| Abstract: |
Cancer of the vulva is a relatively rare neoplasm accounting for approximately 4% of all gynecologic malignancies and less than 1% of all cancers in women. The most common histologic type is squamous-cell carcinoma, which represents 80% to 90% of all vulvar cancers. Most women present with vulvar pruritis and a recognizable lesion. Modern optimal management of squamous-cell carcinoma of the vulva includes careful consideration of less radical surgery for early-stage disease, the use of plastic reconstructive techniques for large surgical defects, and the incorporation of radiation therapy into the treatment regimen of locoregionally advanced disease. By taking a more individualized treatment approach, physical and psychological morbidity has been significantly decreased without compromising overall survival. The single most important factor influencing survival is lymph node status. Overall, the 5-year survival rate for patients with positive lymph nodes is 30-40% less than for patients with negative nodes. Better treatment options are needed for patients with nodal metastases. Multimodality therapy that incorporates radiation therapy, chemotherapy, and surgery has demonstrated encouraging results in the treatment of locally advanced vulvar cancer and appears to be the most promising area of investigation in the management of node-positive patients. The prognosis for patients with distant metastases is dismal and points to the need for the development of effective systemic therapy. |
