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FRCR CO2A Clinical Oncology > Vulvar Carcinoma FRCR CO2A > Flashcards

Vulvar Carcinoma FRCR CO2A Flashcards

(52 cards)

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1
Q

what are different subsites of Vulva?

A
  1. Mons Pubis
  2. Labia Majora
  3. Labia Minora
  4. Clitoris’s
  5. Vestibule
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2
Q

what are common malignancies of Vulva?

A

Sq cell carc (>90%)
AC
BCC
Melanoma

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3
Q

what are the RFs a/w vulvar cancer?

A
  1. old age
  2. HPV (16 is predominant) others 33, 18, 45
  3. HPV 6 and 11 : verrucus
  4. smoking
  5. immunocompromised
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4
Q

what are the molecular abnormalities in vulvar cancer?

A

disruption of PTEN and TP53,

TP 53 is inactivated by binding of HPV E6 protein

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5
Q

How does vulvar cancer Spread?

A

locoregional to perineum, urethra, vagina, anus, bladder, rectum or pubic bone

Lymphatic to inguinal, femoral and pelvic nodes

Blood: Lung, Liver and Bone

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6
Q

what % of operable vulvar cancer have inguinal LN

A

30%

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7
Q

How is primary vulvar tumor evaluated?

A

EUA and Biopsy

size, location (distance from midline), fixity, involvement of adjacent structures (urethra, vagina or anal canal)

Cystoscopy
Proctoscopy and cervical smear

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8
Q

How is nodal stations evaluated for vulvar cancer?

A

Examination
USG and FNAC

for full surgical staging, an inguinofemoral groin node dissection or a SNLN biopsy

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9
Q

What is Rx of early stage (I and II) vulvar cancer?

A

stage IA: WLE only, remaining vulva must be normal and 1 cm margin is required

Stage IB to II: Radical vulvectomy and BGND

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10
Q

what is ideal margin in vulvar cancer?

A

15 mm

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11
Q

when is re-excision advised in vulvar cancer post Sx?

A

margin < 10 mm

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12
Q

what’s the % of Local recurrence with margin < 8 mm and > 8 mm?

A

48% Vs 0%

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13
Q

what margin is indication for post op RT in vulvar cancer?

A

< 8 mm

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14
Q

what are the s/Es of BGND?

A
  1. Lymphcele
  2. Lymphedma (47%)
  3. wound breakdown
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15
Q

when should post op RT added post BGND?

A

LN +

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16
Q

what are Rx options for LAVC ? (st III and IVA)

A
  1. Surgery: Radical Vulvectomy and BGND
  2. NART or CRT f/b surgery: for initial inoperable or with aim of sphincter sparing (pelvic exenteration)
  3. Primary RT or CRT : for unfit or very very LAVC
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17
Q

what are the indications for Post op RT in LAVC?

A

margin + or < 8mm

To the nodes if 2 or > 2 LN +

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18
Q

what should be taken in CTV for vulvar cancer post op?

A

Surgical Scar and remaining vulval tissue + LNs (Inguinofemoral nodes and distal ext and int Iliac nodes)

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19
Q

what RT dose is given for Vulval cancer?

A

45 Gy/ 25# followed by surgical removal or boost RT to dose of 60 to 65 Gy in 1.8 Gy/ 2 Gy per fraction

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20
Q

What Conc Chemo can be given with EBRT for vulvar cancer?

A

Cisplatin 40 mg/m2 weekly
Cisplatin 50 mg/m2 on D1 and D29 and 5 FU 1000 mg/m2 every 24 hours D1 to D 4 and D29 - 32

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21
Q

where does vulval cancer recur ?

Study These Flashcards
A

perineal area (53.4%)
Inguinal (18.7%) and
Pelvic ( 5.7 %)
distant (7.9 %)

22
Q

what are the Prognostic RFs for vulvar cancer?

Study These Flashcards
A
  1. LN + (inguinofemoral LN)
  2. Tumor diameter > 3.5 cm
24
Q

What is the annual incidence of new vulval cancer cases in the UK?

Study These Flashcards
A

1022 new cases

25
What age group is predominantly affected by vulval cancer?
Older women, with 80% of cases occurring in those over 60
26
Which HPV types are primarily associated with vulval cancer?
HPV types 16, 18, and 31
27
What percentage of vulval cancers is attributed to HPV?
Approximately 30–50%
28
List some risk factors for vulval cancer.
* HIV * Immunosuppressions * Smoking * Chronic skin conditions (e.g., lichen sclerosus, lichen planus, Paget’s disease)
29
What are the two varieties of intraepithelial neoplasia related to vulval cancer?
* Squamous cell carcinoma-in-situ (Bowen’s disease) * Vulvar intraepithelial neoplasia III
30
What is the most common type of vulval cancer?
Squamous cell carcinoma (90% of cases)
31
What is the incidence of melanoma in vulval cancer cases?
4%
32
How does vulval cancer typically spread?
* Direct extension to adjacent structures * Lymphatic channels to inguinal and femoral groin nodes * Haematogenous spread to distant sites
33
What is the overall incidence of lymph node metastases in vulval cancer?
Approximately 30%
34
What are common clinical features of vulval cancer?
* Itch or irritation * Pain and soreness * Thickened, raised area of discolouration * Ulcer * Vaginal discharge or bleeding * Lump
35
What method is used to diagnose vulval cancer?
Biopsy
36
How is vulval cancer staged?
Using the FIGO classification
37
What is the treatment of choice for early-stage vulval cancer (Stages I and II)?
Surgery involving wide and deep resection (radical local excision)
38
What is the required surgical margin during resection for vulval cancer?
At least 1 cm
39
What postoperative treatment is indicated for certain patients after surgery of Vulval Cancer?
Bilateral pelvic and groin irradiation
40
What are the indications for postoperative bilateral pelvic and groin irradiation in Vulval Cancer?
* One macrometastases (>5 mm) * Two or more micrometastases (≤5 mm) * Extracapsular spread
41
What is the 5-year survival rate for women with locally advanced vulval cancer treated by radical ano-vulvectomy?
62%
42
What is the FIGO Stage I for vulval cancer?
* IA: Lesions ≤2 cm, confined to vulva or perineum with stromal invasion ≤1.0 mm, no nodal metastasis * IB: Lesions >2 cm or with stromal invasion >1.0 mm
43
What characterizes Stage III vulval cancer?
Tumour of any size with or without extension to adjacent perineal structures with positive inguino-femoral lymph nodes
44
What is the prognosis for vulval cancer in the absence of lymph node involvement?
5-year survival is >80%
45
What is a common late complication following treatment for vulval cancer?
Lymphoedema
46
What is the incidence of lymphoedema following groin node dissection?
62–69%
47
What are common complications following radiotherapy for vulval cancer?
* Vulval soreness * Skin blistering * Diarrhoea * Urinary frequency * Formation of fistulae
48
What is the recurrence rate for vulval cancer?
15 to 33%
49
Where are the most common sites of recurrence for vulval cancer?
* Vulva (69.5%) * Groin nodes (24.3%) * Pelvis (15.6%) * Distant metastases (18.5%)
50
How are local vulval recurrences typically managed?
By surgery when possible
51
What treatment is preferred for groin recurrences?
Radiotherapy, with consideration for surgery in previously irradiated patients
52
Management of Vulval Cancer Algorithm

FRCR CO2A Clinical Oncology (35 decks)

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