Vulvar carcinoma
From IKE
Vulvar cancer accounts for about 3 to 4% of all gynecologic malignancies in the USA, with an estimated 3 300 new cases diagnosed in 1996. The average age at diagnosis is about 70 yr, and incidence increases with age. Often, patients with vulvar carcinoma lesions neglect their disease out of embarrassment, fear or guilt. The implication of this is that vulvar lesions that should not have progressed to terminal cancer do. As such, the basic steps of preventing vulvar cancer are to address the embarrassment, fear, and guilt with patients, and to always refer any visible lesion for biopsy. Physicians should not merely treat a persistent unexplained itch for greater than three weeks, since this would be disregarding the underlying cause.
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Presentation
The most common presenting symptoms for a patient with vulvar cancer are discomfort, itch and irritation, though secondary symptoms such as groin or leg swelling may also occur. In more advanced stages, tertiary symptoms of neoplasm may be found.
Investigations
Physical examination of a carcinomic vulva may reveal a raised area, redness, whiteness, ulceration, exudation, or necrosis. A punch biopsy is used to obtain a specimen for pathological exmaination.
Management
Vulvar carcinoma can be managed with surgery by performing a wide excision and inguinal node dissection from the side of the lesion, or both sides if the lesion central.
The two most important prognostic factorsare a surgical margin of more than 1cm, and the absence of inguinal node metastases. For patients with a positive inguinal node dissection, treatment involves radiation to both the groin and the pelvis.
