••• Chapter 48^ Vulvar and Vaginal Carcinoma^471
❍ What alternatives to radical surgery are available for women with a locally advanced vulvar carcinoma?
Preoperative chemoradiation has been utilized to reduce the size of many tumors that may be initially invading
structures such as the bladder and anus. This treatment plan may allow for limited surgical resection.
❍ Which vulvar cancer has a predilection for hematogenous spread?
Vulvar sarcomas. In one series 50% had pulmonary metastases.
❍ What is the name of the vaginal tumor that presents as a mass of grapelike nodules most commonly in the
first 2 years of life?
Embryonal rhabdomyosarcoma (sarcoma botryoides).
❍ What is the current acceptable conservative surgical treatment of a vulvar cancer confined to one labia with
no central involvement?
Wide local excision or vulvectomy with ipsilateral groin node dissection that should include all nodes. No attempt
should be made to distinguish between superficial and deep inguinal lymph nodes. Groin node dissection cannot
be totally dispensed of unless invasion is less than 1 mm.
❍ What is the overall rate of recurrence in treated vulvar cancer, and where does it recur?
Approximately 25% of patients will recur, and 80% of these recurrences are in the first 2 years. Most recurrences
are on the vulva, with a few in the groin.
❍ What is the treatment of node-positive vulvar cancer?
Two factors appear to be important in the management of regional disease. Radiation therapy can have a
significant impact on controlling or eradicating small volume nodal disease, and surgical resection of bulky nodal
disease also improves regional control and probably enhances the curative potential of radiation. Patients with
positive nodes, particularly more than one positive node, are likely to benefit from postoperative irradiation to the
groin and pelvis.
❍ Is surgical debulking of positive pelvic nodes in vulvar cancer superior to radiation for treatment?
No. Radiation therapy has been found to be superior in the management of patients with positive pelvic nodes.
❍ True or False: Primary cancer of the vagina is one of the rarest of the malignant processes in the human body.
True.
❍ What is the most common type of vaginal cancer?
Squamous cell carcinoma.
❍ If a malignant neoplasm involves both the cervix and the vagina and is histologically compatible with origin
in either organ, is it classified vaginal or cervical?
Cervical cancer.
❍ What is the spread pattern of vaginal cancer?
If it occurs in the upper half of vagina, extension is similar to cervical cancer; if it occurs in the lower part of the
vagina, extension is similar to carcinoma of the vulva.