A 28 year old woman diagnosed with vulvar carcinoma. The lesion is on right labia, away from midline and measures 3 cm with stromal invasion of 2mm with no inguinal lymph nodes. Treatment is?
VULVAL CARCINOMA: STAGING AND MANAGEMENT STAGE 1 1A Limited to vulva/perineumSize<=2cm stromal invasion <=1mm Wide local excision 1B Size >2cm stromal invasion >1mm Radical local excision plusB/L LAD: central lesionU/L LAD: lateral lesion (>2cm from midline) STAGE 2 Any sizeSpreads to lower 1/3 urethra, lower 1/3 vagina, anus Early: radical excision/ radical vulvectomy plus B/L LADAdvanced: radiation + surgery + LAD STAGE 3 Positive inguinofemoral lymph nodes Radiation + surgery + LAD STAGE 4 A 4B Upper urethra, upper vagina, bladder, rectum, pelvis side wallDistant metastasis, Pelvic or other lymph nodes Radiation + surgery + LAD LAD= lymphadenectomy This is stage iB (tumour size >2 cm with stromal invasion >1mm and no nodal involvement The lesion is lateral, not involving midline structures like clitoris or urethra Treatment of this stage is radical local excision with a tumor free margin of 1 cm with ipsilateral lymph node dissection. Bilateral lymph node dissection is done when midline structures are involved.
Wide local excision
Radical local excision with 1 cm tumor free margin with ipsilateral lymph node dissection
Radical local excision with 1 cm tumor free margin with bilateral lymph node dissection
Radical local excision without LN dissection
Vulvar cancer