Vulvar cancer medical therapy: Difference between revisions
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{{CMG}} | {{CMG}}{{AE}}{{MD}}{{sali}} | ||
{{Vulvar cancer}} | {{Vulvar cancer}} | ||
__NOTOC__ | __NOTOC__ | ||
==Overview== | ==Overview== | ||
The optimal therapy for vulvar cancer depends on the stage at diagnosis.<ref name=xyz> Stage 0 Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref><ref name=abc> Stage I Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_76 Accessed on September 25, 2015</ref><ref name=zzz> Stage II Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_83 Accessed on September 25, 2015</ref><ref name=xxx> Stage III Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref><ref name=yyy> Stage IV Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_96 Accessed on September 25, 2015</ref> | The optimal therapy for vulvar cancer depends on the stage at [[diagnosis]].<ref name=xyz> Stage 0 Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref><ref name=abc> Stage I Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_76 Accessed on September 25, 2015</ref><ref name=zzz> Stage II Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_83 Accessed on September 25, 2015</ref><ref name=xxx> Stage III Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref><ref name=yyy> Stage IV Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_96 Accessed on September 25, 2015</ref> | ||
==Medical therapy== | ==Medical therapy== | ||
==== | ====Vulvar intraepithelial neoplasia (VIN)==== | ||
:* CO2 [[laser surgery]] and vaporization. A disadvantage of vaporization is that it does not provide tissue for histologic examination to confirm complete removal of the lesion and the absence of invasive disease.<ref name=xyz> Stage 0 Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref> | :* CO2 [[laser surgery]] and vaporization. A disadvantage of vaporization is that it does not provide tissue for histologic examination to confirm complete removal of the lesion and the absence of invasive disease.<ref name=xyz> Stage 0 Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref> | ||
:* Ultrasonic surgical aspiration (USA) | :* Ultrasonic surgical aspiration (USA) | ||
:* Topical [[imiquimod]] for patients wishing to avoid surgery | :* Topical [[imiquimod]] for patients wishing to avoid surgery | ||
====Stage I Vulvar Cancer==== | ====Stage I Vulvar Cancer==== | ||
:* Radical [[radiation therapy]] for patients unable to tolerate surgery or deemed unsuitable for [[surgery]] because of site or extent of disease.<ref name=abc> Stage I Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_76 Accessed on September 25, 2015</ref> | :* Radical [[radiation therapy]] for patients unable to tolerate surgery or deemed unsuitable for [[surgery]] because of site or extent of disease.<ref name=abc> Stage I Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_76 Accessed on September 25, 2015</ref> | ||
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:* For those few patients unable to tolerate [[radical surgery]] or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with favorable survival.<ref name=zzz> Stage II Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_83 Accessed on September 25, 2015</ref> | :* For those few patients unable to tolerate [[radical surgery]] or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with favorable survival.<ref name=zzz> Stage II Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_83 Accessed on September 25, 2015</ref> | ||
====Stage III Vulvar Cancer==== | ====Stage III Vulvar Cancer==== | ||
:* [[Radical vulvectomy]] with inguinal and femoral node dissection followed by radiation therapy in patients with large primary lesions and narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and a thickness of greater than 5 mm, particularly if the nodes are involved. Radiation therapy to the pelvis and groin is usually given if two or more groin nodes are involved.<ref name=xxx> Stage III Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref> | :* [[Radical vulvectomy]] with [[inguinal]] and [[femoral]] node dissection followed by radiation therapy in patients with large primary lesions and narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and a thickness of greater than 5 mm, particularly if the nodes are involved. Radiation therapy to the pelvis and groin is usually given if two or more [[groin]] nodes are involved.<ref name=xxx> Stage III Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015</ref> | ||
:* Preoperative neoadjuvant radiation therapy or chemoradiation may be used to improve operability and even decrease the extent of surgery required. | :* Preoperative neoadjuvant radiation therapy or chemoradiation may be used to improve operability and even decrease the extent of surgery required. | ||
