Vulvar Carcinoma FRCR CO2A Flashcards
what are different subsites of Vulva?
- Mons Pubis
- Labia Majora
- Labia Minora
- Clitoris’s
- Vestibule
what are common malignancies of Vulva?
Sq cell carc (>90%)
AC
BCC
Melanoma
what are the RFs a/w vulvar cancer?
- old age
- HPV (16 is predominant) others 33, 18, 45
- HPV 6 and 11 : verrucus
- smoking
- immunocompromised
what are the molecular abnormalities in vulvar cancer?
disruption of PTEN and TP53,
TP 53 is inactivated by binding of HPV E6 protein
How does vulvar cancer Spread?
locoregional to perineum, urethra, vagina, anus, bladder, rectum or pubic bone
Lymphatic to inguinal, femoral and pelvic nodes
Blood: Lung, Liver and Bone
what % of operable vulvar cancer have inguinal LN
30%
How is primary vulvar tumor evaluated?
EUA and Biopsy
size, location (distance from midline), fixity, involvement of adjacent structures (urethra, vagina or anal canal)
Cystoscopy
Proctoscopy and cervical smear
How is nodal stations evaluated for vulvar cancer?
Examination
USG and FNAC
for full surgical staging, an inguinofemoral groin node dissection or a SNLN biopsy
What is Rx of early stage (I and II) vulvar cancer?
stage IA: WLE only, remaining vulva must be normal and 1 cm margin is required
Stage IB to II: Radical vulvectomy and BGND
what is ideal margin in vulvar cancer?
15 mm
when is re-excision advised in vulvar cancer post Sx?
margin < 10 mm
what’s the % of Local recurrence with margin < 8 mm and > 8 mm?
48% Vs 0%
what margin is indication for post op RT in vulvar cancer?
< 8 mm
what are the s/Es of BGND?
- Lymphcele
- Lymphedma (47%)
- wound breakdown
when should post op RT added post BGND?
LN +
what are Rx options for LAVC ? (st III and IVA)
- Surgery: Radical Vulvectomy and BGND
- NART or CRT f/b surgery: for initial inoperable or with aim of sphincter sparing (pelvic exenteration)
- Primary RT or CRT : for unfit or very very LAVC
what are the indications for Post op RT in LAVC?
margin + or < 8mm
To the nodes if 2 or > 2 LN +
what should be taken in CTV for vulvar cancer post op?
Surgical Scar and remaining vulval tissue + LNs (Inguinofemoral nodes and distal ext and int Iliac nodes)
what RT dose is given for Vulval cancer?
45 Gy/ 25# followed by surgical removal or boost RT to dose of 60 to 65 Gy in 1.8 Gy/ 2 Gy per fraction
What Conc Chemo can be given with EBRT for vulvar cancer?
Cisplatin 40 mg/m2 weekly
Cisplatin 50 mg/m2 on D1 and D29 and 5 FU 1000 mg/m2 every 24 hours D1 to D 4 and D29 - 32
where does vulval cancer recur ?
perineal area (53.4%)
Inguinal (18.7%) and
Pelvic ( 5.7 %)
distant (7.9 %)
what are the Prognostic RFs for vulvar cancer?
- LN + (inguinofemoral LN)
- Tumor diameter > 3.5 cm
