Gynecologic Cancers: Vulvar Cancer

Vulvar cancer is one of the rarer gynecologic cancers. Previously, it was thought to affect only postmenopausal women, but a recent epidemiologic review reveals that younger premenopausal females are being affected at higher rates because of human papillomavirus infection. Family physicians are uniquely positioned as a common initial point of contact for many reproductive-age patients and can provide valuable patient education on the need for human papillomavirus vaccination and importance of addressing risk factors early. Early and prompt recognition of vulvar pathology is crucial because the diagnosis of vulvar cancer is estimated to be delayed by 2 years after initial presentation. For the family physician, routine visualization of the perineum, vulva, and labia should be considered standard of care during a routine gynecologic examination. Identification and management of risk factors including vulvar conditions (eg, lichen sclerosus) may require closer surveillance, detection of premalignant lesions, disease prevention, and/or earlier diagnosis. Suspicious lesions should be biopsied. Management depends on stage. In early stages, vulvectomy is considered with lymph node evaluation. In later stages, external beam radiation therapy, chemotherapy, and lymph node evaluation are performed. It is hoped that enhanced awareness of vulvar cancer will reduce delays in diagnosis, lead to earlier initiation of treatment, and improve survival. Survivorship care should be specific to the patient's gynecologic concerns and attentive to maintaining their general health.