:* For the few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. Some physicians prefer to add concurrent 5-FU or 5-FU and cisplatin. | :* For the few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical [[radiation therapy]] may be associated with long-term survival. Some physicians prefer to add concurrent 5-FU or 5-FU and [[cisplatin]]. | ||
====Stage IV Vulvar Cancer==== | ====Stage IV Vulvar Cancer==== | ||
:* Surgery followed by radiation therapy for large resected lesions with narrow margins. | :* Surgery followed by radiation therapy for large resected lesions with narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and thickness greater than 5 mm. Radiation therapy to the pelvis and groin is given if two or more groin nodes are involved.<ref name=yyy> Stage IV Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_96 Accessed on September 25, 2015</ref> | ||
:* Neoadjuvant radiation therapy or chemoradiation of large primary lesions to improve operability, followed by radical surgery. | :* Neoadjuvant radiation therapy or chemoradiation of large primary lesions to improve operability, followed by radical surgery. | ||
:* For those patients unable to tolerate radical vulvectomy or who are deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. When radiation therapy is used for primary definitive treatment of vulvar cancer, some physicians prefer to add concurrent 5-FU or 5-FU and [[cisplatin]]. | :* For those patients unable to tolerate radical vulvectomy or who are deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. When radiation therapy is used for primary definitive treatment of vulvar cancer, some physicians prefer to add concurrent 5-FU or 5-FU and [[cisplatin]]. | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
[[Category:Gynecology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
Latest revision as of 14:32, 2 April 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Syed Musadiq Ali M.B.B.S.[3]
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Risk calculators and risk factors for Vulvar cancer medical therapy |
Overview
The optimal therapy for vulvar cancer depends on the stage at diagnosis.[1][2][3][4][5]
Medical therapy
Vulvar intraepithelial neoplasia (VIN)
- CO2 laser surgery and vaporization. A disadvantage of vaporization is that it does not provide tissue for histologic examination to confirm complete removal of the lesion and the absence of invasive disease.[1]
- Ultrasonic surgical aspiration (USA)
- Topical imiquimod for patients wishing to avoid surgery
Stage I Vulvar Cancer
- Radical radiation therapy for patients unable to tolerate surgery or deemed unsuitable for surgery because of site or extent of disease.[2]
Stage II Vulvar Cancer
- For those few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with favorable survival.[3]
Stage III Vulvar Cancer
- Radical vulvectomy with inguinal and femoral node dissection followed by radiation therapy in patients with large primary lesions and narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and a thickness of greater than 5 mm, particularly if the nodes are involved. Radiation therapy to the pelvis and groin is usually given if two or more groin nodes are involved.[4]
- Preoperative neoadjuvant radiation therapy or chemoradiation may be used to improve operability and even decrease the extent of surgery required.
- For the few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. Some physicians prefer to add concurrent 5-FU or 5-FU and cisplatin.
Stage IV Vulvar Cancer
- Surgery followed by radiation therapy for large resected lesions with narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and thickness greater than 5 mm. Radiation therapy to the pelvis and groin is given if two or more groin nodes are involved.[5]
- Neoadjuvant radiation therapy or chemoradiation of large primary lesions to improve operability, followed by radical surgery.
- For those patients unable to tolerate radical vulvectomy or who are deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. When radiation therapy is used for primary definitive treatment of vulvar cancer, some physicians prefer to add concurrent 5-FU or 5-FU and cisplatin.
References
- ↑ 1.0 1.1 Stage 0 Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015
- ↑ 2.0 2.1 Stage I Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_76 Accessed on September 25, 2015
- ↑ 3.0 3.1 Stage II Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_83 Accessed on September 25, 2015
- ↑ 4.0 4.1 Stage III Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_70 Accessed on September 25, 2015
- ↑ 5.0 5.1 Stage IV Vulvar Cancer. National Cancer Institute. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_96 Accessed on September 25, 2015