Variables in the diagnosis and management of vulvar carcinoma as observed by the Philadelphia Committee for the Study of Pelvic Cancer

Abstract

1.1. The diagnosis and management of 131 patients with proved vulvar carcinoma, in twenty Philadelphia hospitals, are reviewed.2.2. The patients were predominantly white (71.55 per cent) and the aver-age age was 53.5 years. The series was about equally divided between nulliparous and parous patients.3.3. The most common symptoms were pruritus, presence of a lump, bleeding, and urinary symptoms.4.4. There was a total patient delay of 66.41 per cent with an average delay of 2.35 years. Procrastination as a cause of patient delay is emphasized.5.5. The total physician-institution delay was 52.67 per cent with an aver-age of 1.2 years. In 12 cases more than one physician was involved in delay.6.6. Failure to examine the patient was the most common cause of physician delay.7.7. Improper diagnosis was the next most common cause of physician delay.8.8. Sixteen different types of treatment, or treatment combinations, were employed in the 127 patients who were treated.9.9. Radical vulvectomy with node dissection was most frequently used. followed by radical vulvectomy alone, and then by x-ray therapy.10.10. Twenty-two patients had other surgery at the time of their operation for vulvar carcinoma.11.11. Fifty-seven patients observed five or more years had a survival rate of 47.37 per cent. The patients who had been treated by radical vulvectomy and bilateral groin dissection had a five-year survival rate of 78.94 per cent in spite of the delay in diagnosis.12.12. The most important factor bringing about a favorable five-year survival rate is the type of therapy rather than the delay involved.13.13. The type of treatment employed depends more upon the plan of the physicians in charge of the case than on the stage of the disease.