Carinoma Vulva

Summary:

92 old lady with recurrent VIN III of Vulva.

Carinoma Vulva

Nikhilesh Patil 22 Feb 2010 04:13

92 yrs elderly lady, KPS 70/80 %,diagnosed of carcinoma vulva 1983 which was treated surgically, had several recurrence which were all salvaged surgically. Most recent surgery April 2009 (4.7 cms x 3cms tumor, depth 1.9cms Sq.ca ) had wound healing issues till Nov-Dec 2009. Now has local recurrence on left vulva clinically 5cm x 3cms, max depth 2cms which is painful, discharge and minimal oozing, repeat biopsy VIN III, B/L pedal odema due to her prior GND. Co-morbidities DM,HT,IHD all controlled. Several allergies—-including erythromycin,penicillin,domperidone, codeine,docusate sodium, phytoin and many other drugs. No lymph node palpable. CT scans normal except the primary area which is not very clearly visualized.

How would you treat this lady, options ?

Re: Carinoma Vulva

Harsha Dod 22 Feb 2010 08:18

LASER EXCISION????

Re: Carinoma Vulva

Nikhilesh Patil 22 Feb 2010 19:07

Laser is not an option in this case, 2 cms depth. We are planning her with en-face electrons, dose 30Gy/10#.

Re: Carinoma Vulva

Rohit Malde 22 Feb 2010 20:16

If surgeon happy to do wide local excision - best thing to do.
If not -> i agree best thing is 30Gy/10# as palliative option.

Re: Carinoma Vulva

Srinivas Chilukuri 25 Feb 2010 19:20

nikhilesh
I have a similar strange 73 yrs old patient who was diagnosed with ca cx II with minimal upper vaginal involvement treated with rad RT 6 months back and on follow up 3 months later was found to have multiple omental, liver mets and multiple para-aortic nodes. We gave her oral xeloda for 3 months and now she has come back with a large recurrence at the introitus involving lower few cm of vagina and labial edema. Locally she is controlled. She is complaining of severe pain and burning micturition. I am planning to give some palliative RT to her.

Re: Carinoma Vulva

Nikhilesh Patil 25 Feb 2010 19:56

Hi Srinivas, you are right, pleas give your pall RT for the mass. My patient will start treatment sometime in mid March (social problems, no support). Will let you guys know about the response.

Re: Carinoma Vulva

Rohit Malde 26 Feb 2010 04:10

Radical RT was given 6 months back. Wonder where are you giving RT and what Palliation is being acheived here.
for severe pain (? ? where locally) and burning micturition …..

This lady needs Best Supportive Care with analgesics, antibiotics if appropriate, laxatives and district nurse support.

Re: Carinoma Vulva

Srinivas Chilukuri 26 Feb 2010 10:54

Rohit
The answers to your questions:

1. RT is being given to lower vagina which was not included in the previous RT portal.

2. Palliation is in terms of pain I believe which the patient has due to local infiltration. the urine cultures have been done and they are sterile. Antibiotics and urine alkalizers were previously given by non-oncologist before she came to me. The pain is localized near introitus. She is on Morphine (45 mg per day) and tryptomer (30 mg in 3 divided doses). The pain relief is suboptimal. Other than these complaints she is frail but fit.