Beruflich Dokumente
Kultur Dokumente
DIAGNSTICO Y TRATAMIENTO
Dr. PEDRO HERNNDEZ MORN
CIRUJANO ONCLOGO
GINECLOGO ONCLOGO
Instituto Regional de Enfermedades Neoplsicas
IREN NORTE
2015
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.
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.
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.
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.
FIGO staging for carcinoma of the vulva, cervix, and endometrium, Sergio Pecorelli,
Chairman, IJGO 2009.
FIGO staging for carcinoma of the vulva, cervix, and endometrium, Sergio Pecorelli,
Chairman, IJGO 2009.
Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.
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.
T1 T2
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.
DR. PEDRO HERNNDEZ MORN
MANAGEMENT
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.
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.
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.
Cancer of the vulva; Neville F. Hacker a, Patricia J. Eifel b, Jacobus van der
Veldenc, FIGO 2012.
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
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
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.
Surgical Techniques for Vulvar Cancer, Neville F. Hacker, MD Penny Blomfield, MD. ESGO 2010
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.
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.
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.
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.
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.
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.
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.)
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.)
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.
Surgical Treatment of Vulvar Cancer, Robert V Higgins, MD; Chief Editor: Warner K Huh, MD
Aug 27, 2013.