Vulvar Vulvar Cancer Cancer

Women’s Hospital,School of MedicineWomen’s Hospital,School of Medicine Zhejiang UniversityZhejiang University

General ConsiderationsGeneral Considerations

Vulvar cancer is uncommonVulvar cancer is uncommon

USA:3,800 new cases and 800 deaths annuallyUSA:3,800 new cases and 800 deaths annually Representing 3%-5% of malignancies of the female Representing 3%-5% of malignancies of the female

genital tractgenital tract

The peak incidence of onset is in the age 60-80 yearsThe peak incidence of onset is in the age 60-80 years

Recently, the incidence appears to be increasing Recently, the incidence appears to be increasing

EtiologyEtiology

unknown unknown Associated factorsAssociated factors

HPV

STDSTD

Chronic vulvar dystrophyChronic vulvar dystrophy

PathologyPathology

Histological typeHistological type

squamous cell squamous cell carcinomacarcinomamelanomamelanomasarcomasarcomabasal cellbasal celladenocarcinomaadenocarcinomabartholin glandbartholin gland squamous squamous adenocarcinomaadenocarcinomaundifferentiatedundifferentiated

Main focusMain focus Changes around focusChanges around focus ：： skin incrassation, skin incrassation,

increased or decreased increased or decreased pigmentationpigmentation

PathologyPathology

Clinical manifestationClinical manifestation

symptomssymptoms vuval pruritusvuval pruritus massmass advanced stage advanced stage

featurefeature signsign

Tumor focusTumor focus positive lymph nodes positive lymph nodes

Vulvar cancer spreads by the following Vulvar cancer spreads by the following routesroutes ：：

Direct extension,to involve adjacent Direct extension,to involve adjacent structures such as the vagina,urethra,and structures such as the vagina,urethra,and anusanus

Lymphatic embolization to the regional Lymphatic embolization to the regional inguinal and femoral lymph nodesinguinal and femoral lymph nodes

Hematogenous spread to distant Hematogenous spread to distant sites,including the lungs,liver,and bonesites,including the lungs,liver,and bone

Routes of SpreadRoutes of Spread

History & symptomsHistory & symptoms signsign Assistant examinationsAssistant examinations

histologyhistology

cytologycytology

imageimage

cystoscopycystoscopy

proctoscopyproctoscopy

DiagnosisDiagnosis

Staging(FIGO,2009)Staging(FIGO,2009)

Treatment Treatment （（ 11 ））

Principle: Principle:

surgerysurgery

combined with combined with

radiotherapy ,chemotherapy radiotherapy ,chemotherapy

Treatment Treatment （（ 22 ）） Early stageEarly stage ：： individualindividual ，， conservative surgery conservative surgery

when good prognosis was ensured when good prognosis was ensured

advanced stage advanced stage combined therapycombined therapy ，， improve improve

survivalsurvival

Treatment Treatment （（ 33 ））SOGC Clinical Practice SOGC Clinical Practice

GuidelinesGuidelines

Radical vulvectomy

Treatment Treatment （（ 44 ））radiotherapyradiotherapy sensitivesensitive ：： squamous squamous

acanecracanecr Side effects of irradiation Side effects of irradiation

to vulvato vulva indicationindication

radiotherapy prior to radiotherapy prior to surgerysurgery

adjuvant radiotherapyadjuvant radiotherapy after surgery

residual or relapse tumorresidual or relapse tumor

Treatment Treatment （（ 55 ））chemotherapychemotherapy Advanced Advanced

stage, relapsestage, relapse drugs drugs

DDP DDP ，， CPCP BLMBLM 5-Fu5-Fu ADMADM

Outcome and Prognosis Overall survival for patients with vulvar

carcinoma is excellent, especially in those with early-stage disease. Experience with modern treatment from the Mayo clinic shows that the overall survival rate for women with vulvar carcinoma is 75%, compared to an 89% actuarial survival rate for age-matched controls. The 5-year survival rates after surgery for vulvar cancer are as follows:

Stage I - 90% Stage II - 81% Stage III - 68% Stage IV - 20%

Follow-upFollow-up

Prognostic factorsPrognostic factors ：： Lymph metastasisLymph metastasis Invasive Depth Invasive Depth Tumor sizeTumor size LocationLocation StageStage TreatmentTreatment

Follow-upFollow-up

Follow-upFollow-up

Year 1Year 1 ： ： 1-2 monthly1-2 monthly Year 2Year 2 ： ： 3 monthly3 monthly Year 3-5Year 3-5 ： ： 6 monthly6 monthly Year 6-Year 6- ： ： 1212 monthlymonthly