Management of patients with vulvar cancer: a perspective review according to tumour stage

Abstract

Treatment of patients with vulvar cancer is challenging for gynaecologic oncologists. Owing to the localization in a sensitive area, surgical radicality and the indication for adjuvant treatment have to be balanced with psychosocial aspects to treat patients adequately. Clinical management is therefore highly dependent on the tumour stage. For patients with early-stage disease (FIGO I-II) therapy mainly concentrates on surgery with resection of the primary tumour and staging of the groin lymph nodes. In intermediate-stage vulvar cancer (FIGO III), advanced disease is expressed by affected inguinofemoral lymph nodes bringing radical lymphadenectomy and adjuvant therapy as well as radiation or chemoradiation into the focus of treatment. For locally advanced or metastatic vulvar cancer (FIGO IV) neoadjuvant or definitive chemoradiation has to be considered besides surgery. Owing to the low incidence of the disease, the level of evidence for different treatment modalities is poor. This review therefore puts different recommendations of clinical management in context and highlights the need for future trials.

Primary mucinous adenocarcinoma of the vulva: A case report and review of the literature

“…Patients with early-stage disease have a fairly good prognosis with an individualized treatment plan and a less radical surgical approach (12). Local tumor resection rather than radical vulvectomy and the implementation of the sentinel technique have decreased therapy-associated morbidity and psychosocial impairment in these patients, while maintaining oncological safety (11). The clinical management in our case was different from that of the first case of primary vulvar mucinous adenocarcinoma.…”

“…As regards vulvar cancer lymph node metastases from the superficial to the deep inguinal and femoral lymph nodes (including the Cloquet's lymph node) and then to the pelvic lymph nodes, the mean incidence is 22-39% and the lesion size, infiltration depth and stage are closely associated. The case report of vulvar mucinous adenocarcinoma in the literature, the lesion was on the upper medial aspect of the right labium majus, with lymphatic flow mainly to the inguinal lymph nodes; in our case, the tumor was on the perineal body, with lymphatic flow mainly to the pelvic lymph nodes (11). There was no pelvic lymph node metastasis on the systemic PET-CT.…”

“…No compromise in oncological safety was observed in patients with early-stage disease compared with the control group (1). Considering the significant morbidity of radical lymphadenectomy and the fact that only 25-30% of the patients present with lymph node metastases at first diagnosis, sentinel node dissection is considered a favorable alternative for patients with a clinically node-negative inguinal area (11). Patients with early-stage disease have a fairly good prognosis with an individualized treatment plan and a less radical surgical approach (12).…”

Recent trends in surgical and reconstructive management of vulvar cancer: review of literature

“…In more then T1 stage of VC bilateral inguinofemoral lymphadenectomy is necessary due to the higher rate of nodal metastasis involvement correlated with stage of disease, size of lesion, and depth of invasion. In these stages Groin surgery is not adequate and resection of at least six nodes per groin is recommended to ensure complete dissection [12]. Radical vulvectomy consists in removal of entire vulva until the deep fascia of the thigh and pubis's periosteum and inferior fascia of the urogenital diaphragm elimination [2].…”

“…Because of these poor results, Basset advocated a more radical technique, including vulvectomy en bloc with bilateral inguinofemoral lymphadenectomy ('butterfly resection'); it has been the standard therapy up to 1990s, used even by Taussig and Way, that reported a 5-year survival rates of 60-70 %. The aim of radical en bloc resection was to remove all tissue possibly involved in VC including the skin bridge between vulva and groins [12].…”