CC Sept 2015 Vulvar Cancer

echoecho's version from 2016-05-09 03:45


Question Answer
What differential diagnoses should be ruled out for a patient with an area of white color of labial mucosa?1) vulvar intraepithelial neoplasia (VIN) 2) vulvar cancer
What is vulvar intraepithelial neoplasia (VIN)?a premalignant lesions
Describe the VIN lesion color variations? red, brown, gray or pink
What is mandatory to make a diagnosis?biopsy
Vulvar cancer is a rare genital malignancy accounting for ____-____% of total female genital cancer and up to ____% of total female cancers?4-5%; 1%
Vulvar cancer is usually diagnosed in _______(premenopausal vs. post menopausal) women, with a mean age of ____ years? postmenopausal; 65
Recent epidemiologic studies show that the age at dx is _____ (increasing vs. decreasing)decreasing
90% of vulvar cancers are what type of carcinomas?squamous cell carcinoma
*** List the two subtypes?1) HPV infection 2) non-HPV chronic inflammatory states
*** HPV-associated subtypes are linked with _____ (older vs. younger) age at dx and vaginal or cervical intraepithelial neoplasia?younger
What is the cause for the younger age at dx overall in more recent studies?60% of vulvar CAs are of the HPV-associated subtype and HPV infection is so prevalent
What must be considered at the dx of vulvar cancer?presence of synchronous genital HPV-associated lesions/carcinoma
List 3 risk factors associated with both subtypes of vulvar cancer?1) cigarette smoking 2) lichen sclerosis 3) immunodeficiency syndromes
Women of _____ socioeconomic status are dxed later and have higher mortality?lower
List other histopathological subtypes of vulvar cancer?1) malignant melanoma 2) basal cell carcinoma 3) Paget's disease with or without underlying adenocarcinoma 3) Bartholin's gland carcinoma 4) sarcoma
Why is a high index of suspicion required?because vulvar cancer is rare and patients are often asymptomatic or have symptoms (pruritius) associated with other, more common diagnoses
Can symptoms be present for years before the dx is made?yes
List less common symptoms?1) bleeding 2) discharge 3) dyspareunia 4) skin color changes 5) burning sensation 6) groin mass
List physical symptoms?1) unifocal plaque 2) ulcer or mass usually located on the labia majora and less frequently on the labia minora, clitoris, mons pubis and perineum
What may be present at the groin?groin adenopathy
List differential dx?1) vulvar dystrophy (lichen sclerosus) 2) cysts 3) Bartholin gland disorders 4) dermatoses 5) condylomata acuminate 6) infection
*** All pts w/ suspicious complaints and/or lesions should under go what?pelvic evaluation and biopsy of suspicious lesions
*** What should be considered in women with vulvar symptoms or lesions that do not respond to usually appropriate therapy?biopsy
In the case of symptoms where a lesion is not grossly evident, the copious application of what to the tissue and examination with a colposcope or magnifying glass may allow visualization of the lesion, as it will become ______?1) 5% acetic acid 2) acetowhite
In 5% of cases, there maybe _____ lesions, so careful exam is necessary?multifocal
Unfortunately, patients with vulvar CA are often dxed at an advanced stage. Earlier stage dx significantly improves what?prognosis and impacts treatment modalities
Data extrapolated from cervical cancer trials suggest what imaging to assess nodal involvement?PET-CT (positron emission tomography-computed tomography)
Surgical procedure selection depends on what 4 conditions?1) disease stage 2) tumor location 3) co-morbidities 4) patient preference
Staging follows what recommendations?1) American Joint Committee on Cancer (TMN system) 2) International Federation of Gynecology and Obstetrics (FIGO)
Early disease may be treated by what?surgery (with lymphadenectomy or sentinel biopsy) with / without adjuvant treatment depending on histopathological risk factors (tumor size, depth of invasion, lymphovascular invasion)
Surgical approaches are less radical than in the past when what was the standard of treatment?radical vulvectomy
List adjuvant treatment?1) chemoradiation OR 2) radiotherapy
What is the treatment of locally advanced disease?surgery and/or chemoradiation / radiotherapy depending on the patient's status and tumor resectability
Surgery may be offered to patients with what disease?posttreatment residual disease
Treatment is based mostly on what?single institution case series and small population studies
Vulvar pruritis may result from what?poor hygiene, infections (candida vaginitis and bacterial vaginosis) or acute or chronic inflammation
What are the symptoms of candida?erythema and intense pruritus associated with a white vaginal discharge
What may helped with pruritus and is the first-line treatment for lichen sclerosis, but vulvar CA must be ruled out first?topical steroid
What vaginitis is common in hypoestrogenic women and can cause pruritus?atrophic
*** SUMMARY = Vulvar cancer is usually diagnosed in postmenopausal women, with a mean age of ____ years; however, recent epidemiologic studies show that the age of dx is _____?65; decreasing
*** SUMMARY = Why is a high index of suspicion required?1) vulvar CA is rare 2) pts are often asymptomatic 3) may have symptoms (pruritus) associated with other, more common diagnoses
*** SUMMARY = List symptoms of vulvar CA?1) pruritus (most common) 2) dyspareunia 3) bleeding 4) burning sensation 5) mass