Management of Early-Stage Vulvar Cancer

Abstract

Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The first subtype is associated with persistent human papillomavirus infection and is usually diagnosed in younger women. The second subtype is associated with lichen sclerosus condition, and in most cases is diagnosed in postmenopausal women. Currently, an increase in first subtype cases has been observed, which raised the concern about associated mortality and treatment morbidity among young women. Vulvar cancer treatment depends on histopathology grade and staging, but surgery with or without radiotherapy as adjuvant treatment is considered the gold standard. In recent decades, sentinel lymph node biopsy has been incorporated as part of the treatment. Therefore, we sought to review and discuss the advances documented in the literature about vulvar cancer focusing on the treatment of early-stage disease. Relevant articles, such as the GROINS-V studies and the GOG protocols, are presented in this review. Additionally, we discuss key points such as the evolution of treatment from invasive surgery with high morbidity, to more conservative approaches without compromising oncologic safety; the role of sentinel lymph node mapping in the initial staging, since it reduces the complications caused by inguinofemoral lymphadenectomy; the recurrences rates, since local recurrence is common and curable, however, groin-associated, or distant recurrences have a poor prognosis; and, finally, the long-term follow-up that is essential for all patients.

Based on the surveillance, epidemiology, and end results programme, to develop and validate nomograms for predicting overall survival and cancer-specific survival in geriatric patients with vulvar squamous cell carcinoma

“…Our study also confirms that both TNM and AJCC stages are significant predictors for OS and cancer-specific CSS in VSCC patients, aligning with their established roles in predicting patient survival [15]. Surgery has traditionally been considered the primary treatment for vulvar cancer [29]. However, it may not be suitable for patients with stage IV tumors involving bone, fixed lymph nodes, or distant metastasis [30].…”

Role of Sentinel Lymph Node Biopsy for Skin Cancer Based on Clinical Studies

“…In this review, SCC is divided into cutaneous SCC (cSCC), which develops in nonspecial skin sites, and anogenital SCC, including vulvar SCC, penile SCC, and anal SCC, because anogenital SCC may have different characteristics from those of cSCC, such as a high potential of nodal metastases and frequent association with high-risk HPV infection or lichen sclerosis et atrophicus [ 52 , 53 ].…”

Establishment and validation of a nomogram for estimating the overall survival of vulvar squamous cell carcinoma patients aged 50 years or older

“…As the fourth most common gynecologic tumor [1], the primary malignant tumor of the vulva accounts for 4% of all cancers of the female genital tract [2]. It is more prevalent in elderly women and has a median age at diagnosis of about 68 years [3,4].…”