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1 Keratinizing type occurs in older women; associated with other vulvar dystrophies such as lichen sclerosis but not with HPV; usually unifocal 2 Warty or basaloid type found in younger women; associated with HPV, VIN, and cigarette smoking; usually multifocal 1 Direct extension: to the vagina, urethra, or anus 2 Lymphatic dissemination: occurs via the superficial inguinal nodes into the deep inguinal and femoral nodes and finally into the pelvic lymphatics 3 Hematogenous dissemination: rare; occurs mostly in patients who also have lymphatic dissemination; spreads to lung, liver, and bone Lymphatic spread occurs in 30% of vulvar cancers and its likelihood increases with the size of the lesion and the depth of invasion The FIGO system is used to stage vulvar cancer and is based on both the microscopic evaluation of the removed tumor as well as of the regional lymph nodes See Table 5-3 In general, treatment needs to be individualized using the most conservative treatment that will lead to cure of the disease The possible modalities are listed below: 1 Groin node dissection with either wide local excision or radical vulvectomy is the mainstay of treatment 2 Adjuvant radiation therapy can be added postoperative in patients with either positive inguinal nodes or close/positive surgical margins or preoperatively in patients with advanced disease

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using System; ...bulk of using statements omitted... using System.Collections.ObjectModel; using System.Collections.Specialized; namespace GraphingWithShapes { public partial class ColumnGraphCtrl : UserControl { private ObservableCollection<NameValuePair> dataPoints = null; private List<Color> columnColors = new List<Color>() { Colors.Blue, Colors.Red, Colors.Green }; public ColumnGraphCtrl() { InitializeComponent(); }

This delivery mode is included because everyone is familiar with it, so it provides a baseline from which to compare the other modes To deliver analog video, all you need is a videocassette recorder (VCR) connected to a television set The good news is that almost everyone uses the VHS format The bad news is that different countries use differing, and incompatible, television standards The main broadcast television standards are NTSC (used in North America), PAL (used in Europe) and SECAM (used in scattered places like France and Korea) This means that you can take a videocassette anywhere in the world that shares the

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Stage 0 Tis Stage I T1 N0 M0 Stage II T2 N0 M0 Stage III T3 N0 M0 T3 N1 M0 T1 N1 M0 T2 N1 M0 T1 N2 M0 T2 N2 M0 T3 N2 M0 T4 N-any M0 Stage IVB T-any N-any M1 Any distant metastasis including pelvic lymph nodes Tumor of any size with: (1) adjacent spread to the lower urethra and/or the vagina, or the anus; and/or (2) unilateral regional lymph node metastasis Tumor invades any of the following: upper urethra, bladder mucosa, rectal mucosa, pelvic and/or bilateral regional lymph node metastasis Tumor confined to the vulva and/or perineum; >2 cm in diameter; no palpable nodes Tumor confined to the vulva and/or perineum; <2 cm in diameter; no palpable nodes Carcinoma in situ; intraepithelial carcinoma

public void SetData(ObservableCollection<NameValuePair> data) { dataPoints = data; dataPoints.CollectionChanged += new NotifyCollectionChangedEventHandler(DataChanged); Update(); }

void DataChanged(object sender, NotifyCollectionChangedEventArgs e) { Update(); Called when } collection changes Handles changes

14

3 Chemoradiotherapy can be used for advanced stage disease where surgery is associated with high morbidity and mortality 4 Adjunctive chemotherapy alone is only of limited value When is node dissection warranted and how is it done All patients with more than 1 mm of stromal invasion require an inguinal femoral lymphadenectomy Unilateral lesions only need node dissection on the ipsilateral side if these nodes are negative Midline or bilateral lesions warrant bilateral node dissection Sentinel node biopsy is currently under investigation as a method to evaluate degree of treatment

public void Update() { Rectangle rect; foreach (NameValuePair nvp in dataPoints) { if (nvp.Tag == null) Creates Rectangle for { each NameValuePair rect = new Rectangle(); rect.Stroke = Brushes.Black; rect.StrokeThickness = 1; main.Children.Add(rect); nvp.Tag = rect; } }

same television standard, and be certain of being able to play it back On a domestic level, you can take a promo of your company or products and present it anywhere in the same country Or you can transcode (ie translate) your videocassette content into another format and play it back in a country which uses a different standard

CalculatePositionsAndSizes(); } public void CalculatePositionsAndSizes() { if (dataPoints == null) return; double spaceToUseY = main.ActualHeight * 0.8; double spaceToUseX = main.ActualWidth * 0.8;

What is the difference between the following: Wide local excision: Surgical excision of the lesion down to the layer of underlying fascia that must include at least 1 cm negative surgical margins

double barWidth = spaceToUseX / dataPoints.Count; double largestValue = GetLargestValue(); double unitHeight = spaceToUseY / largestValue; double bottom = main.ActualHeight * 0.1; double left = main.ActualWidth * 0.1;

requires the traditional analog production process This is illustrated in Figure 14 - 2

Rectangle rect; int nIndex = 0; foreach (NameValuePair nvp in dataPoints) { rect = nvp.Tag as Rectangle; rect.Fill = new SolidColorBrush(columnColors[nIndex++ % columnColors.Count]);

Radical vulvectomy:

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