Management of vulvar cancer

Current therapy of vulvar malignancies is reviewed with emphasis on screening, etiology, diagnosis, staging, and treatment of preinvasive and invasive cancer.

Screening procedures, etiologic possibilities, diagnostic techniques, staging implications, and treatment approaches are discussed in detail.

All malignancies of the vulva should be detected at an early stage, when they are most amenable to curative therapy. Regular examination of all women and increased efforts to educate patients should in time reduce patient and physician delay in diagnosis. The cause of the disease remains unclear, because the precursor state has not been defined accurately. The impetus to perform more conservative surgery has been accompanied by the realization of the severe psychosexual sequelae associated with radical vulvectomy. High risk prognostic factors include number of positive groin lymph nodes and diameter of the primary lesion. Diameter of the largest metastasis, intracapsular versus extracapsular nodal tumor location, laterality of spread, and deep groin nodal spread may be predictors of survival.

The overall incidence of vulvar malignancies will not be changed until the pathophysiology of the disease is better understood. Improved survival will depend on earlier and more accurate diagnosis and treatment, including use of radiation therapy.