68 Vulvar Cancer

arunmp's version from 2016-12-15 13:55


Question Answer
Vulvar cancer is ---% of all malignancies1-2%
Vulvar cancer is ---% of all gynec malignancies3-4%
HPV subtypes associated with vulvar cancer6,16, 18, and 33
HPV-associated oncoproteins bind and inactivate tumor suppressor proteins such asRb, p53, and p21
70% of vulvar cancers arise from thelabia majora/ minora
Locally advanced vulvar cancer is defined asa vulvar tumor burden that cannot be resected without exenterative surgery.
% of vulvar cancers are locally advanced at Dx30
50 Gy to the femoral neck is associated with an --- risk of fracture at 5 yrs.11%


Question Answer
1st echelonsuperficial inguinofemoral
2nd echelondeep inguinofemoral and femoral
3rd echelonexternal iliac nodes
skip mets common forclitoris
clitoris can drain directly to the deep inguinofemoral or pelvic nodes
2 strongest predictors of LN involvement in vulvar cancer aretumor grade and DOI.
% of vulvar cancers are multifocal5%

depth of invasion and % of LN mets

Question Answer
≤1 mm doi<5%
1–3 mm doi8%
3–5 mm doi27%
5 mm doi34%
Stage I17%
Stage II40%
Stage III30%–80%
Stage IV80%–100%

staging and workup

Question Answer
Test in vulvar which u might missEUA,DRE to r/o multifocal Dz
Biopsy approach for small (<1 cm) vulvar lesionsexcisional Bx with a 1-cm margin, including the skin, dermis, and connective tissue
Bx approach for large (>1 cm)Wedge Bx from the edge of the lesion to include the interface between normal skin and the tumor
In vulvar cancer, all pts with clinically suspicious nodes requirebilat inguinal LND
Which pts with vulvar cancer do not require inguinal LND?clinicaly no nodes and DOI<1mm +No LVI +Low grade
Which patients can have sentinel lymph node dissection (SLD) for nodal evaluation?Patient with low-risk disease( clinically node–,unifocal T1/T2 disease)
study that evaluated safety of SLD in early stage vulvar cancerGROINSS-V(Groningen International Study on Sentinel Nodes in Vulvar Cancer) study
study that assessed sensitivity of SLDGynecologic Oncology Group’s GOG 173 study (Sensitivity of SLD was 91.7%. In tumors <4 cm,the false– rate was 2%).
staging system for vulvar cancer surgical or clinical?surgical(Imaging results are not included in FIGO staging)

FIGO(2008) staging for vulvar cancer upto stage III and its treatment

Question Answer
Stage IAlesion ≤2 cm, confined to vulva or perineum with stromal invasion <1 mm, no nodal mets
Stage IBlesion >2 cm or with stromal invasion >1 mm, confined to vulva or perineum, no nodal mets
Stage IIlesion of any size with extension to adjacent structures (lower 3rd of urethra, lower 3rd of vagina or anus), no nodal mets


Question Answer
Tx for vulvar CIS or VIN?superficial local excision
How primary of a pt with FIGO stage I or II vulvar cancer be treated?WLE, which includes resection of the tumor + a gross 1.0-cm margin of normal tissue around it.(In a pt with stage I or II vulvar cancer, radical vulvectomy and WLE have similar recurrence rates (~7%)
if margins are positive following surgical resection of vulvar cancerreexcison OR ADJ RT

How inguinal nodes treated in vulvar cancer stage IA? Stage IB? Stage II?

Question Answer
Stage IAlymph node evaluation is not necessary (consider for high-grade lesions).
Stage IBif the lesion is well lateralized, consider unilat dissection. If there is a midline lesion, then bilat groin nodal dissection is required. SLD forpatients with tumor size <4 cm. GROINSS-V II is evaluating the role for adjuvant RT in patients with SLD+ groin.
Stage IIBilat LND is recommended


Question Answer
Tx approach for pts with stages III–IV vulvar cancer?1. Surgery (if –margins can be achieved) + PORT (2). Neoadj CRT (phase II) → surgery for thoseinitially unresectable (3). Definitive CRT
What studies support neoadj CRT in initially unresectable vulvar cancer?GOG 101 (a phase II study) cisplatin/5-FU + RT 47.6 Gy. 97% of pts were converted to resectable Dz.


5-yr estimated OS by FIGO stage:
Question Answer
Stage I90%
Stage II81%
Stage III68%
Stage IV20%