Carcinoma Vulva

    • Carcinoma of Vulva
      • Most often found in women age 60–70.(MCQ)
      • Unlike the cervix, the vulva does not have a transformation zone. .(MCQ)
      • Vulvar intraepithelial lesions are less likely than cervical intraepithelial
      • lesions to become high grade or cancers.
      • can arise as carcinoma of various types:
        • Squamous (90%)..(MCQ)
        • Adenocarcinoma (Paget disease, Bartholin’s gland).
        • Basal cell carcinoma. , Melanoma (4–5%).
        • Metastasis. Sarcoma. Verrucous carcinoma.
      • Signs and symptoms
        • Pruritus (most common). .(MCQ)
        • Ulceration.
        • Mass (often exophytic).
        • Bleeding.
      • Risk factors
        • Postmenopausal. .(MCQ)
        • Smoking.
        • Immunodeficiency syndromes.
        • Age
        • HPV ,VIN ,HIV
        • Vulvar skin disease (dystrophy)
        • Melanoma,Atypical moles
      • Diagnosis
        • Biopsy of the suspicious lesion.
      • Vulvar Cancer Staging, FIGO Revised.(MCQ)
        • Stage I: Tumor confined to the vulva
          • IA:
            • Lesions < 2 cm in size.(MCQ)
            • confined to the vulva or perineum
            • stromal invasion < 1.0 mm. .(MCQ)
            • No nodal invasion
          • IB:
            • Lesions > 2 cm in size or with stromal invasion > 1.0 mm
            • confined to the vulva or perineum.
            • No nodal metastasis
        • Stage II:
          • Tumor of any size with extension to adjacent perineal structures (1/3-  lower urethra ,1/3-  lower vagina, anus) with negative nodes
        • STAGE III: Tumor of any size with or without extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with positive inguino-femoral lymph node
          • IIIA
            • With lymph node metastasis (> 5 mm) .(MCQ)
            • 1–2 lymph node metastasis(es) (< 5 mm), .(MCQ)
          • IIIB:
            • With 2 or more lymph node metastases (> 5 mm)
            • 3 or more lymph node metastases (< 5 mm)
          • IIIC:
            • With positive nodes with extracapsular spread
        • STAGE IV:
          • Tumor invades other regional (2/3 upper urethra, 2/3 upper vagina), or distant structures
            • IVA : Tumor invades any of the following:
              • upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to pelvic bone, or  fixed or ulcerated inguino-femoral lymph nodes
              • IVB:
                • Any distant metastasis including pelvic lymph nodes
        • Treatment
          • Stages I–II:
            • Radical vulvectomy and lymphadenectomy (wide local excision is sometimes possible for certain small lesions < 1 cm). .(MCQ)
          • Stages III–IV:
            • As above, plus removal of affected organs and adjunct r diation therapy
        • Clinical Pearls for MD Entrance
          • Remember that a dark- pigmented lesion could be a melanoma, even in the vulvar region.
          • Most common site of vulvar dysplasia is labia majora. .(MCQ)
          • Pruritus is the most common symptom of vulvar cancer. .(MCQ)
          • Always biopsy itchy, white lesions on exam.
          • Most common vulvar cancer is squamous cell. .(MCQ)

        Cancer of the Vulva
        understanding cancer of the vulva, the causes, symptoms, anatomy, stages, treatment and outcomes
        Carcinoma Verrugoso de la vulva- Dra Teresita Audisio (Cordoba-Argentina)
        64 años – Tumoración de aparición rápida, de crecimiento exofitico de apariencia papilomatosa granular, marcadamente hiperqueratótico, ausencia de vasos; compromete y reemplaza ambos labios menores y clitoris. Ausencia de adenopatias regionales. La biopsia, demostró un Carcinoma Escamoso altamente diferenciado compatible con Carcinoma Verrugoso.

        vulvar cancer
        vulvar cancer,
        vulvar cancer
        Carcinoma Condilomatoso de la vulva – Dra Teresita Audisio (Cordoba-Argentina)
        55 años- Inmunodeficiencia – Tumoración de vulva de crecimiento rapido de 6 meses de evolución. Se observa tumor que reemplaza labios menores y clitoris. Presenta superficie irregular de aspecto papilar , con vasos y espículas , blanquesino por la hiperqueratosis. Adenopatias inguinales bilaterales. El estudio histopatologico demostró un Carcinoma Condilomatoso (Warty Carcinoma)
        Carcinoma escamoso queratinizante de vulva –