Diagnosis and Management of Vulvar Cancer

Abstract

Vulvar cancer is rare, comprising only 5% of all gynecologic malignancies. However, the incidence of invasive vulvar carcinoma has been increasing moderately over the past two decades, and the incidence of in situ vulvar carcinoma has increased more than fourfold in the same period. Vulvar squamous cell carcinoma, the most common form of this cancer, is commonly divided into two basic types, HPV-associated and HPV-independent. To improve vulvar cancer survival, early detection by careful screening is important. FIGO surgical staging system for vulvar cancer was updated in October 2021. The most unique aspect of this change is that it is based on the NCDB data analysis to be validated, and much simpler than earlier revisions. In this revision, the depth of invasion is newly defined for stage III. Tumors of any size with extension to the upper part of adjacent perineal structures, or with any number of nonfixed, nonulcerated lymph node were defined for stage III. Tumors of any size fixed to bone, or fixed, ulcerated lymph node metastases, or distant metastases were defined for StageIV. The findings of cross-sectional imaging can be incorporated into the staging of vulvar cancer. The standard treatment for vulvar cancer has been primarily surgery; however, to decrease morbidity and improve survival outcome, more conservative and individualized treatment practices have recently been explored. The benefit of postoperative adjuvant therapy has been shown in the past decades, although an indication for adjuvant therapy needs further discussion. In advanced vulvar cancer, multimodality therapy including neoadjuvant chemo-radiotherapy followed by surgical resection and definitive chemo-radiotherapy has been investigated to avoid exenterative surgery or stoma formation. For patients with clinical positive inguino-femoral lymph nodes, node dissection or neoadjuvant chemo-radiation therapy is now recommended.