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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Metastases to inguinofemoral lymph nodes in patients with carcinoma of the vulva alter the prognosis and treatment of this disease. Our goal was to determine if immunohistochemical staining could reveal occult metastatic nodal disease not detected with routine hematoxylin and eosin staining. We retrospectively examined a total of 110 lymph nodes from 10 patients who had undergone lymph node dissection and found to have all negative nodes. Paraffin embedded lymph nodes were immunostained with a monoclonal antibody directed against multiple low- and high-molecular weight cytokeratins. Micrometastases were not detected in any lymph nodes examined with immunohistochemistry. All positive and negative controls yielded satisfactory results. It is concluded that immunohistochemistry with cytokeratin antibodies does not provide greater sensitivity than routine hematoxylin and eosin staining for the detection of nodal metastases in vulvar carcinoma.
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PMID:Screening for occult nodal metastasis in squamous cell carcinoma of the vulva. 1090 73

A substantial proportion of all women dying from gynaecological malignancies are aged >75 years. Many reports have indicated that the survival of these patients is decreased compared with younger patients. Differences in biological behaviour, stage of the disease at presentation, and reluctance to undergo aggressive treatment with its associated morbidity are among the factors thought to be responsible for this difference in outcomes. However, investigations also indicate that elderly patients may receive less surgical and chemotherapeutic treatment without obvious clinical rationale. This overview is aimed at providing a guideline of chemotherapy appropriate for patients with epithelial ovarian, uterine (corpus and cervix), and vulvar cancer, aged 70 to 75 years and over. Platinum-based chemotherapy is the cornerstone of drug treatment in patients with ovarian cancer. Patients aged between 70 and 75 years with a good performance status can be treated with cisplatin- or carboplatin-based chemotherapy. Carboplatin, either in combination or as a single-agent, may offer advantages in patients aged >75 years and in those with a poor performance status. For patients with early recurrence there is no standard treatment, but several cytostatic and hormonal agents can be used with palliative intent. Patients with a late recurrence are probably best retreated with a platinum-based regimen. In metastatic endometrial cancer, hormonal therapy is the first choice in tumours expressing a progesterone receptor. Poorly differentiated tumours infrequently respond to endocrine therapy. In this situation, and for patients with tumours that have become resistant to hormonal manipulation, platinum-based chemotherapy may be used. The use of carboplatin-based regimens seems preferable in elderly patients, particularly in those with a decreased performance status. The usefulness of chemotherapy in elderly patients with cervical cancer is limited. In case of recurrent or metastatic disease, the use of single agent (low-dose) cisplatin should be balanced against best supportive care. Although overall chemoradiation seems superior than radiotherapy alone in patients with locally advanced cervical cancer, the feasibility of this approach in elderly patients needs further investigation. Chemoradiation might also be considered in patients with locally advanced vulvar cancer. However, treatment-related morbidity can be considerable and randomised studies are lacking to prove a survival benefit. Our understanding of the tolerance and effectiveness of chemotherapy in elderly patients is still incomplete due to a paucity of trials that specifically focus on this subset of patients. However, there appears no argument to withhold chemotherapy based purely on age.
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PMID:Drug therapy for gynaecological cancer in older women. 1093 13

Rose PG. Skin bridge recurrences in vulvar cancer: frequency and management. The use of separate groin incisions has markedly reduced the rate of wound breakdown from radical vulvectomy. This retrospective review was undertaken to evaluate the frequency and management of skin bridge recurrences. Five cases of skin bridge recurrence in vulvar cancer were identified among 128 patients. Patient demographics, pathology, recurrence management, and follow-up were obtained from operative and clinical records and tumor registries. Five cases of isolated skin bridge recurrence were studied, of which four patients had squamous cancer and one melanoma. Excluding one case referred at recurrence, this occurred in 2.4% of patients with squamous cell carcinoma and was more common in patients with positive nodes 3 of 41 patients versus 0 of 85, relative risk 3.07 (95% confidence interval 2.39-3.95). The median time to recurrence following surgery was 4.0 months (range 1-47 months). Four recurrences were treated by radical local excision alone, but 3 had already received radiation therapy. One patient developed a second skin bridge recurrence and was treated with a second radical local excision. Three patients are alive and recurrence-free 38+ to 56+ months (median 51+ months) following treatment for recurrence. Skin bridge recurrences are rare and more common in patients with inguinal node metastasis. Local excision with or without radiation therapy is the most common therapy that has been employed. In the absence of other metastases local excision is associated with a good recurrence-free survival.
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PMID:Skin bridge recurrences in vulvar cancer: frequency and management. 1124 Aug 20

One hundred and thirty-one squamous cell carcinomas of the vulva were examined by FCM-DNA measurements. Samples were prepared from paraffin-embedded tissue. Of these, 66 were found to be diploid, 52 aneuploid and 13 could not be evaluated. The 5-year crude survival rate was 62% for the diploid and 23% for the aneuploid tumors (P < 0.001). The aneuploid tumors without lymph node (LN) metastases showed a 5-year cancer-related survival rate of 44% as compared to 58% for the diploid tumors with LN metastases. In a multivariate Cox regression analysis the most important independent prognostic parameters were (1) LN involvement (P < 0.0001), (2) tumor ploidy (P = 0.0001) and (3) tumor size (P = 0.0039). By using ploidy and lymph node involvement in this way as prognostic factors we are able to identify high- and low-risk groups of patients. We strongly believe that these results should lead to a different attitude towards therapy in vulva cancer patients.
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PMID:Flow cytometric DNA measurements in squamous cell carcinoma of the vulva: an important prognostic method. 1157 55

