Vulvar cancer surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Surgery is a mainstay of therapy and usually accomplished by use of a radical vulvectomy, removal of vulvar tissue as well as the removal of lymph nodes from the inguinal and femoral areas. Complications of such surgery include wound infection, sexual dysfunction, edema and thrombosis. Surgery is significantly more extensive when vulvar cancer has spread to adjacent organs such as urethra, vagina, and rectum. In cases of early vulvar carcinoma the surgery may be less radical and disfiguring and consist of wide excision or a simple vulvectomy.
Surgery
Stage I Vulvar Cancer Standard treatment options:
- Wide excision (without lymph node dissection)
- A wide (1 cm margin) excision (without lymph node dissection) for microinvasive lesions (<1 mm invasion) with no associated severe vulvar dystrophy. For all other stage I lesions, if well lateralized, without diffuse severe dystrophy, and with clinically negative nodes, a radical local excision with complete unilateral lymphadenectomy. Candidates for this procedure should have lesions 2 cm or smaller in diameter with 5 mm or less invasion, no capillary lymphatic space invasion, and clinically uninvolved nodes.
- Radical local excision with ipsilateral or bilateral inguinal and femoral node dissection
- In tumor clinically confined to the vulva or perineum, radical local excision with a margin of at least 1 cm has generally replaced radical vulvectomy; separate incision has replaced en bloc inguinal node dissection, ipsilateral inguinal node dissection has replaced bilateral dissection for laterally localized tumors; and femoral lymph node dissection has been omitted in many cases.
- Radical local excision and sentinel node dissection, reserving groin dissection for those with metastasis to the sentinel node(s).
Stage II Vulvar Cancer
standard treatment options:
- Radical local excision with bilateral inguinal node and femoral node dissection with a resection margin of at least 1 cm. Radical local excision with a margin of at least 1 cm has generally replaced radical vulvectomy, and separate incision has replaced en bloc inguinal node dissection. Large T2 tumors may require modified radical or radical vulvectomy. Adjuvant local radiation therapy may be indicated for surgical margins smaller than 8 mm, capillary-lymphatic space invasion, and thickness greater than 5 mm.
- Radical excision and sentinel node dissection, reserving groin dissection for those with metastasis to the sentinel node(s).