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Vulvar Vulvar Cancer Cancer
Women’s Hospital,School of MedicineWomen’s Hospital,School of Medicine Zhejiang UniversityZhejiang University
General ConsiderationsGeneral Considerations
Vulvar cancer is uncommonVulvar cancer is uncommon
USA:3,800 new cases and 800 deaths annuallyUSA:3,800 new cases and 800 deaths annually Representing 3%-5% of malignancies of the female Representing 3%-5% of malignancies of the female
genital tractgenital tract
The peak incidence of onset is in the age 60-80 yearsThe peak incidence of onset is in the age 60-80 years
Recently, the incidence appears to be increasing Recently, the incidence appears to be increasing
EtiologyEtiology
unknown unknown Associated factorsAssociated factors
HPV
STDSTD
Chronic vulvar dystrophyChronic vulvar dystrophy
PathologyPathology
Histological typeHistological type
squamous cell squamous cell carcinomacarcinomamelanomamelanomasarcomasarcomabasal cellbasal celladenocarcinomaadenocarcinomabartholin glandbartholin gland squamous squamous adenocarcinomaadenocarcinomaundifferentiatedundifferentiated
Main focusMain focus Changes around focusChanges around focus :: skin incrassation, skin incrassation,
increased or decreased increased or decreased pigmentationpigmentation
PathologyPathology
Clinical manifestationClinical manifestation
symptomssymptoms vuval pruritusvuval pruritus massmass advanced stage advanced stage
featurefeature signsign
Tumor focusTumor focus positive lymph nodes positive lymph nodes
Vulvar cancer spreads by the following Vulvar cancer spreads by the following routesroutes ::
Direct extension,to involve adjacent Direct extension,to involve adjacent structures such as the vagina,urethra,and structures such as the vagina,urethra,and anusanus
Lymphatic embolization to the regional Lymphatic embolization to the regional inguinal and femoral lymph nodesinguinal and femoral lymph nodes
Hematogenous spread to distant Hematogenous spread to distant sites,including the lungs,liver,and bonesites,including the lungs,liver,and bone
Routes of SpreadRoutes of Spread
History & symptomsHistory & symptoms signsign Assistant examinationsAssistant examinations
histologyhistology
cytologycytology
imageimage
cystoscopycystoscopy
proctoscopyproctoscopy
DiagnosisDiagnosis
Staging(FIGO,2009)Staging(FIGO,2009)
Treatment Treatment (( 11 ))
Principle: Principle:
surgerysurgery
combined with combined with
radiotherapy ,chemotherapy radiotherapy ,chemotherapy
Treatment Treatment (( 22 )) Early stageEarly stage :: individualindividual ,, conservative surgery conservative surgery
when good prognosis was ensured when good prognosis was ensured
advanced stage advanced stage combined therapycombined therapy ,, improve improve
survivalsurvival
Treatment Treatment (( 33 ))SOGC Clinical Practice SOGC Clinical Practice
GuidelinesGuidelines
Radical vulvectomy
Treatment Treatment (( 44 ))radiotherapyradiotherapy sensitivesensitive :: squamous squamous
acanecracanecr Side effects of irradiation Side effects of irradiation
to vulvato vulva indicationindication
radiotherapy prior to radiotherapy prior to surgerysurgery
adjuvant radiotherapyadjuvant radiotherapy after surgery
residual or relapse tumorresidual or relapse tumor
Treatment Treatment (( 55 ))chemotherapychemotherapy Advanced Advanced
stage, relapsestage, relapse drugs drugs
DDP DDP ,, CPCP BLMBLM 5-Fu5-Fu ADMADM
Outcome and Prognosis Overall survival for patients with vulvar
carcinoma is excellent, especially in those with early-stage disease. Experience with modern treatment from the Mayo clinic shows that the overall survival rate for women with vulvar carcinoma is 75%, compared to an 89% actuarial survival rate for age-matched controls. The 5-year survival rates after surgery for vulvar cancer are as follows:
Stage I - 90% Stage II - 81% Stage III - 68% Stage IV - 20%
Follow-upFollow-up
Prognostic factorsPrognostic factors :: Lymph metastasisLymph metastasis Invasive Depth Invasive Depth Tumor sizeTumor size LocationLocation StageStage TreatmentTreatment
Follow-upFollow-up
Follow-upFollow-up
Year 1Year 1 : : 1-2 monthly1-2 monthly Year 2Year 2 : : 3 monthly3 monthly Year 3-5Year 3-5 : : 6 monthly6 monthly Year 6-Year 6- : : 1212 monthlymonthly
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