Over a 6-year period 100 patients with vulvar cancer were treated by radical vulvectomy and bilateral inguinal femoral lymphadenectomy performed through separate incisions. The average age of the patients was 68.8 years. Ninety patients had squamous carcinoma, six had melanoma and four had other vulvar malignancies. FIGO staging was stage 1-46, stage II-25, and stage III-23, and stage IVa-6. Twenty-seven patients were found to have spread of tumor to groin nodes, 21 unilateral and six bilateral. For patients with squamous carcinomas, groin nodes were positive in four of 45 (8.9%) with tumor diameter < 2 cm vs. 17 of 42 (40.5%) with tumors> 2 cm. In 60 patients with unilateral squamous tumors, no isolated contralateral node metastases were found, however two of 13 patients (15.4%) with positive ipsilateral nodes had positive contralateral nodes also. One patient with negative nodes developed bilateral recurrent tumor in the skin bridges and subsequently died. Overall 5-year survival corrected for death from intercurrent illness was 74.6%. Corrected survival by stage for squamous carcinomas was as follows: stage I-96.7%, stage II-85%, stage III-45.8% and stage IV-50%.
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PMID:Radical vulvectomy and bilateral inguinal-femoral lymphadenectomy through separate incisions-experience with 100 cases. 1157 18

Adenoid cystic carcinoma of the Bartholin's gland has been encountered in 11 patients at the University of Michigan Medical Center since 1936. At the time of presentation the average age was 48.9 years, the lesion size was between 0.5 to 4 cm. The presenting symptoms were pain and/or pruritis associated with a solitary mass. Early in this series, excisional biopsy was used to treat eight patients. The last three patients have been treated with a radical vulvectomy and unilateral or bilateral groin lymph node dissection. Local recurrence has occurred in five patients and distant recurrence in four patients. In spite of the high recurrence rate, 5- and 10-year survival has been high with all seven evaluable patients surviving 5 and 10 years. However, adenoid cystic carcinoma of the vulva is associated with late recurrences and metastases: three patients were dead of disease at 12, 15 and 31 years after initial diagnosis.
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PMID:Adenoid cystic carcinoma of the Bartholin's gland: the University of Michigan experience. 1157 98

Current radiographic techniques are useful for evaluating and managing patients with gynecologic malignancies. Lymphoscintigraphy may prove useful in limiting surgery in women with vulvar cancer who have negative sentinel groin nodes. Selected patients benefit from pretherapy MRI scanning to help determine treatment of cervical or endometrial malignancies. Sonographic techniques are helpful in discriminating benign from malignant adnexal or pelvic masses, and preoperative CT scans are helpful in determining the extent of advanced ovarian cancer. The FDG PET scans appear to help localize occult disease in patients with a variety of gynecologic malignancies. Further refinements of currently available techniques or newer techniques, however, are needed to increase the sensitivity for detection of subclinical or microscopic metastases in patients with gynecologic malignancies.
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PMID:Radiographic imaging in gynecologic oncology. 1168 74

Evidence from recent studies indicates that the technique of sentinel node biopsy might be a useful solution for detecting lymph node status for primary vulvar cancer without having to perform radical inguinal lymphadenectomy. The patient in this report underwent sentinel node biopsy, then bilateral inguino-femoral node dissection, and, lastly, radical vulvectomy. The histologic analysis showed a well differentiated squamous cell carcinoma with metastases in one right inguinal node and one left inguinal node and a false-negative right sentinel node. Technically the biopsy of groin sentinel nodes should be quite easy to perform. The use of preoperative lymphoscintigraphy and the intraoperative use of the gamma probe combined with blue dye helps considerably in identifying lymphatic drainage and the sentinel node for vulvar cancer. Further results are needed to confirm the value of sentinel node dissection in the treatment of early stage vulvar cancer.
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PMID:False-negative sentinel node in patients with vulvar cancer: a case study. 1280 Dec 69

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified.
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PMID:Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. 1291 32

Vulvar cancer is a rare disease. Squamous-cell carcinomas account for 90% of vulvar cancers. The main mode of spread is lymphogenic to the inguinofemoral lymph nodes. Therefore, elective uni- or bilateral inguinofemoral lymphadenectomy is part of the standard treatment in combination with radical (wide) local excision of the vulvar tumour. Lymph drainage studies in relation to the biological behaviour of vulvar cancer are presented, as well as the anatomy and surgery of the groin. The sentinel lymph node procedure is a relatively new method of staging in vulvar cancer which may lead to the omission of inguinofemoral lymphadenectomy in those patients identified as not having inguinofemoral lymph node metastases. The accuracy of this technique appears to be high, but its safety still has to be proven. Moreover, the role of additional histopathological techniques for the examination of the sentinel lymph nodes needs to be established.
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PMID:Groin surgery and the sentinel lymph node. 1296 33


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