Term
| What percentage of women with VIN (vulvar intraepithelial neoplasm) are postivie for HPV? |
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Definition
| 90% (more common in young women) |
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Term
| Name three risk factors for VIN |
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Definition
1. Viral - mostly HPV, but also HIV
2. Smoking
3. Other gential cancers or premalignancies |
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Term
| What is the most common symptom of VIN? |
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Definition
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Term
| What is the preferred treatment of a small focus of VIN? |
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Definition
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Term
| What is the typical presentation of extramammary Paget's disease? |
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Definition
| A lesion with hyperemic areas associated with a superficial white coating described as "cake icing". |
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Term
| What percentage of patients with extramammary Paget's disease have an underlying adenocarcinoma or synchronus (distant site) primary neoplasm? |
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Definition
<20% have an underlying adenocarcinoma
20-30% have a synchronous primary |
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Term
| What is the treatment of extramammary Paget's disease? |
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Definition
| Wide local excision. Histology must confirm clean margins, which may extend beyond visible lesion. Complete vulvectomy often required. |
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Term
| What is the most common cancer of the vulva? |
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Definition
| Squamous cell carcinoma (90%) |
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Term
| Name five risk factors for vulvar cancer |
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Definition
1. Smoking
2. Immunodeficiency syndromes
3. HPV
4. Cervical dysplasia or cancer
5. Chronic vulvar irritation due to: diabetes, granulomatous venereal disease or vulvar atrophy |
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Term
| What is the key factor in determining invasiveness of vulvar cancer? |
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Definition
| Depth of stromal penetration (over or under 1mm) |
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Term
| What is the second most common vulvar cancer? |
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Definition
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Term
| What percentage of vulvar cancer patients are asymptomatic? |
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Definition
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Term
| Define stage I vulvar cancer |
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Definition
Tumor is confined to vulva and/or perineum
IA - tumor ≤2cm in all dimensions, ≤1mm stromal invasion
IB - tumor >2cm in any dimension, >1mm stromal invasion |
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Term
| Define stage II vulvar cancer |
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Definition
| Tumor spread to the lower 1/3 of vagina or urethra, or the anus |
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Term
| Define stage III vulvar cancer |
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Definition
Lymph node involvement:
IIIA - 1-2 nodes ≤5mm or one node >5mm
IIIB - ≥3 nodes of any size, or ≥2 nodes >5mm
IIIC - lymph node with extranodal involvement |
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Term
| Define stage IV vulvar cancer |
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Definition
IVA - tumor extends to upper/proximal 2/3 of vagina or urethra, bladder or rectal mucosa, fixed to pelvic bone, fixed or ulcerated regional lymph node
IVB - distant metastasis |
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Term
| What are the four indications for bilateral inguinal femoral lymphadenectomy in vulvar cancer? |
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Definition
1. Stage II disease
2. Multiple lesions
3. Lesions crossing midline
4. Positive lymph nodes discovered on one side |
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Term
| What are the indications for adjuvant radiotherapy in vulvar cancer? (At least 4) |
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Definition
Any macroscopically involved or ≥2 microscopically involved lymph nodes
Also considered in patients with tumors >4cm, positive or close margins, lymphovascular invasion |
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Term
| What is the recommeded treatment of VAIN (vaginal intraepithelial neoplasm)? |
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Definition
VAIN I - usually regresses
VAIN II or III - surgical excision or CO2 laser ablation |
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Term
| What is the most common vaginal cancer? |
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Definition
| Secondary vaginal carcinoma - extension of cervical cancer to the vagina |
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Term
| Define stage II vaginal cancer |
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Definition
| Tumor has involved subvaginal tissue without extending to the pelvic wall |
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Term
| Define stage III vaginal cancer |
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Definition
| Tumor has extended to pelvic wall |
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Term
| What is the appropriate treatment of stage I vaginal cancer? |
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Definition
Radical hysterectomy with upper vaginectomy and bilateral lymphadenectomy
(Obviously only for stage I lesions in the upper vagina) |
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Term
| What is the non-surgical treatment of local vaginal cancer? |
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Definition
| Primary radiotherapy: brachytherapy for small lesions, external beam for larger lesions |
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Term
| What are the 5-year survival rates for each stage of vaginal cancer? |
|
Definition
Stage I - 77%
Stage II - 45%
Stage III - 31%
Stage IV - 18% |
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