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Vulvar Cancer
Women’s Hospital,School of Medicine
Zhejiang University
General Considerations
Vulvar cancer is uncommon
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USA:3,800 new cases and 800 deaths annually
Representing 3%-5% of malignancies of the female genital tract
The peak incidence of onset is in the age 60-80 years
Recently, the incidence appears to be increasing
Etiology
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unknown
Associated factors
HPV
STD
Chronic vulvar dystrophy
Pathology
Histological type
squamous cell carcinoma
melanoma
sarcoma
basal cell
adenocarcinoma
bartholin gland
squamous
adenocarcinoma
undifferentiated
Pathology
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Main focus
Changes around focus：
skin incrassation,
increased or decreased pigmentation
Clinical manifestation
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symptoms
vuval pruritus
 mass
 advanced stage feature
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sign
Tumor focus
 positive lymph nodes
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Routes of Spread
Vulvar cancer spreads by the following routes：
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Direct extension,to involve adjacent structures such
as the vagina,urethra,and anus
Lymphatic embolization to the regional inguinal
and femoral lymph nodes
Hematogenous spread to distant sites,including the
lungs,liver,and bone
Diagnosis
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History & symptoms
sign
Assistant examinations
histology
cytology
image
cystoscopy
proctoscopy
Staging(FIGO,2009)
Treatment （1）
Principle:
surgery
combined with
radiotherapy ,chemotherapy
Treatment （2）
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Early stage：
individual，conservative surgery when good
prognosis was ensured
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advanced stage
combined therapy，improve survival
Treatment （3）
SOGC Clinical Practice Guidelines
Radical vulvectomy
Treatment （4）
radiotherapy
 sensitive：squamous acanecr
 Side effects of irradiation to
vulva
 indication
radiotherapy prior to surgery
 adjuvant radiotherapy after
surgery
 residual or relapse tumor
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Treatment （5）
chemotherapy
 Advanced stage,
relapse
 drugs
DDP ，CP
 BLM
 5-Fu
 ADM
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Outcome and Prognosis
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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-up
Prognostic factors：
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Lymph metastasis
Invasive Depth
Tumor size
Location
Stage
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Treatment
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Follow-up
Follow-up
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Year 1：
Year 2 ：
Year 3-5：
Year 6-：
1-2 monthly
3 monthly
6 monthly
12 monthly