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CNCER DE VULVA

DIAGNSTICO Y TRATAMIENTO
Dr. PEDRO HERNNDEZ MORN
CIRUJANO ONCLOGO
GINECLOGO ONCLOGO
Instituto Regional de Enfermedades Neoplsicas
IREN NORTE
2015

DR. PEDRO HERNNDEZ MORN


EPIDEMIOLOGA
Approximately 40% of vulvar cancers are HPV
positive, and
about 85% of HPV-positive invasive vulvar
cancers are attributable to HPV-16
Prophylactic HPV vaccines have the potential to
decrease the incidence of invasive vulvar cancer by
about one-third overall (8), and
To be even more effective in younger women.
the radical en bloc dissection for vulvar cancer, and reported
5-year survival rates of 6070%.

Gynecologic Oncology, Berek and Hackers 5th Edition, 2015


Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


HISTOLOGA

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


ADVANCES
The most significant advances have included the following:
1. Individualization of treatment for all patients with invasive
disease
2. Vulvar conservation for patients with unifocal tumors and an
otherwise normal vulva
3. Omission of the groin dissection for patients with T1 tumors
and no more than 1 mm of stromal invasion.
4. Elimination of routine pelvic lymphadenectomy.
5. The use of separate groin incisions for the groin dissection to
improve wound healing.
6. Omission of the contralateral groin dissection in patients with
lateral T1 lesions and negative ipsilateral nodes.
Gynecologic Oncology, Berek and Hackers 5th Edition, 2015
Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


ADVANCES
The most significant advances have included the following:
7. The use of preoperative radiation therapy or definitive radiation
therapy to obviate the need for exenteration in selected patients
with advanced disease.
8. The use of postoperative radiation to decrease the incidence of
groin recurrence and improve survival of patients with multiple
positive groin nodes.
9. Resection of bulky positive groin and pelvic nodes without
complete node dissection to decrease the risk of lymphedema prior
to pelvic and groin radiation.
10. The use of sentinel node biopsy to obviate the need for
complete groin dissection in carefully selected patients with early
vulvar cancer.
Gynecologic Oncology, Berek and Hackers 5th Edition, 2015
Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


CLINICAL FEATURES
Predominantly affects postmenopausal white women.
Symptoms are usually pruritus and vulvar soreness.
The lesion has an eczematoid appearance
macroscopically and usually begins on the hair-
bearing portions of the vulva
It may extend to involve the mons pubis, thighs, and
buttocks.
Extension to involve the mucosa of the rectum, vagina, or
urinary tract also has been described.
The more extensive lesions are usually raised and velvety
in appearance and may weep persistently.

Gynecologic Oncology, Berek and Hackers 5th Edition, 2015


Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


CUADRO CLNICO

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


DR. PEDRO HERNNDEZ MORN
VIN CLASSIFICATION

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


ENFERMEDAD PAGETS VULVA

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


ENFERMEDAD PAGETS VULVA

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


TNM FIGO

a The depth of invasion is defined as the measurement of the tumor from the epithelialstromal junction of the
adjacent most superficial dermal papilla to the deepest point of invasion

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der Veldenc, FIGO
2012.

DR. PEDRO HERNNDEZ MORN


TNM FIGO

a The depth of invasion is defined as the measurement of the tumor from the epithelialstromal junction of the
adjacent most superficial dermal papilla to the deepest point of invasion

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der Veldenc, FIGO
2012.

DR. PEDRO HERNNDEZ MORN


TNM FIGO

a The depth of invasion is defined as the measurement of the tumor from the epithelialstromal junction of the
adjacent most superficial dermal papilla to the deepest point of invasion

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der Veldenc, FIGO
2012.

DR. PEDRO HERNNDEZ MORN


TNM FIGO

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der Veldenc, FIGO
2012.
DR. PEDRO HERNNDEZ MORN
TNM VULVAR CANCER

FIGO staging for carcinoma of the vulva, cervix, and endometrium, Sergio Pecorelli,
Chairman, IJGO 2009.

DR. PEDRO HERNNDEZ MORN


TNM VULVAR CANCER

FIGO staging for carcinoma of the vulva, cervix, and endometrium, Sergio Pecorelli,
Chairman, IJGO 2009.

DR. PEDRO HERNNDEZ MORN


TNM VULVAR CANCER

FIGO staging for carcinoma of the vulva, cervix, and endometrium, Sergio Pecorelli,
Chairman, IJGO 2009.

DR. PEDRO HERNNDEZ MORN


STAGING MELANOMA VULVAR

Gynecologic Oncology, Berek and Hackers, 6th Edition, 2015


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Warner K 2013.

DR. PEDRO HERNNDEZ MORN


STAGING MELANOMA CUTNEO

Gynecologic Oncology, Berek and Hackers, 6th Edition, 2015


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Warner K 2013.

