Ebook Principles and practice of gynecologic oncology: Part 2
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Ebook Principles and practice of gynecologic oncology: Part 2
SECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2lva are rare and account for less than 5% of all cancers of the female genữal tract. In 2015. there were art estimated 5.150 new cases of and 1.080 deaths from invasive vulvar carcinoma m the United States (1). Because of is low incidence, most primary care providers will never encounter a patient w Ebook Principles and practice of gynecologic oncology: Part 2all vulvar cancer. Although a rare patient with vulvar cancer will present without symptoms, most women with vulvar cancer initially present with compEbook Principles and practice of gynecologic oncology: Part 2
laints such as vulvar irritation, pruritus, pain, or a mass that does not resolve. The interval between the onset of symptoms and the diagnosis of canSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2 without a proper physical examination or tissue biopsy confirmation. Jones and Joiua (2) evaluated the clinical events preceding the diagnosis of squamous cell carcinoma of the vulva and found that 88% of patients had experienced symptoms for more than 6 months. 31% of women had three or more medic Ebook Principles and practice of gynecologic oncology: Part 2al consultations before the diagnosis of vulvar carcinoma, and 27% had applied topical estrogen or corticosteroids to the vulva.The vulva is covered bEbook Principles and practice of gynecologic oncology: Part 2
y keratinized squamous epithelium: accordingly, most maliguant vulvar tumors are squamous cell carcinomas (SCCs). Consequently. our current understandSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2ant melanoma is the second most common cancel of the vulva. .Although there is some consensus regarding the behavior and treatment of vulvar melanoma, its rarity has thus far precluded robust, prospective chnical trials A number of other malignant tumors, both epithelial and stromal m origin, arise Ebook Principles and practice of gynecologic oncology: Part 2from normal vulvar tissue and are discussed in detail later in this chapter. Fmally. the vulva may be secondarily involved with malignant disease origEbook Principles and practice of gynecologic oncology: Part 2
inating in the cervix, bladder, anorecnun. colon, breast, or other organs.The traditional therapeutic approach to vulval- cancer has been radical surgSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2erative radiation therapy (RT) to selected patients deemed to be at high risk for locoregional failure. More recently, the use of neoadjuvant radiotherapy (RT) with concomitant radiosensmzing chemotherapy (CT) has proven to be effective m treating vulvar cancer patients for whom radical surgery woul Ebook Principles and practice of gynecologic oncology: Part 2d be either too morbid or technically not feasible. New surgical techniques. Deluding sentinel lymph node (SLN) biopsy, hold the promise of better outEbook Principles and practice of gynecologic oncology: Part 2
comes for patients with early disease. An individualized approach to vulvar cancer management, often employing multiple modalities in an effort to achSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2e principles of management of women with vulvar cancer.ANATOMY833The vulva consists of the external genital organs—including the moils pubis, labia minora and majors. clitoris, vaginal vestibule, and perineal body—and then supporting subcutaneous tissues. The vulva is bordered superiorly by the ante Ebook Principles and practice of gynecologic oncology: Part 2rior' abdominal wall, laterally by the Libiocnrral told at the medial thigh, and inferiorly by the anus. The vagina and urethra open onto the vulva. TEbook Principles and practice of gynecologic oncology: Part 2
he tnons pubis is a prominent mound of hair-bearing skin and subcutaneous adipose and connective tissue that is located anterior to the pubic symphysiSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2 smaller pan of skin folds medial and parallel to the labia rnajora that extend inferiorly Io form the margin of the vaginal vestibule. Superiorly, the labia minora separate into two components that course above and below the clitoris, fttsing with those of the opposite side to form the prepuce and Ebook Principles and practice of gynecologic oncology: Part 2frenulum, respectively, rhe skin of the labia minora contains sebaceous glands near its junction with the labia majors. but it is not hair-bearing andEbook Principles and practice of gynecologic oncology: Part 2
