Gynecologic tumor board: a radiologist’s guide to vulvar and vaginal malignancies

Abstract

Primary vulvar and vaginal cancers are rare female genital tract malignancies which are staged using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging. These cancers account for approximately 2,700 deaths annually in the USA. The most common histologic subtype of both vulvar and vaginal cancers is squamous cell carcinoma, with an increasing role of the human papillomavirus (HPV) in a significant number of these tumors. Lymph node involvement is the hallmark of FIGO stage 3 vulvar cancer while pelvic sidewall involvement is the hallmark of FIGO stage 3 vaginal cancer. Imaging techniques include computed tomography (CT), positron emission tomography (PET)-CT, magnetic resonance imaging (MRI), and PET-MRI. MRI is the imaging modality of choice for preoperative clinical staging of nodal and metastatic involvement while PET-CT is helpful with assessing response to neoadjuvant treatment and for guiding patient management. Determining the pretreatment extent of disease has become more important due to modern tailored operative approaches and use of neoadjuvant chemoradiation therapy to reduce surgical morbidity. Moreover, imaging is used to determine the full extent of disease for radiation planning and for evaluating treatment response. Understanding the relevant anatomy of the vulva and vaginal regions and the associated lymphatic pathways is helpful to recognize the potential routes of spread and to correctly identify the appropriate FIGO stage. The purpose of this article is to review the clinical features, pathology, and current treatment strategies for vulvar and vaginal malignancies and to identify multimodality diagnostic imaging features of these gynecologic cancers, in conjunction with its respective 2009 FIGO staging system guidelines.

MRI in the Evaluation of Locally Advanced Vulvar Cancer Treated with Chemoradiotherapy and Vulvar Cancer Recurrence: The 2021 Revision of FIGO Classification and the Need for Multidisciplinary Management

“…Recognition of its benign nature is paramount, as it can mimic residual or recurrent disease. In the same way as muscle edema, myositis shows increased T2 signal intensity and correlates to the RT field [ 29 ].…”

“…On the contrary, patients with residual disease must be considered for tumor resection or additional RT/CRT [ 1 , 14 , 25 , 26 ]. Therefore, the multidisciplinary tumor board is crucial in defining the best approach for each patient with LAVC, either before or after multimodal treatment [ 8 , 14 , 25 , 29 ].…”

MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View

“…The treatment of vulvar cancer should be personalized, including tailored primary tumor resection and lymph nodes evaluation and/or primary chemoradiation therapy or exclusive chemo-radiation based on an individual patient's characteristics [1]. In this setting, patients with vulvar cancer should be referred to a dedicated cancer center as diagnosis and management should be multidisciplinary with a dedicated team, including a gynecologist, radiation oncologist, radiologist, nuclear medicine physician, medical oncologist, pathologist, and plastic surgeon [22][23][24][25].…”

Search for Optimal MRI Protocol for the Diagnosis of Vaginal Tumor

“…Первичный рак влагалища (ПРВ) -редкое онкологическое заболевание, на долю которого приходится, по данным разных источников, от 1% до 3% всех новообразований женской репродуктивной системы [1][2][3]. В то же время вторичное опухолевое поражение влагалища встречается гораздо чаще и определяется в основном при распространенных процессах рака матки [4,5].…”

“…Трудности в оценке состояния стенок влагалища связаны с нарушением анатомо-топографических взаимоотношений органов после проведенного хирургического лечения, постлучевыми реактивными изменениями, а также с несоблюдением протоколов проведения исследования. Все это приводит к диагностическим ошибкам, негативно влияя на выбор варианта лечения и исход заболевания [3,5,13].…”