Carcinoma of Vulva: A Guide to Diagnosis and Staging
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Carcinoma of Vulva: A Guide to Diagnosis and Staging
- 1. Carcinoma of Vulva Prof. Surendra Nath Panda, M.S. Department of Obstetrics and Gynecology M.K.C.G.Medical College Berhampur, Orissa, India
- 31. Thank You At the service of women
Notas del editor
- Carcinoma of the Vulva – Clinical Staging - - TNM Classification FIGO - 1988 T, Primary Tumor Tis, Pre-invasive carcinoma (carcinoma in-situ) T 1, Tumor confined to the vulva and/or perineum - 2 cm or less in greatest dimension T 2, Tumor confined to the vulva and/or perineum - more than 2 cm in greatest dimension T 3, Tumor of any size with adjacent spread to the urethra and/or vagina and/or to the anus T 4, Tumor of any size infiltrating the bladder mucosa and/or the rectal mucosa including the upper part of the urethral mucosa and/or fixed to the bone N, Regional lymph nodes N 0, No nodes palpable N 1, Unilateral regional lymph node metastasis N2, Bilateral regional lymph node metastasis M, Distant metastasis M 0, No clinical metastasis M 1, Distant metastasis (including pelvic lymph node metastasis)
- Carcinoma of the Vulva – Clinical Staging - - TNM Classification FIGO - 1988 T, Primary Tumor - Tis, Pre-invasive carcinoma (carcinoma in-situ) T 1, Tumor confined to the vulva and/or perineum - 2 cm or less in greatest dimension T 2, Tumor confined to the vulva and/or perineum - more than 2 cm in greatest dimension T 3, Tumor of any size with adjacent spread to the urethra and/or vagina and/or to the anus T 4, Tumor of any size infiltrating the bladder mucosa and/or the rectal mucosa including the upper part of the urethral mucosa and/or fixed to the bone N, Regional lymph nodes - N 0, No nodes palpable N 1, Unilateral regional lymph node metastasis N2, Bilateral regional lymph node metastasis M, Distant metastasis - M 0, No clinical metastasis M 1, Distant metastasis (including pelvic lymph node metastasis)
- Carcinoma of the Vulva – Clinical Staging - - TNM Classification FIGO - 1988 T, Primary Tumor - Tis, Pre-invasive carcinoma (carcinoma in-situ) T 1, Tumor confined to the vulva and/or perineum - 2 cm or less in greatest dimension T 2, Tumor confined to the vulva and/or perineum - more than 2 cm in greatest dimension T 3, Tumor of any size with adjacent spread to the urethra and/or vagina and/or to the anus T 4, Tumor of any size infiltrating the bladder mucosa and/or the rectal mucosa including the upper part of the urethral mucosa and/or fixed to the bone N, Regional lymph nodes - N 0, No nodes palpable N 1, Unilateral regional lymph node metastasis N2, Bilateral regional lymph node metastasis M, Distant metastasis - M 0, No clinical metastasis M 1, Distant metastasis (including pelvic lymph node metastasis)
- In terms of etiology, pathogenesis, and clinical presentation, vulvar squamous cell carcinomas may be divided into two general groups. The first group is associated with cancer-related (high-risk) HPV, may be multicentric, and frequently coexists with or is preceded by a classic and easily recognized precancerous change called vulvar intraepithelial neoplasia (VIN). This form of VIN is also termed carcinoma in situ or Bowen disease. ] VIN is characterized by nuclear atypia in the epithelial cells, increased mitoses, and lack of surface differentiation. It is analogous to high-grade squamous intraepithelial lesions of the cervix (see under cervix). These lesions usually present as white or pigmented plaques on the vulva; identical lesions are encountered in the male. VIN is appearing with increasing frequency in women younger than 40 years. With or without associated invasive carcinoma, VIN is frequently multicentric, and 10% to 30% are associated with another primary squamous neoplasm in the vagina or cervix. This association indicates a common etiologic agent. Indeed, 90% of cases of VIN and many associated cancers contain HPV DNA, specifically types 16, 18, and other cancer-associated (high-risk) types. ] Spontaneous regression of VIN lesions has been reported; the risk of progression to invasive cancer increases in older (older than 45 years) or immunosuppressed women. The second group of squamous cell carcinomas are associated with squamous cell hyperplasia and lichen sclerosus. The etiology of this group of carcinomas is unclear, and they are infrequently associated with HPV. In one scenario, genetic alterations arise in lichen sclerosus or hyperplasia, leading directly to invasion, or by an intermediate step in which atypia develops within hyperplasia or lichen sclerosus (differentiated VIN). These tumors have also been associated with mutations in p53 and appear to have a significantly worse prognosis than HPV-positive tumors do. A variety of chromosome abnormalities are linked to invasive vulvar cancer, some of which may be specific for HPV-positive tumors.
