Presentation is loading. Please wait.

Presentation is loading. Please wait.

CARCINOMA VULVA. Mons pubis Labia majora Labia minora Clitoris Vestibule Perineum Bartholin gland Vestibular gland Vulva - Anatomy Vulva - Anatomy.

Similar presentations


Presentation on theme: "CARCINOMA VULVA. Mons pubis Labia majora Labia minora Clitoris Vestibule Perineum Bartholin gland Vestibular gland Vulva - Anatomy Vulva - Anatomy."— Presentation transcript:

1 CARCINOMA VULVA

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

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) Human Papilloma virus ( 16,18,31) Herpes Simplex Type II virus Herpes Simplex Type II virus Carcinoma cervix (20-50%) Carcinoma cervix (20-50%) Immune suppression Immune suppression

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

6 Lichen sclerosis pre-cancerous

7

8 Asymptomatic20% Pruritus vulvae 71% Vulvar mass58% Ulceration 28% Bleeding 26% Vulvar pain 23% Urinary tract symptoms 14% Discharge 13% CLINICAL FEATURES

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

10 Advanced squamous cell carcinoma

11 SITE

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

13 Lymphatic drainage

14 PATHOLOGY Squamous cell 90% Melanoma5-10% Basal cell carcinoma 2% Adenocarcinoma1%

15 FIGO staging (1995) Stage I 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 Stage III 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 FIGO staging (1995)

17 DIAGNOSIS History History Examination Examination Biopsy Biopsy

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

19 VINInvasiveVIN Pathology

20 Basal and Squamous cell ca Squamous cell carcinoma Pathology

21 Histopathology VIN

22 Histopathology

23 Paget’s disease

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

25

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

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

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

29 ADJUVANT RADIOTHERAPHY Pre operative Pre operative Post operative Post operative

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

31 Follow Up Post Surgical Every 4 months 1 Year Every 4 months 1 Year Every 6 months2 – 5 Years Every 6 months2 – 5 Years Annually + 5 Years Annually + 5 Years Post Radiation First visit 1 Month First visit 1 Month Every 2 months1 Year Every 2 months1 Year Every 6 months2 – 3 Years Every 6 months2 – 3 Years Annually + 3 Years Annually + 3 Years

32 SURVIVAL RESULTS Depend on the extent of the disease at the time of diagnosis and treatment undertaken Five year survival rate. Five year survival rate. 1. Stage I & II 90% 2. All stages75% 3. Negative lymph nodes 96% 4. Positive lymph nodes 66%

33


Download ppt "CARCINOMA VULVA. Mons pubis Labia majora Labia minora Clitoris Vestibule Perineum Bartholin gland Vestibular gland Vulva - Anatomy Vulva - Anatomy."

Similar presentations


Ads by Google