vulva and vaginal cancers by Basira.pptx
- 1. IslamicImaratsofAfghanistan Ministryofpublichealth ParwanHospital Obstetricsandgynecologydepartment Vulvar Cancer Vaginal Cancer By : Basira Mansoori
- 2. VulvarCancer Relevant Anatomy Epidemiology Risk factors Diagnosis Staging Prognosis Treatment Surveillance RECURRENT DISEASE VERRUCOUS CARCINOMA MELANOMA Metastatic Disease BASAL CELL CARCINOMA VULVAR SARCOMA VULVAR PAGET DISEASE Bartholin GLAND CARCINOMA VULVAR PAGET DISEASE CANCER METASTATIC TO The VULVA
- 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 .
- 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.
- 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.
- 15. Inguinofemoral Lymphadenecto my This procedure is usually an integral part o surgical cancer staging and accompanies radical partial or radical 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 .
- 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.
- 20. VERRUCOUS CARCINOMA This rare variant of squamous cell carcinoma constitutes less than 1 percent of all vulvar cancers.
- 21. MELANOMA Melanoma is the second most common vulvar cancer and accounts or 10 percent of all vulvar malignancies .
- 22. BASALCELL CARCINOMA Basal cell carcinoma (BCC) of the vulva accounts or <2 percent of all vulvar cancers and is most commonly found in elderly women.
- 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 .
- 24. VULVARPAGET DISEASE Extramammary Paget disease is a heterogeneous group of intraepithelial neoplasias and when present on the vulva, appears as an eczematoid, red, weeping area.
- 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.
- 26. VaginalCancer Relevant Anatomy Incidence Squamous cell carcinoma Adenocarcinoma Mesynchymal Tumors Melanoma
- 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.
- 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.
- 32. ClearCell Adenocarcinom a Of primary vaginal adenocarcinomas, the clear cell type is most closely associated with DES exposure.
- 33. MESENChYMAL TUMORS Embryonal Rabdomyosarcoma: This is the most common malignancy of the vagina in infants and children, and most embryonal rhabdomyosarcomas are the sarcoma botryoides subtype .
- 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.
- 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
- 38. Thanks