1. ONCOLOGY OF VULVA AND VAGINA

2. THE VULVA

5. INCIDENCE: OVER 400, OVER DETHS (ANNUAL IN POLAND) 40-60% STAGE III and IV – FIGO – inolved lymph nodes

6. Risk factors low level of hygiene, HSV, HPV(40%), chlamydia trachomatis, cosmetics age – organism involution (i.e. metabolic abnormalities)

7. Prognosis 5-year survival I (FIGO) - 90% IV (FIGO) - 18% (all togother 35%)

8. VIN - vulvar intraepithelial neoplasia (SIL –squamos intraepithelial lesion)

9. VIN 1 (low grade dysplasia) – 1/3 lower part of epithelium VIN 2 (intermediary grade dysplasia) – 2/3 lower part of epithelium VIN 3 (high grade dysplasia) – 1/3 upper part of epithelium or whole epithelium - ca praeinvasivum or 1/3 lower part similar - ca planoepitheliale G1

10. Ca planoepitheliale - 90% Bartholin gland Ca - 5% other glandular – Paget disease sarcomas metastatic – breast, kidney, stomach, melanoma

11. Two types of vulvar cancer

12. 1/3 papillar or basal cell ca relatively young women before ca – VIN and virus infection multifocal

13. 2/3 planoepithelial keratodes in older age before no VIN lichen sclerosus planoepithelial hyperplasia virus infection rare monofocality

14. Symptoms. - no. - itching. - pain (clitoris). - abnormalities of
Symptoms no itching pain (clitoris) abnormalities of defecation and miction smell secretion

15. Ways of invasion infiltration of neighbour structures (urethra, vagina, anus) metastasis into regional lymph nodes

16. Diagnositic EVERY disease in region of vulva needs histioathological verification

17. If melanoma suspection: resection of the whole abnormal tissue with margin of normal tissue

18. in 20% of cases vulvar malignancy coexist with second malignancy of FGT

19. Stage O (carcinoma in situ, intraepithelial carcinoma) treatment simple resection of vulva local resection

20. Stage I (tumor infiltrating vulva or perineum; in largest diam max 2 cm; no metastasis to lymph nodes) vulvectomy with bilateral inguinal lymph nodes margin min.: 8 – 10 mm

21. If metastasis in lymph nodes – complementary radiation theraphy

22. In case of patient who does not agree for surgery – radical radiotheraphy

23. Stage II ((tumor infiltrating vulva or perineum; in largest diam over 2 cm; no metastasis to lymph nodes)

24. Radical vulvectomy (margin of inaffected tissues - min 10 mm) with bilateral inguinal lymph nodes

25. Complementary radiotheraphy - metastasis in inguinal lymph nodes
Complementary radiotheraphy - metastasis in inguinal lymph nodes (2 or more without cossing the capsule of LN or 1 with cossing the capsule of LN or macroscopic invasion) - margin smaller than 8 mm - deph of invassion larger than 5 mm - lymph or capillary vassels invassion

26. Stopień III (tumor of any size infiltrating urethra, vagina, anus or/and unilateral metastasis to LN)

27. Deep radical vulvectomy with superficial and profundal inguinal LN, urethra resection, partial resection of anus

28. Radiotheraphy in patients who can not be qualified to surgery or do not agree

29. Stopień IV IV A – tu infiltration upper part of urethra, urinal cyst mucose, mucose of anus, pelvic bones, and/or bilateral inguinal LN IV B – distant metastasis including pelvic LN

30. 1. Radical vulvectomy with involved organs (urethra, urinal cyst, anus), with regional LN complementary radiation Radical radiotheraphy Paliative radiation Symptomatic treatment.

31. Chemotheraphy - as a part of radiochemotheraphy in preoperative radiation in stage III/IV - in recurence 5-fluorouracyl i cisplatin

33. SROM

34. SROM

38. The Vagina

39. Ca of vagina – primary - 1-2% of all FGT cancers
Very rare
1-2% of all FGT cancers
80-90% secondary
Planoepithelial ca - (85%)
- in this 80% cervical ca, 17% vulva ca
Glandular ca -
– endometrium (32%), colon (26%), ovary (17%)
kidney, breast, chorioncarcinoma

40. Ethiology of primary ca of vagina persistent leukorrhea?
mechanic contraceptives
persistent leukorrhea
leucoplakia
vaginitis
late menopause
masturbation
viral infection
pessars
lack of estrogenes

41. Location Most frequent - 1/3 – back-upper wall
Less frequent - 1/3 low part
Sporadic in the middle part of vagina

42. Contact bleeding, leukorrhea, urinal bladder, anus abnormalities
Symptoms
At the beginning – NO
In advanced stages –
Contact bleeding, leukorrhea, urinal bladder, anus abnormalities

43. Diagnosis - other cancer than planoepithelial
- hist-pat verification of the tumor
- colposcopy with biopsy
- exclussion of cervical cancer (cervical tissue sections / abrasion)
- other cancer than planoepithelial
- Uteral cave abrassion, USG, mammography
- cystoscopy + tissue sections ( front wall)
- rectoscopy + tissue sections ( back wall)

44. chemotheraphy (advanced stages) (Cisplatyna, 5Fu, Mitomycyna)
Treatment
Surgery (partly!)
radiotheraphy !
teleradiotheraphy
brachyteraphy
(chir + rtp)
chemotheraphy (advanced stages) (Cisplatyna, 5Fu, Mitomycyna)

45. 5-year survival
average 35 %
Iº - 70% - 80%
IVº - 0% - 18%