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Vulvar and Vaginal Cancer
Brad Perry, MD; Paige Bennett, MD
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KEY FACTS

  • Imaging

    • Diagnostic Checklist

      TERMINOLOGY

      • Definitions

        • Vulvar cancer: Squamous cell carcinoma most common
          • Primary tumor: Most often labia majora; other sites include labia minora, perineum, clitoris, mons
          • Regional spread: Involvement of adjacent structures (vagina, urethra, anus)
            • Sensitivity 80%, specificity 90%, NPV 80% for lymph node metastases
            • PET/CT most beneficial to assess radiation response of groin lymph nodes
          • Lymphatic spread: Inguinal-femoral nodes initially, then pelvic nodes
          • Hematogenous spread: Rare, only in advanced disease; lung most common
        • Vaginal cancer: Squamous cell carcinoma most common (also, adenocarcinoma, sarcoma, and melanoma)
          • Primary tumor in vaginal wall (lesion in middle or lower 1/3 of vagina is poor prognostic factor)
          • Regional spread: Invasion of paravaginal tissues, parametria, bladder and rectal mucosa
          • Lymphatic spread: Upper 1/3 → pelvic, lower 2/3 → inguinal, posterior tumors → deep pelvic
          • Hematogenous spread: Lung most common, less frequently liver and bone

      IMAGING

      • General Features

        • F-18 FDG PET/CT Findings

          • MR Findings

            DIFFERENTIAL DIAGNOSIS

              PATHOLOGY

              • Staging, Grading, & Classification

                CLINICAL ISSUES

                • Presentation

                  • Demographics

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          Selected References

                          1. Oldan JD et al: Positron emission tomography/computed tomography for gynecologic malignancies. Obstet Gynecol Surv. 71(9):545-56, 2016
                          2. Basu S et al: PET and PET-CT imaging of gynecological malignancies: present role and future promise. Expert Rev Anticancer Ther. 9(1):75-96, 2009
                          3. Stehman FB et al: Carcinoma of the vulva. Obstet Gynecol. 107(3):719-33, 2006
                          4. Yen TC et al: Positron emission tomography in gynecologic cancer. Semin Nucl Med. 36(1):93-104, 2006
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Imaging

                            • Diagnostic Checklist

                              TERMINOLOGY

                              • Definitions

                                • Vulvar cancer: Squamous cell carcinoma most common
                                  • Primary tumor: Most often labia majora; other sites include labia minora, perineum, clitoris, mons
                                  • Regional spread: Involvement of adjacent structures (vagina, urethra, anus)
                                    • Sensitivity 80%, specificity 90%, NPV 80% for lymph node metastases
                                    • PET/CT most beneficial to assess radiation response of groin lymph nodes
                                  • Lymphatic spread: Inguinal-femoral nodes initially, then pelvic nodes
                                  • Hematogenous spread: Rare, only in advanced disease; lung most common
                                • Vaginal cancer: Squamous cell carcinoma most common (also, adenocarcinoma, sarcoma, and melanoma)
                                  • Primary tumor in vaginal wall (lesion in middle or lower 1/3 of vagina is poor prognostic factor)
                                  • Regional spread: Invasion of paravaginal tissues, parametria, bladder and rectal mucosa
                                  • Lymphatic spread: Upper 1/3 → pelvic, lower 2/3 → inguinal, posterior tumors → deep pelvic
                                  • Hematogenous spread: Lung most common, less frequently liver and bone

                              IMAGING

                              • General Features

                                • F-18 FDG PET/CT Findings

                                  • MR Findings

                                    DIFFERENTIAL DIAGNOSIS

                                      PATHOLOGY

                                      • Staging, Grading, & Classification

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Consider

                                                  Selected References

                                                  1. Oldan JD et al: Positron emission tomography/computed tomography for gynecologic malignancies. Obstet Gynecol Surv. 71(9):545-56, 2016
                                                  2. Basu S et al: PET and PET-CT imaging of gynecological malignancies: present role and future promise. Expert Rev Anticancer Ther. 9(1):75-96, 2009
                                                  3. Stehman FB et al: Carcinoma of the vulva. Obstet Gynecol. 107(3):719-33, 2006
                                                  4. Yen TC et al: Positron emission tomography in gynecologic cancer. Semin Nucl Med. 36(1):93-104, 2006