3. Relevant
Anatomy
The vulva includes the mons pubis, labia major and
minor, clitoris, vestibule, vestibular bulbs, Bartholin
glands, lesser vestibular glands, Para urethral glands,
and the urethral and vaginal openings.
5. Epidemiology
Of vulvar tumors, approximately 90 percent are
squamous cell carcinoma . Malignant melanoma is the
second most common, but rare histologic subtypes may
also be considered.
6. Riskfactors
Age is a prominent factor and positively correlates with
this cancer.
These cancers are usually described histologically as
basaloid or warty and are linked with human
papillomavirus (HPV).
Herpes simplex virus infection is also linked with vulvar
cancer in several studies .
Chronic immunosuppression can predispose to vulvar
cancer.
Lichen sclerosus is a chronic vulvar infammatory disease
and is related to vulvar cancer development.
7. Diagnosis
Symptoms:
Women with VIN and vulvar cancer commonly present
with pruritus and a visible lesion However, pain,
bleeding, ulceration, or inguinal mass may be other
complaints. Manifestations can persist for weeks or
months before diagnosis, as many patients may be
embarrassed or may not recognize the significance to
their symptoms.
8. Lesion
Evaluation
Lesions may be raised, ulcerated, pigmented, or warty,
but in younger women with multi focal disease, as well-
defined mass is not always present.
For this, colposcopic examination o the vulva, termed
vulvoscopy, can direct biopsy site selection.
9. StagingSystems
The International Federation of Gynecology and
Obstetrics (FIGO) advocates surgical staging of
patients with vulvar cancer that is based on a tumor,
nodal, metastatic ( TNM) calcinations. Thus, staging
involves: (1) primary tumor resection to obtain tumor
dimensions and (2) dissection o superficial and deep
inguinofemoral lymph nodes to evaluate tumor
spread .
10.
11. PROGNOSIS
Overall survival rates of women with squamous cell
carcinoma of the vulva are relatively good.
Apart rom FIGO stage, other important prognostic
factors include lymph node metastasis, lesion size, depth
of invasion, resected-mar-gin status, and lymphatic
vascular space involvement (LVSI).
Of these, lymph node metastasis is the single most
important vulvar cancer predictor.
12.
13. Treatment
Surgery :
For vulvar cancer treatment, surgery is often an integral
part .
Potential procedures, in increasing order of radicality,
include wide local excision (WLE), radical partial
vulvectomy, and rad-ical complete vulvectomy.
16. SentinelLymph
NodeBiopsy
As another less morbid option, selective dissection of a
solitary node or nodes, termed sentinel lymph node
biopsy (SLNB).
Physiologically, the first lymph node to receive tumor
lymphatic drainage is termed the sentinel lymph node .
17.
18. SURVEILLANCE
After completing primary treatment, all patients receive
thorough physical examination, including inguinal lymph
node palpation and pelvic examination.
Vulvoscopy and biopsies are performed if concerning
areas are noted during history or physical examination.
Radiologic imaging and biopsies to diagnose possible
tumor recurrence are performed as indicated.
23. VULVAR
SARCOMA
Sarcoma of the vulva is rare, and leiomyosarcoma,
malignant fibrous histiocytoma, epithelioid sarcoma, and
malignant rhabdoid tumor are the more requently
encountered histologic types .
Of these, leiomyosarcoma appears to be most common .
25. CANCER
METASTATICTO
ThEVULVA
Metastatic tumors make up approximately 8 percent of
all vulvar cancers .
Tumors may extend from primary cancers of the
bladder, urethra, vagina, or rectum. Less proximate
cancers include those from the breast, kidney, lung,
stomach, and gestational choriocarcinoma.
27. Relevant
Anatomy
During embryogenesis, the müllerian ducts fuse caudally
to form the uterovaginal canal The canal’s distal portion
forms the proximal vagina, whereas the distal vagina
arises from the urogenital sinus.
28.
29. Incidence
Vaginal cancer rates increase with age and peak among
women ≥
80 years. The median age at diagnosis is 58
.
Of histologic forms, squamous cell carcinoma accounts
for 70 to 80 percent of all primary vaginal cancer cases.
31. ADENOCARCIN
OMA
Primary adenocarcinoma of the vagina is rare, making
up only 13 percent of all vaginal cancers. Histologic
types include clear cell, endometrioid, mucinous, and
serous carcinoma, and these may arise in endometriosis
foci, in areas of vaginal adenosis, in periurethral glands,
or in wolfan duct rem-nants.
34. Leiomyosarcom
a
This is the most common type of vaginal sarcoma in
adults. However, it makes up no more than 1 percent of
vaginal malignancies, and only 140 cases have been
described in the literature to date.
35.
36. MELANOMA
Primary malignant melanoma in the vagina is rare,
accounting for less than 3 percent of all vaginal cancers.
In women, only 1.6 percent o melanomas are genital
