Outcome and Patterns of Recurrence for International Federation of Gynecology and Obstetrics (FIGO) Stages I and II Squamous Cell Vulvar Cancer
ABSTRACT To study patterns of recurrence, to evaluate pathologic features correlating with recurrence, and to estimate the prognostic implications for each different pattern of recurrence in the International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer.
This was a retrospective study of 121 cases of vulvar cancer managed at our institution from 1987 to 2005. Time to recurrence, sites of local and distant recurrence, and the type of surgery were recorded. Relapse-free and overall survival were calculated.
There was no difference in recurrence rates, time to recurrence, or survival between patients with FIGO stages I or II disease. The 5-year actuarial survival (corrected for competing risks) for stage I disease was 97% compared with 95% for stage II (P=.83). Progression-free survival at 5 years was 86% for stage I and 94% for stage II.In this study, 95.9% of patients were treated with vulvar-conserving surgery without detriment with respect to recurrence or survival.
Vulvar-conserving surgery, even for large tumors, results in excellent outcomes. Vulvar recurrences have an excellent prognosis, but primary site and remote site vulvar recurrences are biologically different. There is no justification for the FIGO differentiation of node-negative cancers confined to the vulva on the basis of tumor size.
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ABSTRACT: The terminology for human papillomavirus (HPV)-associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care.Journal of Lower Genital Tract Disease 07/2012; 16(3):205-42. DOI:10.1097/LGT.0b013e31825c31dd · 1.11 Impact Factor
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ABSTRACT: Vulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders. Squamous cell carcinoma (SCC) is the most common malignant tumor of the vulva (95%). Pruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain. The gold standard for even a small invasive carcinoma of the vulva was historically radical vulvectomy with removal of the tumor with a wide margin followed by an en bloc resection of the inguinal and often the pelvic lymph nodes. Currently, a more individualized and less radical treatment is suggested: a radical wide local excision is possible in the case of localized lesions (T1). A sentinel lymph node (SLN) biopsy may be performed to reduce wound complications and lymphedema. The survival of patients with vulvar cancer is good when convenient therapy is arranged quickly after initial diagnosis. Inguinal and/or femoral node involvement is the most significant prognostic factor for survival.International Journal of Women's Health 01/2015; 7:305-13. DOI:10.2147/IJWH.S68979
Article: Revised FIGO Staging System[Show abstract] [Hide abstract]
ABSTRACT: The International Federation of Gynecology and Obstetrics (FIGO) updated the staging system for carcinoma of the vulva, cervix, and endometrium in 2009. A new staging system for uterine sarcoma has been designed. This review summarizes the changes. There were minor changes in carcinoma of endometrium and cervix. The staging systems for uterine sarcomas were newly developed. Major changes were made for the carcinoma of vulva. There were no changes for cancer of the ovary, tube, vagina, and gestational trophoblastic neoplasia.Journal of the Korean Medical Association 01/2010; 53(3). DOI:10.5124/jkma.2010.53.3.245 · 0.18 Impact Factor