is used`

Skin Radiation therapy (40 decks)

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