Transcript Treatment
Vulvar Cancer Women’s Hospital,School of Medicine Zhejiang University General Considerations Vulvar cancer is uncommon USA:3,800 new cases and 800 deaths annually Representing 3%-5% of malignancies of the female genital tract The peak incidence of onset is in the age 60-80 years Recently, the incidence appears to be increasing Etiology unknown Associated factors HPV STD Chronic vulvar dystrophy Pathology Histological type squamous cell carcinoma melanoma sarcoma basal cell adenocarcinoma bartholin gland squamous adenocarcinoma undifferentiated Pathology Main focus Changes around focus： skin incrassation, increased or decreased pigmentation Clinical manifestation symptoms vuval pruritus mass advanced stage feature sign Tumor focus positive lymph nodes Routes of Spread Vulvar cancer spreads by the following routes： Direct extension,to involve adjacent structures such as the vagina,urethra,and anus Lymphatic embolization to the regional inguinal and femoral lymph nodes Hematogenous spread to distant sites,including the lungs,liver,and bone Diagnosis History & symptoms sign Assistant examinations histology cytology image cystoscopy proctoscopy Staging(FIGO,2009) Treatment （1） Principle: surgery combined with radiotherapy ,chemotherapy Treatment （2） Early stage： individual，conservative surgery when good prognosis was ensured advanced stage combined therapy，improve survival Treatment （3） SOGC Clinical Practice Guidelines Radical vulvectomy Treatment （4） radiotherapy sensitive：squamous acanecr Side effects of irradiation to vulva indication radiotherapy prior to surgery adjuvant radiotherapy after surgery residual or relapse tumor Treatment （5） chemotherapy Advanced stage, relapse drugs DDP ，CP BLM 5-Fu ADM Outcome and Prognosis Overall survival for patients with vulvar carcinoma is excellent, especially in those with early-stage disease. Experience with modern treatment from the Mayo clinic shows that the overall survival rate for women with vulvar carcinoma is 75%, compared to an 89% actuarial survival rate for age-matched controls. The 5-year survival rates after surgery for vulvar cancer are as follows: Stage I - 90% Stage II - 81% Stage III - 68% Stage IV - 20% Follow-up Prognostic factors： Lymph metastasis Invasive Depth Tumor size Location Stage Treatment Follow-up Follow-up Year 1： Year 2 ： Year 3-5： Year 6-： 1-2 monthly 3 monthly 6 monthly 12 monthly