Vulvar cancer medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Syed Musadiq Ali M.B.B.S.[3]

Vulvar cancer Microchapters
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Patient Info
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Vulvar cancer from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
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Overview

The optimal therapy for vulvar cancer depends on the stage at diagnosis.

Medical therapy

Vulvar intraepithelial neoplasia (VIN)

• CO2 laser surgery and vaporization. A disadvantage of vaporization is that it does not provide tissue for histologic examination to confirm complete removal of the lesion and the absence of invasive disease.
• Ultrasonic surgical aspiration (USA)
• Topical imiquimod for patients wishing to avoid surgery

Stage I Vulvar Cancer

• Radical radiation therapy for patients unable to tolerate surgery or deemed unsuitable for surgery because of site or extent of disease.

Stage II Vulvar Cancer

• For those few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with favorable survival.

Stage III Vulvar Cancer

• Radical vulvectomy with inguinal and femoral node dissection followed by radiation therapy in patients with large primary lesions and narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and a thickness of greater than 5 mm, particularly if the nodes are involved. Radiation therapy to the pelvis and groin is usually given if two or more groin nodes are involved.
• Preoperative neoadjuvant radiation therapy or chemoradiation may be used to improve operability and even decrease the extent of surgery required.
• For the few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. Some physicians prefer to add concurrent 5-FU or 5-FU and cisplatin.

Stage IV Vulvar Cancer

• Surgery followed by radiation therapy for large resected lesions with narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and thickness greater than 5 mm. Radiation therapy to the pelvis and groin is given if two or more groin nodes are involved.
• Neoadjuvant radiation therapy or chemoradiation of large primary lesions to improve operability, followed by radical surgery.
• For those patients unable to tolerate radical vulvectomy or who are deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. When radiation therapy is used for primary definitive treatment of vulvar cancer, some physicians prefer to add concurrent 5-FU or 5-FU and cisplatin.