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GYNECOLOGICAL ONCOLOGY . . . CONT.

Stage 0

Description

Treatment

intraepithelial neoplasia (VIN) carcinoma in situ

local excision laser

1

< 2 cm no suspicious groin nodes

wide local excision simple or radical vulvectomy nodal dissection

2

> 2 cm no suspicious groin nodes

individualized local surgery +/– radiation

3

local extention to adjacent structures suspicious or positive unilateral groin nodes

as for stage 2

4

fixed bilateral groin nodes distant spread

as for stage 2

Table 5. Staging Classification and Treatments of Vulvar Cancer (Surgical Staging)

superficial vulvectomy

prognosis • depends on nodal involvement and tumour size • node status is most important • lesions > 3 cm associated with poorer prognosis • overall 5 year survival rate: 70% • 90% if no nodes • < 70% if nodes involved

VAGINA

B e n i g n V a g i n a l L e s i o n s V A I N ( V a g i n a l I n t r a - E p i t h e l i a l N e o p l a s i a ) p r e - m a l i g n a n t g r a d e s : p r o g r e s s i o n t h r o u g h V A I N 1 , V A I N 2 , V A I N 3 d i a g n o s i s P a p s m e a r c o l p o s c o p y S c h i l l e r t e s t ( n o r m a l e p i t h e l i u m t a k e s u p i o d i n e ) b i o p s y t r e a t m e n t V A I N 1 : o f t e n r e g r e s s a n d r e c u r t h e r e f o r e m a n a g e c o n s e r v a t i v e l y w i t h r e g u l a r f o l l o w u p V A I N 2 : l a s e r a b l a t i o n , e l e c t r o s u r g i c a l c a u t e r y V A I N 3 : a b l a t i o n , e x c i s i o n a l b i o p s y s h o u l d b e c o n s i d e r e d t o r u l e o u t i n v a s i o n

M a l i g n a n t V a g i n a l L e s i o n s a s s e s s m e n t c y t o l o g y ( P a p s m e a r ) 1 0 - 2 0 % f a l s e n e g a t i v e r a t e i n c r e a s e d i n c i d e n c e i n p a t i e n t s w i t h p r i o r h i s t o r y o f c e r v i c a l a n d v u l v a r c a n c e r > e x t r a v i g i l a n c e i n p e r f o r m i n g P a p s m e a r i n p a t i e n t w i t h p r i o r h y s t e r e c t o m y f o r c e r v i c a l c a n c e r c o l p o s c o p y S c h i l l e r t e s t b i o p s y , p a r t i a l v a g i n e c t o m y s t a g i n g ( s e e T a b l e 6 ) s q u a m o u s c e l l c a r c i n o m a 2 % o f g y n e c o l o g i c a l m a l i g n a n c i e s m o s t c o m m o n s i t e i s t h e u p p e r 1 / 3 o f p o s t e r i o r w a l l o f v a g i n a s y m p t o m s a s y m p t o m a t i c v a g i n a l d i s c h a r g e ( o f t e n f o u l - s m e l l i n g ) v a g i n a l b l e e d i n g e s p e c i a l l y d u r i n g c o i t u s u r i n a r y s y m p t o m s s e c o n d a r y t o c o m p r e s s i o n t r e a t m e n t r a d i o t h e r a p y i f a p r i m a r y h y s t e r e c t o m y a n d v a g i n e c t o m y

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 37

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