- In terms of etiology, pathogenesis, and clinical presentation, vulvar squamous cell carcinomas may be divided into two general groups. The first group is associated with cancer-related (high-risk) HPV, may be multicentric, and frequently coexists with or is preceded by a classic and easily recognized precancerous change called vulvar intraepithelial neoplasia (VIN). This form of VIN is also termed carcinoma in situ or Bowen disease. ] VIN is characterized by nuclear atypia in the epithelial cells, increased mitoses, and lack of surface differentiation. It is analogous to high-grade squamous intraepithelial lesions of the cervix (see under cervix). These lesions usually present as white or pigmented plaques on the vulva; identical lesions are encountered in the male. VIN is appearing with increasing frequency in women younger than 40 years. With or without associated invasive carcinoma, VIN is frequently multicentric, and 10% to 30% are associated with another primary squamous neoplasm in the vagina or cervix. This association indicates a common etiologic agent. Indeed, 90% of cases of VIN and many associated cancers contain HPV DNA, specifically types 16, 18, and other cancer-associated (high-risk) types. ] Spontaneous regression of VIN lesions has been reported; the risk of progression to invasive cancer increases in older (older than 45 years) or immunosuppressed women. The second group of squamous cell carcinomas are associated with squamous cell hyperplasia and lichen sclerosus. The etiology of this group of carcinomas is unclear, and they are infrequently associated with HPV. In one scenario, genetic alterations arise in lichen sclerosus or hyperplasia, leading directly to invasion, or by an intermediate step in which atypia develops within hyperplasia or lichen sclerosus (differentiated VIN). These tumors have also been associated with mutations in p53 and appear to have a significantly worse prognosis than HPV-positive tumors do. A variety of chromosome abnormalities are linked to invasive vulvar cancer, some of which may be specific for HPV-positive tumors.
- In terms of etiology, pathogenesis, and clinical presentation, vulvar squamous cell carcinomas may be divided into two general groups. The first group is associated with cancer-related (high-risk) HPV, may be multicentric, and frequently coexists with or is preceded by a classic and easily recognized precancerous change called vulvar intraepithelial neoplasia (VIN). This form of VIN is also termed carcinoma in situ or Bowen disease. ] VIN is characterized by nuclear atypia in the epithelial cells, increased mitoses, and lack of surface differentiation. It is analogous to high-grade squamous intraepithelial lesions of the cervix (see under cervix). These lesions usually present as white or pigmented plaques on the vulva; identical lesions are encountered in the male. VIN is appearing with increasing frequency in women younger than 40 years. With or without associated invasive carcinoma, VIN is frequently multicentric, and 10% to 30% are associated with another primary squamous neoplasm in the vagina or cervix. This association indicates a common etiologic agent. Indeed, 90% of cases of VIN and many associated cancers contain HPV DNA, specifically types 16, 18, and other cancer-associated (high-risk) types. ] Spontaneous regression of VIN lesions has been reported; the risk of progression to invasive cancer increases in older (older than 45 years) or immunosuppressed women. The second group of squamous cell carcinomas are associated with squamous cell hyperplasia and lichen sclerosus. The etiology of this group of carcinomas is unclear, and they are infrequently associated with HPV. In one scenario, genetic alterations arise in lichen sclerosus or hyperplasia, leading directly to invasion, or by an intermediate step in which atypia develops within hyperplasia or lichen sclerosus (differentiated VIN). These tumors have also been associated with mutations in p53 and appear to have a significantly worse prognosis than HPV-positive tumors do. A variety of chromosome abnormalities are linked to invasive vulvar cancer, some of which may be specific for HPV-positive tumors.
- In terms of etiology, pathogenesis, and clinical presentation, vulvar squamous cell carcinomas may be divided into two general groups. The first group is associated with cancer-related (high-risk) HPV, may be multicentric, and frequently coexists with or is preceded by a classic and easily recognized precancerous change called vulvar intraepithelial neoplasia (VIN). This form of VIN is also termed carcinoma in situ or Bowen disease. ] VIN is characterized by nuclear atypia in the epithelial cells, increased mitoses, and lack of surface differentiation. It is analogous to high-grade squamous intraepithelial lesions of the cervix (see under cervix). These lesions usually present as white or pigmented plaques on the vulva; identical lesions are encountered in the male. VIN is appearing with increasing frequency in women younger than 40 years. With or without associated invasive carcinoma, VIN is frequently multicentric, and 10% to 30% are associated with another primary squamous neoplasm in the vagina or cervix. This association indicates a common etiologic agent. Indeed, 90% of cases of VIN and many associated cancers contain HPV DNA, specifically types 16, 18, and other cancer-associated (high-risk) types. ] Spontaneous regression of VIN lesions has been reported; the risk of progression to invasive cancer increases in older (older than 45 years) or immunosuppressed women. The second group of squamous cell carcinomas are associated with squamous cell hyperplasia and lichen sclerosus. The etiology of this group of carcinomas is unclear, and they are infrequently associated with HPV. In one scenario, genetic alterations arise in lichen sclerosus or hyperplasia, leading directly to invasion, or by an intermediate step in which atypia develops within hyperplasia or lichen sclerosus (differentiated VIN). These tumors have also been associated with mutations in p53 and appear to have a significantly worse prognosis than HPV-positive tumors do. A variety of chromosome abnormalities are linked to invasive vulvar cancer, some of which may be specific for HPV-positive tumors.