carcinoma of the vulva

carcinoma of the vulva

clinipicture
symptoms
1-chronic vulval irritation
2-pruritic vulval lesion
3-painful lesion
4-bleeding if ulceration has occured
5-mass may be present
signs
1-general:cachexia,loss of weight,pallor,anemia
2-abdominal:signs of matastasis(ascities,liver mass)
3-local:1-malignant ulcer with raised everted edge
2-kissing ulcer if in both vulva
3-vulval mass
4-enlarged inguinal lymph nodes
investigation
1-colposcopy
2-biobsy
3-additional inv(chest x-ray,ct,mri,cystoscopy,proctoscopy)
managment
1-correction of general condition
2-surgery
a-if tumer less 2cm
do local exision of lesion with safty margin 1cm laterally and down to inferior fascia
b-if lesion more than 2cm
1-in central large lesion;
do modified radical vulvectomy
2-in lateralized lesion:
do modified radical hemivulvectomy
c-tumer with spread to inguinal lymphnode
do modified radical vulvectomy and bilateral inguinal and femoral lymphadenectomy
and it may be followed by external radiation
d-if advanced disease
1-palliative surgery and may be followed by skin and muscular graftingfor extensive lesion
2-palliative radiotherapy
3-palliative chemotherapy