Vulvar cancer surgery

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]

Vulvar cancer Microchapters
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Overview
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Differentiating Vulvar cancer from other Diseases
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Overview

The feasibility of surgery depends on the stage of vulvar cancer at diagnosis.

Surgery

Vulvar intraepithelial neoplasia (VIN)

• Separate excision of focal lesions
• Wide local excision
• Superficial skinning vulvectomy with or without grafting

Stage I Vulvar Cancer

• 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 nodes.

Stage II Vulvar Cancer

• 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 nodes.

Stage III Vulvar Cancer

• Modified radical or radical vulvectomy with inguinal and femoral node dissection. Radiation therapy to the pelvis and groin is given if inguinal nodes are positive.

Stage IV Vulvar Cancer

• Stage IVA

Radical vulvectomy and pelvic exenteration. Surgery followed by radiation therapy for large resected lesions with narrow margins.

• Stage IVB

There is no standard treatment approach in the management of metastatic vulvar cancer. Local therapy must be individualized depending on the extent of local and metastatic disease. There is no standard chemotherapy for metastatic disease, and reports describing the use of this modality are anecdotal.