Vulvar Cancer: The Evolution of Current Management Strategies

Abstract

The treatment of vulvar cancer is evolving from the single incision “en bloc” highly morbid resection of the entire vulva, groin, and pelvic nodes for all stages of this disease. Currently, micro-invasive disease is treated conservatively by wide local excision, and stage 1 and 2 disease by wide local excision and superficial groin dissection. Vulvar tumours of all stages which by locanan or size preclude both a one cm surgical margin and the sparing of critical midline anatomy; clitoris, urethra or anal sphincter, can now be considered for primary irradiation rather than surgery. This approach may preserve the function and anatomic integrity of these important structures. Surgico-pathologic factors can greatly assist in identifying those post-surgical patients at higher than normal risk of relapse, so that they can receive targeted, adjunctive therapy.The extent of the psychological sequelae of the diagnosis and treatment of vulvar cancer is becoming known. Further information about these non-physical morbidities may help us to choose between the available treatment options, based on additional outcome measures including cost of treatment and patient preference.At this time, our clinical goal is to maintain cure and local control rates and to minimize morbidity in early disease, while we attempt to improve local control and curability for patients with advanced disease. This will be achieved by 1) limiting the amount of tissue treated/excised for patients with early stage/good prognosis disease and, 2) by minimizing the physical and psychologic morbidity, without sacrificing curability, for patients with advanced disease or with adverse risk factors.