Diagnosis and management of vulvar cancer

Abstract

Vulvar cancer is rare, comprising only 5% of all gynecologic malignancies. However, the incidence of invasive vulvar carcinoma has been increasing moderately over the past two decades, and the incidence of in situ vulvar carcinoma has increased more than fourfold in the same period. Vulvar squamous cell carcinoma, the most common form of this cancer, is commonly divided into two basic types: HPV-associated and HPV-independent. To improve vulvar cancer survival, early detection by careful screening is important. FIGO surgical staging system for vulvar cancer was updated in 2009, incorporating prognostic factors such as inguinal lymph node metastasis. The number and morphology including the size, extracapsular spread of the involved nodes have been taken into account. The presence of fixed or ulcerated inguino-femoral nodes is also included to a staging system. The standard treatment for vulvar cancer has been primarily surgery; however, to decrease morbidity and improve survival outcome, more conservative and individualized treatment practices have recently been explored. The benefit of postoperative adjuvant therapy has been shown in the past decades; although an indication for adjuvant therapy needs further discussion. In advanced vulvar cancer, multimodality therapy including neoadjuvant chemoradiotherapy followed by surgical resection and definitive chemoradiotherapy has been investigated to avoid exenterative surgery or stoma formation. For patients with clinical positive inguino-femoral lymph nodes, node dissection or neoadjuvant chemoradiation therapy are now recommended.