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(13 cards)
Approximately how many pts are affected by vulvar cancer per yr in the U.S.?
What is the incidence of vulvar cancer in the U.S.?
Vulvar cancer accounts for what % of gyn malignancies?
What % of all malignancies in women are vulvar malignancies?
~ 3,500 pts are affected by vulvar cancer per yr in the U.S. The incidence is 1/ 100,000 people.
Vulvar cancer represents 3%– 5% of all gyn malignancies. This comprises 1%– 2% of all cancers in women.
What are the risk factors for vulvar cancer?
- Increasing age
- HPV
- Vulvar intraepithelial neoplasia (VIN)
- Bowen Dz (squamous cell CIS)
- Paget Dz (lesions arising from Bartholin, urethra, or rectum)
- Smoking
- Immune deficiency
- Lichen sclerosis
What HPV subtypes associated with vulvar cancer
What is the function of HPV-associated oncoproteins?
- 6, 16, 18, and 33.
- It is thought that HPV-associated oncoproteins bind and inactivate tumor suppressor proteins such as Rb, p53, and p21.
What are the 7 subsites of the vulva? Subsites of the vulva:
- Labia majora
- Labia minora
- Mons pubis
- Clitoris
- Vaginal vestibule
- Perineal body
- Posterior fourchette
What are the most common presenting Sx of pts with vulvar cancer?
pruritus, vulvar discomfort or pain, dysuria, oozing, or bleeding.
In which subsites does vulvar cancer most commonly arise?
70% of vulvar cancers arise from the labia majora/ minora.
How is “locally advanced” vulvar cancer defined
What percentage are locally advanced
- vulvar tumor burden that cannot be resected without exenterative surgery.
- 30% are locally advanced at dx
What are the 1st-, 2nd-, and 3rd-echelon LN regions in vulvar cancer, and which subsite is associated with skip nodal mets?
- 1st echelon: superficial inguinofemoral
- 2nd echelon: deep inguinofemoral and femoral
- 3rd echelon: external iliac nodes
- The clitoris can drain directly to the deep inguinofemoral or pelvic nodes.
What are the 2 strongest predictors of LN involvement in vulvar cancer?
- Tumor Grade
- DOI
Estimate the risk of inguinal LN involvement based on the DOI of a cervical tumor: < 1 mm, 1– 3 mm, 3– 5 mm, and > 5 mm. L (Hacker NF et al., Cancer 1993)
- DOI: ≤ 1 mm: < 5%
- 1– 3 mm: 8%
- 3– 5 mm: 27%
- 5 mm: 34%
Estimate the risk of inguinal LN involvement based on the vulvar cancer FIGO stage.
- Stage I: 17%
- Stage II: 40%
- Stage III: 30%– 80%
- Stage IV: 80%– 100%
What histology constitutes the vast majority of vulvar cancers? Name 3 other histologies of tumors found on the vulva.
- squamous cell carcinoma (80%– 90%).
- Other histologies include melanoma, basal cell, Merkel cell, sarcoma, and adenocarcinomas of the Bartholin glands.
What % of vulvar cancers are multifocal?
- 5%
