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Skin Radiation therapy > Vulvar cancer > Flashcards

Vulvar cancer Flashcards

(44 cards)

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1
Q

is vulvar cancer common or uncommon

A

its rare

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2
Q

risk for vulvar cancer

A

Associated w/ HPV 16 & 18
Previous CIN or invasive cervical cancer (increase risk by 10x)
STIs like herpes and HIV
Immunosuppression groups after renal transplant (100 fold increase in risk)
Smoking
Multiple sexual partners
Sex at a young age

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3
Q

parts of the vulva

A

labia, clitoris, urethral and vaginal openings

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4
Q

site of distant mets

A

lung

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5
Q

natural history of vulvar cancer

A

Local invasion to surrounding soft tissues and pubic bone

Distant mets to lungs

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6
Q

most common age for vulvar cancer

A

most common in women >70y.o.

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7
Q

disease progression of vulvar cancer

A

most start out as VIN (Vulvar intraepithelial neoplasia) and progress to SCC

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8
Q

Most vulvar cancer are diagnosed in ____stage. Why?

A

early stages, this is because the disease is palpable in early stages, however 35% are still diagnosed late

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9
Q

most common parts of the vulva for vulvar cancer

A

most commonly in labia minor and labia majora

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10
Q

most common risk factor in younger its

A

HPV infections

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11
Q

most common risk factor in older patients

A

chronic vulvar inflammation or lichen sclerosis (patchy white skin that appears thinner than normal in the gene area)

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12
Q

S&S of vulvar cancer

A 
No symptoms in the VIN stage 
palpable mass
history of pruritis 
painful urination 
bleeding vaginally
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13
Q

most common spread

A

Most common spread is through direct extension to adjacent LN and organs

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14
Q

LN spread in vulvar cancer

A

SUPERFICIAL inguinal LN —Pelvic LN

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15
Q

Diagnosis of vulvar cancer

A

Physical exam and local biopsy

FNA used for more advanced local disease

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16
Q

most common pathology of vulvar cancer

A

SCC

Other pathologies: BCC, melanoma, Sarcoma

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17
Q

Staging of vulvar cancer

A

FIGO and TNM can be used
TNM-
TNM:
T1: Confined to the vulva =/< 2cm in diameter
T2: Confined to the vulva > 2cm in diameter
T3: Involves the urethra, vagina, perineum or anus
T4: Invades rectal or bladder mucosa, urethral mucosa or bone
N1: Mobile l/n in groin- not clinically suspicious
N2: Mobile l/n in groin- clinically suspicious
N3: Fixed or ulcerated l/n
M1: Distant mets
Staging:
Stage I: T1
Stage II: T2
Stage III: T3 or N1
Stage IV: T4, N2 or M1

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18
Q

surgery in vulvar cancer

Study These Flashcards
A

Surgery is the primary tx
Radical local excision is preferred to a radical vulvectomy as there is a lower mortality rate
Stage I: Radical local excision
Stage II & III: Radical vulvectomy & bilateral groin dissection b/c of increased risk of l/n involvement

19
Q

use of chemo in vulvar cancer and timing

Study These Flashcards
A

used concurrently with XRT

Is used with advanced, recurrent or inoperable disease

20
Q

chemo agents for vulvar cancer

Study These Flashcards
A

5FU and cispltinum

21
Q

indications for XRT in vulvar cancer

Study These Flashcards
A

Post op XRT is used for pts with 2+ nodal mets
preop xrt can be used for pts with tumours close to critical structures
XRT can be used for very large tumours where surgery is not an option
palliation

22
Q

CT scanning limits

Study These Flashcards
A

canning Limits:
Sup Border – L3/L4
Inf Border – 5cm inf from ischial tuberosities

23
Q

phases for AP/PA POP

Study These Flashcards
A

Phase I: AP/PA photons w/ a dose of 45-50Gy at 160-180cGy/fraction
Phase II: Electron boost to the groin bringing dose to 60-65Gy
Phase III: Electron boost to positive l/n bringing dose to 65-70Gy

24
Q

field borders for large vulvar cancer

Study These Flashcards
A 
Sup= Top of L4
Inf= Cover vulva to allow fall off
Lat= ASIS to cover inguinofemoral l/n
25
field borders for small vulvar cancer
Sup=Above pubis Inf= Cover vulva to allow fall off Lat= 3cm on each side of the lesion
26
patient positioning for photon vs electron tx
photon- pt in typical gyne set-up: FDLI, pillow hands on chest holding ring electron- pt should be in stirrups - lithotomy position
27
treatment considerations for vulvar cancer
patients may require a 3-4 week break if they get moist desquamation patients should have bolus if the skin is involved
28
most important prognostic factor for vulvar cancer
inguinal + =worse prognosis therefore LN involvement is most important
29
stage 1 treatment
Radical local excision which may be followed by XRT if there are positive margins or l/n involvement
30
stage 2 and 3 treatment
Radical vulvectomy
31
lymphatics of the labia perineum and prepuce
superficial inguinal- femoral- pelvic (external and common iliac)
32
drainage of the glans clitoris
inguinal and deep femoral LN but can also bypass the femoral nodes and go from the inguinal LN to the external iliac nodes
33
Vulvar LN spread typically
typically follows a predictable route | superficial inguinofemoral LN,--deep inguinofemoral LN---contralateral inguinal and pelvic LN involvement is rare
34
most common sites of distant mets
lung liver and bone, but mets is uncommon
35
pre invasive vukvar cancers
carcinoma in situ ( Bowen's disease) erythoplasia of Queyrat and Paget's disease (like the precancerous breast lesion of the nipple)
36
2 subtypes of SCC of the vulva
SCC is the most common type, subtypes are: adenosquamous and basaxoid carcinoma
37
XRT dose for LN- vulvar cancer, - margins and + margins
if the patient has a simple vulvectomy: 50Gy with 6-18Mv and bolus if the patient has wide local excision - margins 50Gy with 6-18MV and perineal electron boost bringing the excision site to a dose of 60Gy if there is + margins after 60Gy boost to + margins or +LN (5Gy) with electrons
38
indications for post op XRT in stage 3 vulvar cancer and dose
primary tumour >4cm + surgical margins 3 or more +LN DOSE: 50Gy to vulva and inguinal areas, boost to + margins (10-15Gy) via perineal portal or interstitial implant boost to inguinal LN via AP field (10-15Gy)
39
treatment for stage 4 vulvar cancer
pelvic exenteration which is the removal of all organs in the pelvic cavity first neoadjuvant XRT to 45Gy is given to pelvis and inguinal areas with radical vulvectomy and complete inguinal LN dissection Post op boost of 10-15Gy is given with interstitial intracavitiary or electrons if the patient has palpable LN
40
treatment of its with + LN
patients with + LN can benefit from prep XRT 45-50gY OR XRT +chemo XRT is better than Sx for LN + patients
41
dose for patients with palpable LN
for palpable inguinal LN the dose should be 65-70Gy
42
postion for simulation
frog leg position knees apart feet together
43
when is preop XRT used
for patients with advanced primary lesions involving surrounding structures which are unresectable (45-50Gy for 5-6 weeks should be used)
44
treatment after recurrence
- could be treated with surgery | - for prior surgery extensive XRT of 65-70Gy is used`

Skin Radiation therapy (40 decks)

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