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CARCINOMA VULVA.

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Presentation on theme: "CARCINOMA VULVA."— Presentation transcript:

1 CARCINOMA VULVA

2 Vulva - Anatomy Mons pubis Labia majora Labia minora Clitoris Vestibule Perineum Bartholin gland Vestibular gland

3 Incidence 4-5% of the genital tract malignancies Post-menopausal women
Highest between years

4 ETIOLOGY Still unknown, but certain associated etiological factors:
Human Papilloma virus ( 16,18,31) Herpes Simplex Type II virus Carcinoma cervix (20-50%) Immune suppression

5 ETIOLOGY Lower socioeconomic class Poor hygiene Smoking
Contd. ETIOLOGY Lower socioeconomic class Poor hygiene Smoking Chronic granulomatous venereal lesions Diabetes Mellitus Hypertension & arteriosclerosis Obesity

6 Lichen sclerosis pre-cancerous

7

8 CLINICAL FEATURES Asymptomatic 20% Pruritus vulvae 71% Vulvar mass 58%
Ulceration % Bleeding % Vulvar pain % Urinary tract symptoms 14% Discharge %

9 SITE Labia Majora 75% Clitoris Labia Minora Posterior Fourchette Less
common

10 Advanced squamous cell carcinoma

11 SITE

12 ROUTES OF SPREAD Local Lymphatic Vagina Superficial inguinal Perineum
Anal canal Urethra Bone Lymphatic Superficial inguinal Deep inguinal Pelvic nodes

13 Lymphatic drainage

14 PATHOLOGY Squamous cell 90% Melanoma 5-10% Basal cell carcinoma 2%
Adenocarcinoma 1%

15 FIGO staging (1995) Stage I Stage Ia Stage Ib Stage II
Tumour confined to the vulva or perineum , 2 cm or < in greater dimension. No nodal metastasis Stage Ia Less than 1mm stromal invasion Stage Ib >1 mm stromal invasion Stage II Tumour confined to the vulva or perineum or both more than 2 cm in greatest dimension. No nodal metastasis

16 FIGO staging (1995) Stage III Stage IVa Stage IVb
Extends beyond the vulva, vagina, lower urethra or anus; or unilateral regional lymph node metastasis Stage IVa Involves the mucosa of rectum or bladder; upper urethra; or pelvic bone; and / or bilateral regional lymph node metastasis Stage IVb Any distant metastasis, including pelvic lymph node

17 DIAGNOSIS History Examination Biopsy

18 Histological Classification
Squamous carcinoma in situ (VIN III)     Paget's disease     Invasive Squamous cell carcinoma  Basal cell  Malignant melanoma  Adenocarcinoma (Bartholin's gland or Skene's gland)

19 Pathology VIN Invasive VIN

20 Squamous cell carcinoma
Pathology Basal and Squamous cell ca Squamous cell carcinoma

21 Histopathology VIN

22 Histopathology

23 Histopathology Paget’s disease

24 MANAGEMENT MAINSTAY OF TREATMENT IS SURGERY HEMIVULVECTOMY
RADICAL VULVECTOMY WITH LYMPHADENECTOMY EN BLOC DISSECTION BY BUTTERFLY INCISION SEPARATE VULVAR & INGUINAL INCISIONS (TRIPLE INCISION)

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26 PREOPERATIVE EVALUATION
Blood CP Blood glucose random Urine RE X-ray chest, ECG Pap’s smear Pelvic ultrasound IN ADVANCED CASES Colposcopy, Cystoscopy, Proctoscopy CT Scan, MRI

27 COMPLICATIONS OF SURGERY
IMMEDIATE Haemorrhage Wound induration Partial wound dehiscence Infection

28 LATE COMPLICATIONS Lymphoedema Osteitis pubis Sexual dysfunction
Femoral inguinal hernia DVT Paraesthesia

29 ADJUVANT RADIOTHERAPHY
Pre operative Post operative

30 CHEMORADIOTHERAPHY Has a role in clitoris & sphincter preserving surgery in advanced cases

31 Follow Up Post Surgical Post Radiation Every 4 months 1 Year
Every 6 months 2 – 5 Years Annually Years Post Radiation First visit Month Every 2 months 1 Year Every 6 months 2 – 3 Years Annually Years

32 SURVIVAL RESULTS Depend on the extent of the disease at the time of diagnosis and treatment undertaken Five year survival rate. Stage I & II 90% All stages 75% Negative lymph nodes 96% Positive lymph nodes 66%

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