Devita, Hellman, and Rosenberg's Cancer

LWBK1006-23 LWW-Govindan-Review December 12, 2011 19:10

318 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 23.2.17.A 67-year-old woman presents for evaluation of a cancer found in the

vagina. Before any examination or evaluation, you review with her that

all of the following are true, EXCEPT:

A. Prior in utero exposure to the synthetic estrogen diethylstilbestrol

(DES) places a woman at an increased risk for development of vaginal

clear cell adenocarcinoma.

B. Most cancers found in the vagina are actually metastases or direct

extensions from other gynecologic tumors.

C. Vaginal squamous cell carcinoma is thought to be unrelated to the

HPV.

D. Staging for primary vaginal cancers is similar to cervical cancer and

is clinical.

Question 23.2.18.This patient is found to have had a prior hysterectomy for mild dysplasia

and benign indications. Her apparent primary vaginal cancer extends to

the subvaginal tissues and is appropriately staged as a stage II cancer. You

recommend:

A. Referral for total radical vaginectomy

B. Chemotherapy with a cisplatin-based regimen

C. Referral for radiation therapy

D. Local excision followed by close observation

Question 23.2.19.Which of the following statements is INCORRECT regarding invasive

vulvar cancer?

A. There are two distinct types of invasive squamous vulvar cancer.

B. HPV-associated vulvar cancer tends to occur in younger women (age

<55 years) and is associated with prior cervical precancerous abnor-

malities.

C. Melanoma of the vulva is caused by exposure to HPV.

D. Non–HPV-associated invasive squamous vulvar cancer is asso-

ciated with lichen sclerosis.

Question 23.2.20.A 55-year-old patient with a history of abnormal PAP smears presents for

evaluation of a 3-cm vulvar mass. It is located 1 cm lateral to the clitoris on

the right and has an ulcerated appearance. She states she noticed it 2 years

ago and has tried many different ointments to help control the itching

and irritation. This was recently biopsied to reveal invasive squamous

cell carcinoma. What treatment would you recommend?

A. Neoadjuvant chemoradiation followed by local resection

B. Concurrent chemoradiation

C. Radical vulvectomy with bilateral inguinal (groin) lymphadenectomy

D. Local resection followed by radiation and/or chemotherapy