Devita, Hellman, and Rosenberg's Cancer

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

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

continued to be followed closely. If a cancer in the vagina is in contact

with the cervix or the vulva, then it is not classified as a vaginal cancer

and the primary is consider either the cervix or the vulva, respectively.

Staging for primary vaginal cancer is clinical, similar to cervical cancer.

Answer 23.2.18. The answer is C.

Stage II vaginal cancer involves the subvaginal tissues and is typi-

cally not amendable to local resection without injury to the bladder

or rectum. The most appropriate therapy is radiation, likely with both

brachytherapy and external beam radiotherapy to treat the regional

nodal areas. Chemotherapy is not indicated for primary therapy. Extrap-

olating from randomized studies in patients with cervical cancer, one

could consider combination chemoradiotherapy for patients with vaginal

cancer.

Answer 23.2.19. The answer is C.

Vulvar melanoma is not thought to be related to HPV infection. There

does appear to be two types of invasive squamous vulvar cancers. HPV-

related cancers typically occur in younger women and can be multifocal

and associated with vulvar-intraepithelial neoplasia (VIN), whereas non-

HPV cancers occur in older women and are often associated with chronic

vulvar inflammation or lichen sclerosis.

Answer 23.2.20. The answer is C.

Although all options are used to treat patients with invasive vulvar can-

cer, the apparent best option is typically radical vulvectomy with inguinal

lymphadenectomy. Staging is then determined on the basis of the surgi-

cal findings, which also dictate adjuvant therapy. Typically, neoadjuvant

and definitive chemoradiation are often necessary with very large cancers

involving the urethra or anus and can help achieve organ preservation,

but would not be typically used with a 3-cm tumor.

Answer 23.2.21. The answer is B.

Tumor grade has been inconsistent and has not typically been found to

be an independent risk factor. LVSI is a very strong predictor of positive

inguinal lymph nodes. Depth of invasion, tumor diameter, and tumor

thickness are all directly related to lymph node involvement and the

patient’s ultimate survival.

Answer 23.2.22. The answer is D.

Staging for carcinomas of the vulva has been established by the FIGO.

In 1983, FIGO initially adopted a clinical TNM staging system. The reli-

ability of clinical assessment of regional lymph node status was found

to be poor. In 1988, FIGO adopted a surgical staging system, and

this was updated in 1994 to include an additional substage for mini-

mally invasive cancers (IA). Typically, both TNM and FIGO stages are

provided.