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22 Cards in this Set
- Front
- Back
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What is the staging for squamous cell cancer of the vulva?
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Carcinoma of the Vulva
IA Tumor confined to the vulva or perineum, ≤ 2cm in size with stromal invasion ≤ 1mm, negative nodes IB Tumor confined to the vulva or perineum, > 2cm in size or with stromal invasion > 1mm, negative nodes II Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes IIIA Tumor of any size with positive inguino-femoral lymph nodes (i) 1 lymph node metastasis greater than or equal to 5 mm (ii) 1-2 lymph node metastasis(es) of less than 5 mm IIIB (i) 2 or more lymph nodes metastases greater than or equal to 5 mm (ii) 3 or more lymph nodes metastases less than 5 mm IIIC Positive node(s) with extracapsular spread IVA (i) Tumor invades other regional structures (2/3 upper urethra, 2/3 upper vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone (ii) Fixed or ulcerated inguino-femoral lymph nodes IVB Any distant |
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what is the definition of a IA lesion and how is it managed?
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IA vulvar lesion is <2 cm in size and <1mm in depth (stromal invasion)
can be managed with radical local tumour excision without inguino-femoral node dissection |
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what is a stage IB unilateral lesion and how is it treated?
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IB lesion - <2 cm, but >1 mm stromal invasion and >1cm from the midline
treated with radical wide local excision - with inguinal LN dissection (ipsilateral |
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what is the treatment if you have a lesion that is close to the midline (<1 cm from midline?)
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you will have to do a bilateral LN dissection because of the way that the lymphatics spread
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how do you define micro-invasive vulvar cancer?
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squamous cell carcinoma <2 cm in diameter with a depth of <1 mm (basically IA stage lesions)
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how do you measure the depth of invasion?
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the deepest point of invasion is measured from the epithelial stromal junction of the most superficial dermal papilla
Remember this is different from the DEPTH of tumour |
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what characteristics of lesions are at almost NO risk for nodal metastasis?
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lesions with <1mm of invasion an no LVSI
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what is the tumour free margin that you want to have?
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1-2 cm depending on what you can get and the anatomical site
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what were some of the issues that were associated with en bloc radical vulvectomy and inguinal lymph node dissection?
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cellulitis
wound breakdown chronic lymphedema impact on body image and sexual function |
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what do them mean by bridge recurrence?
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There was a concern that the bridge of tissue between the inguinal nodes and the vulva - if left (and not taken like the previous en bloc resection) there would be a risk for recurrence
not borne out in studies |
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what does it mean to do a 'radical dissection'?
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meaning to remove the root of all disease - so dissection is usually taken down to the fascia of the organ or in vulva to the pubic symphysis
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what is the incidence of contralateral lymph node positive status in stage IA disease?
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0.4% (2/476 patients) -so ipsilateral LN dissection is okay
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what has been the benefit of doing 2 different incision for radical vulvectomy and LN dissection?
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there is only 20% risk of chronic lymphedema compared to 35-65%
hospital stay has decreased |
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what does sentinal node mean in the setting of carcinoma?
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first node in the lymphatic basin the receives primary lymphatic drainage
the idea is that if the sentinal node is negative, then the remaining nodes are negative and a LN dissection is not required |
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how is the sentinal node procedure carried out?
is this standard of care? |
1. peritumoral intradermal injection of of isosulfan or patent blue dye
can also inject T99m labeled sulfur colloid groin nodes are then dissected and gamma counting is done, then frozen section with IHC staining and multiple sectioning to look for invasion currently, now standard of care as there is more data coming out about false negatives and we need to ensure safety |
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how is vulvar cancer staged?
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surgically
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what do you do if you have clinically suspicious LN in vulvar cancer?
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You should perform en bloc dissection because of the increased risk of bridge recurrence
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in what circumstanced where PELVIC NODE metastasis present?
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clinically suspicious groin nodes
3 or more positive groin nodes |
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at what point was pelvic +groin radiation more effective than pelvic lymphadenectomy?
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when there were 2 or more positive groin nodes
no difference with 1 positive node |
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what characteristics of the groin node metastasis have higher negative predictive value for survival?
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extracapsular tumour cells
node size greater than 15 mm berek and hacker mention that node size > 10 mm have poor outcome |
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in what setting should you use adjunctive (pelvic and groin) radiotherapy for vulvar cancer??
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- 3 or more micrometastasis in the inguinal nodes
-1 micrometastasis >10 mm in diameter -any evidence of extracapsular spread -bilateral microscopic groin node metastasis |
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what is the best management option for advanced vulvar cancer?
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radiation therapy +/ - chemotherapy followed by surgical resection
previously people would be facing exanteration (anterior or posterior or both) but with radiation sometimes it cam be avoided can operate 6 weeks after completion of radiation therapy |