it has little or no underlying adipose tissue. The clitoris is supported externally by rhe frrsion of the labia minora (prqiuce and frenulum) and is SECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2firsed corpora cavernosa form the body of the clitoris and extend superiorly- from the glans, ultimately- dividing into the two crura. The crura course laterally beneath the ischiocavciiiosus muscles ami attach to the ischial rami.The vaginal vestibule is situated in the center of the vulva and is h Ebook Principles and practice of gynecologic oncology: Part 2omologous to the male distal urethra. It has squamous mucosal qnlhciiiim that is demar cated bilaterally and posteriorly by the junction with the keraEbook Principles and practice of gynecologic oncology: Part 2
tinized epithelium at Hart's line, located on the medial labia mmora and inferiorly on rhe perineal body. The vagina, urethra, periurethral glands, miSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2bular mucosa and open onto its surface, predominantly on the more anterior vestibule. The vestibular bulbs, a loose collection of bilateral erectile tissue covered superficially by the bulbocavernosus muscle, are located laterally. The Bartholin glands, two small, inucus-secretmg glands situated wit Ebook Principles and practice of gynecologic oncology: Part 2hin the subcutaneous tissue of the posterior labia majora. have ducts opening onto the posterolateral portion of the vestibule. The perineal body is aEbook Principles and practice of gynecologic oncology: Part 2
3 to 4 cm band of skin and subcutaneous tissue located between the poster ior extensions of the Libia majora. It separ ates the vaginal vestibule froSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2rom the internal pudendal artery, which arises from the anterior division of the internal diac (hypogastric) artery, and the superficial and deep external pudendal arteries, which arise from the femoral artery. The internal pudendal artery exits the pelvis and passes behind the ischial spine Io reac Ebook Principles and practice of gynecologic oncology: Part 2h the posterolateral vulva, where it divides into several small branches Io the jschiocavcrnosns and bulbocavernosus muscles, the perineal artery, artEbook Principles and practice of gynecologic oncology: Part 2
ery of the bulb, urethral artery, and dorsal and deep arteries of the clitoris. Doth external pudenda] arteries travel medially Io supply the Libia maSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2rom multiple sources and spinal cord levels. The limns pubis arid lipper labia majors are nmervalcd by the ilioinguinsl nerve (1.1) and lire genital branch of the genitofemoral nerve (1.1-2). Hillier of these nerves may be easily injured during pelvic lymph node dissection, w ith resulting paresthes Ebook Principles and practice of gynecologic oncology: Part 2ias. The pudendal nerve (S2 4) enters rhe vulva parallel to the internal pudendal artery and gives rise to several branches that nmcrvslc the lower vaEbook Principles and practice of gynecologic oncology: Part 2
gina, labia. clitoris. pernieal body, and then- supporting structures.Groin Anatomy and Lymphatic DrainageVulvar lymphatics run anteriorly through theSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2ulvar lymphatic channels do not extend lateralis' to the labioemrai folds and do not cross the inidline, unless the site of dye injection is at the clitoris or perineal body (3).The vulvar lymphatics drain to the superficial inguinal LNs located within the femoral uiangle formed by the inguinal liga Ebook Principles and practice of gynecologic oncology: Part 2ment superiorly, the border of the Sartorius muscle laterally, and the border of the adductor longus muscle medial!}'.834There are 8 to 10 inguinal LNEbook Principles and practice of gynecologic oncology: Part 2
s tying along the saphenous vein and ữs branches between Camper 's fascia and fascia overtying the femoral vessels (Fig. 18.1A-C) (3). The fust drainiSECTION inDisease Sites832CHAPTER 18 VulvaEmily Penick, Sushil Beriwal, Edward J. Wilkinson and John w.Moroney*INTRODUCTIONMalignant tumors of the vul Ebook Principles and practice of gynecologic oncology: Part 2e adductor muscle. Second echelon LNs may be in the groin or pelvis. The Cloquet's node, or the most superior inguinal LN. is located under the inguinal ligament. Lymphatic drainage from the SLN K sequential to the external iliac, common iliac, and aortic LNs (Fig. 18.1A-C).Superficial epigastric ve Ebook Principles and practice of gynecologic oncology: Part 2inInguinal ligamentSentinel lymph nodesGreat saphenous veinAOpening of Hunter s canalSuperficial circumflex iliac vein— Femoral veinLateral accessoryEbook Principles and practice of gynecologic oncology: Part 2
saphenous vein835836Gọi ngay
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