Surgical management of squamous cell vulvar cancer without clitoris, urethra or anus involvement

Abstract

Vulvar cancers, which constitute 5% of all gynecologic cancers, are the fourth most common female genital cancers, preceded by uterine, ovarian and cervical cancers. The treatment methods employed for vulvar cancers have changed over the years, with previously applied radical surgical approaches, such as en bloc resection, being gradually suspended in favor of treatment approaches that require dissection of less tissue. While the removal of less tissue, which today's approaches have focused on, prevents morbidity, this method seems to result in higher risks of recurrence. It is therefore important that the balance between preventing the recurrence of the disease and forefending against postoperative complications and vulvar deformity be properly understood. As a working assumption, if patients with vulvar cancer are diagnosed at an early stage, properly evaluated and administered appropriate treatment, the most positive results can be obtained. This paper aims to highlight this assumption and demonstrate, through the provision of actual data, how to plan the treatment approach for patients who are diagnosed early. Statements extracted from the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2016 Sub-Committees on vulvar squamous cell carcinoma and articles by the European Society of Gynaecological Oncology (ESGO) regarding Vulvar Cancer Recommendations were used to obtain updated information.

Vulvar cancer: surgical management and survival trends in a low resource setting

“…The present study suggests that the stage at presentation and lymph node positivity have poor prognostic values. Ipsilateral lymph node dissection is indicated for unilateral lesions, not crossing midline, and either negative ipsilateral nodes, or with positive lymphadenopathy with vulvar lesion smaller than 2 cm [8][9][10]. Also, the depth of invasion (DOI) was reported in only 2 patients histopathological reports.…”

Acquired widespread lymphangiectasia mimicking immunobullous disease: A case report

“…There is a 26%–34% chance of spread to regional lymph nodes in tumors greater than 3 mm in depth (our patient had a depth of 6.2 mm). 4 Given the depth of invasion and its proximity to midline (less than 2 cm), radical vulvectomy with bilateral inguino-femoral lymphadenectomy was indicated. 4 The inguinal lymph nodes are responsible for the abdomen’s lymphatic drainage, from approximately the level of the umbilicus, extending inferiorly to the lower limbs.…”

“… 4 Given the depth of invasion and its proximity to midline (less than 2 cm), radical vulvectomy with bilateral inguino-femoral lymphadenectomy was indicated. 4 The inguinal lymph nodes are responsible for the abdomen’s lymphatic drainage, from approximately the level of the umbilicus, extending inferiorly to the lower limbs. 1 Given the extensive surgical disruption of this drainage pathway, this is likely the reason for the widespread distribution, including portions of our patient’s trunk.…”

Targeting Aldehyde Dehydrogenases to Eliminate Cancer Stem Cells in Gynecologic Malignancies

“…The main subtypes of vulvar cancer are SCC, adenocarcinoma, sarcoma, and basal cell carcinoma, amongst which the most prevalent is SCC [66]. Surgery is the primary mode of treatment for vulvar cancer, followed by radiation or chemotherapy [67].…”