The vulval carcinoma will metastasize commonly into :
Spread of the vulval Tumour : The tumour proliferates mainly by direct spread to the adjacent organs and by the lymphatics; blood-borne metastases are rare. Parry Jones was the first to describe the lymphatic spread that occurs in a systematic manner. At first, the superficial inguinal nodes are involved through lymphatic emboli, but later lymphatic channel permeation occurs causing lymphatic blockage and leg oedema. The malignancy spreads to deep nodes and the gland of Cloquet (uppermost of the femoral or the lowermost of the external iliac gland) to the external iliac glands, obturator and common iliac nodes in the advanced stages. Laterally placed tumours rarely spread to the contralateral inguinal glands, but centrally located lesion involves the lymph nodes of the opposite side in 25% cases and this is because of crossing of lymphatics in the midline. Lymph nodes not clinically suspicious may show metastasis in about 25% cases. Inguinal lymph nodes are involved in 10% in Stage I, 30% in Stage II, 70% in Stage III and 100% cases in Stage IV. Lymphatics of the clitoris drain directly into the pelvic lymph nodes. The regional lymph nodes are assessed by MRI and PET. The involvement of the lymph nodes depends upon the site of the lesion, its size and depth of invasion. Reference : Shaw's Textbook of Gynaecology 16th edition page no 479
Para-aoic group of lymph nodes
Internal iliac group of lymph nodes
External iliac group of lymph nodes
Superficial inguinal group of lymph nodes
Gynaecological oncology