Vulval cancer, 1992-2002 audit--multidisciplinary care and prognostic factors

Vulval carcinoma is becoming increasingly common. Thirty-four cases of vulval carcinoma were treated from 01/01/1992-31/12/2002. The mean age was 67, range (18-90). The presenting complaints were "a lump" (76%)(25/33), "itch" (49%)(16/33), "discomfort" (30%)(10/33) and postmenopausal bleeding (21%)(7/33). Most patients presented with stage 1 or 2 disease (73%) (n = 24/33). The majority (97%) (32/33) underwent surgical treatment. Five-year survival was 61% (17/28), (disease-free survival 76% (13/17)). There were 12 cases of local/regional recurrence. Survival rates deteriorated with stage of disease. Lymph-node results, lowered survival from 79% (11/14), if negative, to 17% (1/6) if positive. Age >70 reduced survival from 69% (11/16) to 50% (6/12). We conclude that age, the stage of disease, and lymph-node status were important prognostic factors. The favourable outcomes reflect muItidisciplinary care--combining clinical examinations with regular home contact with specialist nurses, by telephone.