Vulvar Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Abstract

Vulvar cancer is a rare gynecologic malignancy. Ninety percent of vulvar cancers are predominantly squamous cell carcinomas (SCCs), which can arise through human papilloma virus (HPV)-dependent and HPV-independent pathways. The NCCN Vulvar Cancer panel is an interdisciplinary group of representatives from NCCN Member Institutions consisting of specialists in gynecological oncology, medical oncology, radiation oncology, and pathology. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Vulvar Cancer provide an evidence- and consensus-based approach for the management of patients with vulvar SCC. This manuscript discusses the recommendations outlined in the NCCN Guidelines for diagnosis, staging, treatment, and follow-up.

Cancer of the vulva

“…In addition, CT or MRI could be useful in further treatment planning. 18 F fluorodeoxyglucose ( 18 F‐FDG) positron emission tomography with computed tomography (PET‐CT) can more effectively assess and detect inguinofemoral lymph node involvement compared with CT, influencing the planning of primary surgery and inguinal lymph node dissection to determine the optimum surgical extent without sentinel lymph node dissection and use of frozen sections . Additionally, PET‐CT might be used with larger tumors when metastatic disease is suspected or in the recurrence scenario …”

“…3D conformal/Anterior–Posterior/Posterior–Anterior [AP/PA] fields, intensity‐modulated radiation therapy [IMRT]). To ensure adequate tumor coverage, clinical examination, imaging findings (CT or MRI), and nodal size should be considered to properly define the target volume during 3D planning …”

“…27,28,30 Other therapies such as chemotherapy and immunotherapies are usually reserved for metastatic or palliative settings, or for the treatment of rare histologies such as melanoma. 28 The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. also have abnormal bleeding or discharge, and many will have a history of vulvar symptoms due to underlying lichen sclerosus or HSIL.…”

Minimally Invasive Techniques for Treating Gynecologic Malignancies

“…Many of these cancers can be cured with surgery alone; thus, total abdominal hysterectomy/bilateral salpingo-oophorectomy and sometimes pelvic and para-aortic lymphadenectomy represent the historical standard of care. 2 However, a new standard of care has emerged for early-stage endometrial carcinoma, and the 2017 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Uterine Neoplasms note that “MIS is the preferred approach when technically feasible.” 3 This recommendation is based on 8 randomized controlled trials and 2 meta-analyses, with level 1 evidence 4 demonstrating no difference in survival, Dr. Fader added.…”

Experience with gluteal V‐Y fasciocutaneous advancement flaps in vulvar reconstruction after oncological resection and a modification to the marking: Playing with tension lines

“…Although older patients are currently the predominant population, there is a growing trend for younger women to be diagnosed with different histological types of HPV‐related in situ carcinomas. Other histological types of tumours affecting the vulvar region are extramammary Paget disease, melanoma, sarcoma, basal cell carcinoma, adenocarcinoma, and verrucous carcinoma . Radical surgical resection and regional lymph nodes evaluation are the current cornerstones in the vulvar carcinoma work‐up; surgical removal techniques may involve local excision, modified radical vulvectomy, and radical vulvectomy, up to pelvic exenteration.…”