Vulva

Question 1

What is the outer part of the female genitals called?

Answer 1

The vulva.

Question 2

What does the vulva include?

Answer 2

The opening of the vagina, labia minora, labia majora, and clitoris.

Question 3

What are the labia majora?

Answer 3

The outer lips of the vulva.

Question 4

What are the labia minora?

Answer 4

The inner lips of the vulva.

Question 5

What is the clitoris?

Answer 5

A part of the female genitals located at the top of the vulva.

Question 6

What is the perineum?

Answer 6

The area between the vulva and the anus.

Question 7

What is the anus?

Answer 7

The opening at the end of the digestive tract.

Question 8

What type of malignancy is vulvar cancer?

Answer 8

Vulvar cancer is an uncommon malignancy.

Question 9

What is the typical age of onset for vulvar cancer?

Answer 9

Vulvar cancer usually occurs in postmenopausal women about 70 years old.

Question 10

What are some risk factors for vulvar cancer?

Answer 10

Risk factors include chronic diseases of the vulva, smoking, history of genital warts, leukoplakia, immune system deficiency, multiple sexual partners, and sexual intercourse at a young age.

Question 11

What is the preferred modality for diagnosis and staging of vulvar cancers?

Answer 11

MRI is the preferred modality for diagnosis and staging of vulvar cancers.

Question 12

Is there any screening for vulvar cancers?

Answer 12

No screening.

Question 13

What staging system is most commonly used for vulvar cancers?

Answer 13

FIGO Staging.

Question 14

What is a common presenting symptom of vulvar cancer?

Answer 14

Palpable mass on the Labia Major

Question 15

What history may be associated with vulvar cancer?

Answer 15

History of pruritus

Question 16

What persistent symptoms may indicate vulvar cancer?

Answer 16

Itching, burning, or bleeding on the vulva that does not go away.

Question 17

What changes in skin color may suggest vulvar cancer?

Answer 17

Changes in the color of the skin of the vulva, so that it looks redder or whiter than is normal for you.

Question 18

What skin changes may be observed in vulvar cancer?

Answer 18

Skin changes in the vulva, including what looks like a rash or warts.

Question 19

What is the most common type of vulvar cancer?

Answer 19

Squamous Cell Carcinoma

90% of vulvar cancer cases are Squamous Cell Carcinoma.

Question 20

What is the most common site for vulvar cancer?

Answer 20

Labia Major

This is where tumors are most frequently located.

Question 21

How do tumors of vulvar cancer typically appear?

Answer 21

Tumors appear raised, ulcerated, and wartlike or leukoplakic.

Question 22

What is the most common route of spread for vulvar cancer?

Answer 22

Direct Extension

Question 23

Which structures can vulvar cancer spread to directly?

Answer 23

Vagina, Urethra, Anus

Question 24

What are the lymphatic routes for vulvar cancer spread?

Answer 24

Superficial inguinal nodes, Deep inguinal nodes

Question 25

How do vulvar cancers spread in relation to lymph nodes?

Answer 25

In an orderly pattern from inguinal lymph nodes to pelvic lymph nodes.

Question 26

Is hematogenous spread common in vulvar cancer?

Answer 26

No, hematogenous spread is rare.

Question 27

What is the primary treatment of vulvar cancer?

Answer 27

Surgery is the treatment of choice (TOC) for vulvar cancer.

Question 28

What are the types of surgical procedures for vulvar cancer?

Answer 28

Local excision, vulvectomy, and bilateral inguinal lymphadenectomy.

Question 29

When can preoperative radiation therapy be considered?

Answer 29

Preoperative radiation can be an option for patients with tumors close to critical structures.

Question 30

What is definitive radiation therapy used for?

Answer 30

Definitive radiation can be used to treat very large tumors, where surgery may not be possible.

Question 31

When is postoperative radiation therapy indicated?

Answer 31

Postoperative radiation can be used for patients with positive nodes in the pelvic or groin region.

Question 32

In what position is the patient treated during radiation therapy?

Answer 32

The patient would be treated in frog-leg position.

Question 33

What is neoadjuvant therapy used for?

Answer 33

Neoadjuvant therapy is used for advanced disease.

Question 34

What is concurrent therapy in the context of vulvar cancer?

Answer 34

Concurrent radiation and chemotherapy can be used in treatment.

Question 35

What is the recommended positioning for radiation therapy in vulvar cancer?

Answer 35

Supine position with legs in frog-leg position. ## Footnote The frog-leg position helps decrease dose to the soft tissues of the thighs.

Question 36

What is the purpose of using bolus in radiation therapy for vulvar cancer?

Answer 36

Bolus is used on the vulva to eliminate cold spots within the treatment area.

Question 37

What technique is used to cover vulva regional lymph nodes?

Answer 37

AP/PA technique is used. ## Footnote The patient is supine and in a frog-legged position with bolus.

Question 38

What is the typical radiation dose for AP/PA technique in vulvar cancer?

Answer 38

50 Gy.

Question 39

What is the purpose of the Electron Boost in vulvar cancer treatment?

Answer 39

Aimed directly at the vulva. ## Footnote The patient may be positioned up on all fours with a dose of 10-20 Gy.

Question 40

What is the advantage of using IMRT in vulvar cancer treatment?

Answer 40

IMRT spares healthy tissues, particularly skin, femoral heads and necks, and bowel, reducing long-term complications.

Question 41

Why is vulvar cancer considered difficult to treat effectively?

Answer 41

This is a difficult cancer to treat effectively.