DR. PEDRO HERNNDEZ MORN


MELANOMA VULVAR

Frecuencia. Labio menor y cltoris

Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.

DR. PEDRO HERNNDEZ MORN


METSTASIS GANGLIONAR

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


METSTASIS GANGLIONAR

DR. PEDRO HERNNDEZ MORN


GANGLIOS POSITIVOS SEGN EC.

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


EC y COMPROMISO GANGLIONAR

DR. PEDRO HERNNDEZ MORN


INVASIN Y GANGLIOS POSITIVOS

Cancer of the vulva, Neville F. Hacker, IJGO, 2015

DR. PEDRO HERNNDEZ MORN


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.

DR. PEDRO HERNNDEZ MORN


DIAGNSTICO

Cuadro clnico
Diagnosis requires a wedge or a Keyes biopsy
specimen, which usually can be taken in the
office under local anesthesia.
TAC AP
RMN AP

Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT VULVAR CANCER

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

Early vulvar cncer: I-II


Tumors confined to the vulva without suspicious
lymph nodes.
determined by clinical examination, with or without
ultrasonic or radiological assessment, may be
considered early.

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
Advanced Vulvar Cancer: III-IV
Patients with primary tumors extending
beyond the vulva, or
Bulky positive groin nodes are considered to
have advanced vulvar cancer.
For such patients,multimodality treatment
planning is particularly important.
Locally: IIIA-IVA
Avanced: IVB
IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
Microinvasive vulvar cancer (Stage IA)
Stage IA carcinoma of the vulva is defined as a
single lesion measuring 2 cm or less in diameter with
a depth of invasion of 1.0 mm or less, the depth
being measured from the epithelialstromal junction.
Lesions of this extent should be managed with
radical local excision.
Groin dissection is not necessary for lesions of this type

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
All patients with FIGO stage:
IB or stage
II lesions should have at least an ipsilateral
inguinofemoral lymphadenectomy.
The incidence of positive contralateral nodes in patients with
small lateral lesions and negative ipsilateral nodes is less
than 1%, so unilateral groin dissection is appropriate for such
lesions
Bilateral groin dissection should be performed for midline
tumors, and for those involving the anterior labia minora.
Large lateral tumors should probably also have bilateral
dissection, and definitely if the ipsilateral nodes are positive

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

Although surgical margins may be checked with frozen


sections, and resection of the entire gross lesion
with margins of at least 1 cm will control symptoms
and exclude invasive disease.
The role of radiotherapy for vulvar Pagets disease has
been reviewed by Brown It may be most useful when
the disease involves the anus or urethra, and
surgery would involve diversion and stoma formation.

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
Radical local excision or Vulvectomy radical in T1
and T2.
In young patients with actual involvement of the
clitoris or in whom surgical margins would be <5
mm, consideration should be given to treating the
primary lesion with a small field of radiation therapy.
Small vulvar lesions can often be controlled with 60 to 64
Gy of external radiation.
if there is suspicion of persistent disease, biopsy can be
performed after therapy to confirm complete response.
IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
If groin dissection is indicated in patients with early vulvar
cancer, it should be a thorough inguinofemoral
lymphadenectomy.
It is not necessary to perform a bilateral groin dissection if the
primary lesion is unilateral (defined as 2 cm or more from the
midline) and the ipsilateral nodes are negative.
Lesions involving the anterior labia minora should have
bilateral dissection.
The major morbidity management of vulvar cancer is chronic
lower limb lymphedema, which occurs in about 60% of patients
following groin dissection, and is a lifelong affliction.
IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
Conservative operation than radical Vulvectomy, may
be called a radical local excision, for localized
lesions, this operation is as effective as radical
vulvectomy in preventing local recurrence.
Surgical removal should achieve lateral margins of at
least 1 cm, and the deep margin should be the
inferior fascia of the urogenital diaphragm, which is
co-planar with the fascia lata and the fascia over the
pubic symphysis.
If the lesion is close to the urethra, the distal 1 cm of
the urethra may be resected without jeopardizing
urinary continence.
IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


DR. PEDRO HERNNDEZ MORN
MANAGEMENT
The sentinel node (or nodes) is identified by the injection of
intradermal isosulfan blue dye around the primary vulvar
lesion, in combination with intradermal radioactive 99mTc-
labeled sulfur colloid

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT CA VULVAR

T1 T2

IJGO, Cancer of the


vulva; Neville F. Hacker,
FIGO 2015.

