Cancer of The Vulva. By Dr Emdalala Elasheg. Introduction Vulval cancer is uncommon and accounts for approximately 1-4% of all gynecological cancer
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By Dr Emdalala Elasheg
Little is known
Most commonly the primary lesion is from the cervix or the endometrium .
The lymph nodes are arranged in 5 groups in each groin:
1- Inguinal L.N: Medial I.L.N ,lying inferior to S.I.ring.
Lateral I.L.N ,below the inguinal ligament.
2-Femoral L.N: Medical F.L.N,lying medical to saph.vein
Lateral F.L.N, lying lateral to saph .vein
Medial groups ,lying medial to EIV
Lateral groups,lying lateral to EIA
Anterior groups ,lying between EIV and EIA
Common Iliac Nodes
Para Aortic L.N
Most patients with invasive disease complain of:
The major problem in invasive vulvar cancer is delay between the first appearance of the symptoms and referral to the gynecological opinion due to :
diagnosis is made on histology from full thickness generous biopsy.
FIGO suggest clinical staging in 1969 based on TNM (Tumor node metastasis) classification taking into consideration:
as the involvement of groin nodes is missed on clinical examination in up to
30% of cases and over diagnosis in 5%.
The overall 5 years survival rate for vulval cancer is 70% for all operable cases,
This depends on:
A-invasion of 1 mm no risk of nodal metastases.
B-invasion of 1-3 mm 6-8% incidence of metastases.
C-invasion of 5 mm 22-37% incidence of metastases.
Surgical excision margin of more than 1 cm in all diameters results in a low local recurrence rate.
PND (pelvic node dissection)PNR(pelvic node radiation)
Survival rate 2 years 55% significant improvement of
survival rate of 2 years 70%