Obstetrics & Gynecology>>>>>Benign and Malignant Disorders of the Breast and Pelvis
Question 9#

A woman is found to have a unilateral invasive vulvar carcinoma that is 3 cm in diameter but not associated with evidence of lymph node spread.

Initial management should consist of which of the following?

A. Chemotherapy
B. Radiation therapy
C. Simple vulvectomy
D. Radical vulvectomy with bilateral lymphadenectomy
E. Radical local excision and ipsilateral inguinal lymphadenectomy

Correct Answer is E

Comment:

Women who have invasive vulvar carcinoma usually are treated surgically. Tumors larger than 2 cm are staged as IB. If the lesion is unilateral, is not associated with fixed or ulcerated inguinal lymph nodes, and does not involve the urethra, vagina, anus, or rectum, then treatment usually consists of radical excision and unilateral inguinal lymphadenectomy. The risk of inguinal node metastasis is around 8%. Inguinal lymphadenectomy involves removal of the superficial inguinal and deep femoral lymph nodes. Unilateral rather than bilateral lymphadenectomy decreases postoperative morbidity. The lymph nodes should be sent intraoperatively for frozen section, and if positive, a bilateral lymphadenectomy should be performed. Radiation therapy, though not a routine part of the management of women who have early vulvar carcinoma, is employed in the treatment of women who have local, advanced carcinoma.