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.
DR. PEDRO HERNNDEZ MORN
MANAGEMENT

IJGO, Cancer of the


vulva; Neville F. Hacker,
FIGO 2015.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
Management of patients with positive groin nodes.
GOG demonstrated superior results for pelvic and
inguinal radiation compared with pelvic node
dissection for patients who had an inguinal lymph
node dissection with findings of grossly positive or
more than one positive node.
Reasonable indications for bilateral pelvic and
groin irradiation in patients with positive groin
nodes would be:
The presence of extracapsular spread.
Two or more positive groin nodes.

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

Efficacy of groin radiation, without inguinofemoral


lymphadenectomy, for patients with a single
positive sentinel lymph node 2 mm or less in
diameter.
All patients who have had a sentinel lymph node
biopsy and are found to have one or more positive
nodes should be treated with a full inguinofemoral
lymph node dissection, followed by radiotherapy
to the groins and pelvis if indicated.

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.

DR. PEDRO HERNNDEZ MORN


CA VULVA: T2

A large squamous cell carcinoma of the vulva. Note the small contralateral "kissing lesion" that can be seen with
vulvar carcinomas. (Photograph courtesy of James B. Hall, MD)

Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT
If nodes are clinically positive, a complete lymphadenectomy
should be avoided because full groin dissection together with
postoperative groin irradiation may result in severe lymphedema.
Only enlarged nodes from the groin and pelvis should be
removed if feasible, and the patient given postoperative groin
and pelvic radiation
If there are ulcerated or fixed groin nodes, they should be
resected if not infiltrating muscle or femoral vessels, as
determined by imaging.
If nodes are not felt to be resectable, they should be biopsied
to confirm the diagnosis then treated with primary radiation, with
or without chemotherapy.
If appropriate, the nodes may be resected following radiation if
there has been an incomplete response

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.

DR. PEDRO HERNNDEZ MORN


CA VULVA:T2

A large T2 carcinoma of the vulva crossing the midline and involving the clitoris. (Photograph courtesy of Tom
Wilson)

Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT IIIA-IVA

IJGO, Cancer of the


vulva; Neville F. Hacker,
FIGO 2015.

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.
DR. PEDRO HERNNDEZ MORN
MANAGEMENT
If primary surgery would result in the need for a bowel
or urinary stoma.
it is preferable to employ primary radiation therapy,
sometimes followed by a more limited resection of the
residual tumor or tumor bed Chemoradiation has been
used extensively for large lesions if surgical resection
would damage central structures (anus, urethra).
Treatment with neoadjuvant cisplatin and 5-
fluorouracil, or other drug combinations, has been
reported to be effective for preservation of the anal
sphincter and/or urethra in patients with advanced
vulvar cancer
IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, FIGO 2012.

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

. IJGO, Cancer of the vulva; Neville F.


Hacker, FIGO 2015.
Gynecologic Oncology, Berek and
DR. PEDRO HERNNDEZ MORN
Hackers 6th Edition 2015
RADIOTERAPIA EXTERNA

IJGO, Cancer of the vulva; Neville F. Hacker, FIGO 2015.


Gynecologic Oncology, Berek and Hackers 6th Edition 2015

DR. PEDRO HERNNDEZ MORN


MANAGEMENT

IJGO, Cancer of the


vulva; Neville F. Hacker,
FIGO 2015.

Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.
DR. PEDRO HERNNDEZ MORN
MANAGEMENT

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007


DR. PEDRO HERNNDEZ MORN
MANAGEMENT

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007


DR. PEDRO HERNNDEZ MORN
MANAGEMENT

Figure 821 Algorithm for management of advanced (stage III or IV) vulvar cancer.
GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007
DR. PEDRO HERNNDEZ MORN
SURGICAL TECHNIQUE

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

GYNECOLOGIC ONCOLOGY Berek and Hacker's 6th Edition 2015

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

TECHNIQUE OF RADICAL VULVECTOMY FOR CARCINOMA OF THE VULVA, GRAY

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811, contd F, Vagina being separated from the rectum. G, Clamping the ischiocavernosus
muscle and the crura of the clitoris. H, Molulized specimen is prepared for excision. I, Excision
along the inner margin of the specimen.
GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811, contd F, Vagina being separated from the rectum. G, Clamping the ischiocavernosus
muscle and the crura of the clitoris. H, Molulized specimen is prepared for excision. I, Excision
along the inner margin of the specimen.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

Surgical Techniques for Vulvar Cancer, Neville F. Hacker, MD Penny Blomfield, MD. ESGO 2010

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

GYNECOLOGIC ONCOLOGY Berek and Hacker's 6th Edition 2015


Surgical Techniques for Vulvar Cancer, Neville F. Hacker, MD Penny Blomfield, MD. ESGO 2010

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

GYNECOLOGIC ONCOLOGY Berek and Hacker's 6th Edition 2015


Surgical Techniques for Vulvar Cancer, Neville F. Hacker, MD Penny Blomfield, MD. ESGO 2010

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

GYNECOLOGIC ONCOLOGY Berek and Hacker's 6th Edition 2015


Surgical Techniques for Vulvar Cancer, Neville F. Hacker, MD Penny Blomfield, MD. ESGO 2010

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

DR. PEDRO HERNNDEZ MORN


GYNECOLOGIC ONCOLOGY Berek and Hacker's 6th Edition 2015

DR. PEDRO HERNNDEZ MORN


DR. PEDRO HERNNDEZ MORN
SURGICAL TECHNIQUES

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUES

DR. PEDRO HERNNDEZ MORN


DR. PEDRO HERNNDEZ MORN
SURGICAL TECHNIQUES

DR. PEDRO HERNNDEZ MORN


LINFTICOS EN VULVA

DR. PEDRO HERNNDEZ MORN


COMPROMISO GANGLIONAR

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811 A, Groin incision for moderate-sized lesions. B, Groin incision for a patient with a
matted left inguinal node. C and D, Vulvar incision along the genitocrural fold. E, Clamping the
perivaginal tissue.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811 A, Groin incision for moderate-sized lesions. B, Groin incision for a patient with a
matted left inguinal node. C and D, Vulvar incision along the genitocrural fold. E, Clamping the
perivaginal tissue.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811 A, Groin incision for moderate-sized lesions. B, Groin incision for a patient with a
matted left inguinal node. C and D, Vulvar incision along the genitocrural fold. E, Clamping the
perivaginal tissue.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811, contd F, Vagina being separated from the rectum. G, Clamping the ischiocavernosus
muscle and the crura of the clitoris. H, Molulized specimen is prepared for excision. I, Excision
along the inner margin of the specimen.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811, contd F, Vagina being separated from the rectum. G, Clamping the ischiocavernosus
muscle and the crura of the clitoris. H, Molulized specimen is prepared for excision. I, Excision
along the inner margin of the specimen.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 811, contd F, Vagina being separated from the rectum. G, Clamping the ischiocavernosus
muscle and the crura of the clitoris. H, Molulized specimen is prepared for excision. I, Excision
along the inner margin of the specimen.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 816 Incision can be made as noted so that superficial inguinal nodes can be removed
easily. (Modified from Cabanas RM: An approach to the treatment of penile carcinoma. Cancer
39:456, 1977. Copyright 1977 American Cancer Society. Reprinted by permission of Wiley-Liss,
Inc., a subsidiary of John Wiley & Sons, Inc.)

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 817 Many inguinal nodes are located between the Camper fascia and the cribriform fascia, as noted on
crosssection through the femoral triangle. Additional nodes are clustered in the
foramen ovalis, in the part protruding from beneath the plane of the cribriform fascia. (Modified from Cabanas RM:
An approach to the treatment of penile carcinoma. Cancer 39:456, 1977. Copyright 1977 American Cancer
Society. Reprinted by permission of Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc.)

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

Figure 818 The right side demonstrates the two groups of lymph nodes making up the sentinel nodes. The left
side notes the limits of the dissection with the cribriform fascia removed. The triangle that is dissected in a full
inguinal lymphadenectomy is clearly identified on the patients left side. The inguinal ligament forms the base
of the triangle, and the opening of Hunters canal becomes the apex. The triangle is bound laterally by the
sartorius muscle and medially by the adductor muscles and fascia.

GYNECOLOGIC ONCOLOGY CLINICAL DISAIA-CREASMAN 7th Edition 2007

DR. PEDRO HERNNDEZ MORN


SURGICAL TECHNIQUE

GYNECOLOGIC ONCOLOGY Berek and Hacker's 6th Edition 2015

DR. PEDRO HERNNDEZ MORN


METSTASIS GANGLIONAR
Segn profundidad de la invasin

Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.

DR. PEDRO HERNNDEZ MORN


SURVIVAL
The 5-year survival rates after surgery for vulvar cancer
are as follows:

Gynecologic Oncology, Berek and Hackers, 6th Edition, 2015


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Warner K 2013.

DR. PEDRO HERNNDEZ MORN


SURVIVAL

Gynecologic Oncology, Berek and Hackers, 6th Edition, 2015


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Warner K 2013.

DR. PEDRO HERNNDEZ MORN


SURVIVAL VS LYMPH NODE STATUS

Gynecologic Oncology, Berek and Hackers, 6th Edition, 2015


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Warner K 2013.

DR. PEDRO HERNNDEZ MORN


SEGUIMIENTO

Gynecologic Oncology, Berek and Hackers, 6th Edition, 2015


Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Warner K 2013.

DR. PEDRO HERNNDEZ MORN


INEN

Dr. PEDRO HERNNDEZ MORN

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