Victor Manuel Vargas Hernandez*
Gynecology Service, Hospital Juárez de México, MexicoFulltext PDF
Vulvar cancer is rare, it occupies the Fourth most common type of gynecological cancer that mainly effects postmenopausal women, there is no screening or effective strategies to reduce its incidence, only the timely treatment of predisposing or preneoplastic lesions associated with its development; It can be asymptomatic, most women report chronic pruritus or vulvar pain, or present with a tumor or ulcer; Any suspected vulvar lesion is biopsied(s) to confirm the diagnosis and assess or exclude the invasion. Most vulvar cancer are histopathological type of squamous cell. The most common sub type is Squamous Cell Carcinoma (SCC); it is staged according to the Joint American Committee on Cancer (AJCC) and the International Federation of Gynecology and Obstetrics Systems (FIGO). Surgical staging involves the removal of the primary lesion and the evaluation of the inguinofemoral lymph nodes. In current practice, local radical excision has replaced radical vulvectomy, preserves the anatomy of the vulva and improves wound healing. The treatment of vulvar cancer depends mainly on the histopathological type and surgical staging and is predominantly surgical, particularrly for SCC, although Chemotherapy (Qt) with Radiotherapy (Rt), (Qt-Rt) concomitant is an effective alternative, particularly in advanced stages. Women with stage IA vulvar cancer require surgical resection of the primary lesion alone and without Lymphadenectomy (LDN). For stage IB to stage II who are at low risk of nodal metastases (<4 cm, without palpable lateral nodes), a unilateral (ipsilateral) lymph node lymphadenectomy is appropriate and less morbid than a bilateral LDN. If there is evidence of lymph node involvement (stage III) direct extension to the surrounding tissue, or fixed or ulcerated lymph node metastases (IVA stage) are locally advanced. For most patients with locally advanced disease, and primary resection is performed. Primary Qt-Rt or preoperative Qt-Rt followed by conservative surgery are appropriate alternatives when surgery is performed and have evidence of high risk characteristics (i.e. two or more microscopically positive inguinal lymph nodes, one or more macroscopically affected lymph nodes, or any evidence of extracapsular dissemination), some experts at (IA stage) recommends adjuvant radiotherapy, are treated with Qt- Rt; when primary Qt-Rt is not technically resectable instead of surgery; when treated with primary Qt-Rt, additional treatment is based on the response to treatment, which is usually completed in 6 to 12 weeks after the end of Qt-Rt; if there is a complete clinical response to Qt-Rt, we suggest recognition instead of surgical treatment; in patients with persistent or progressive disease after Qt-Rt, surgical resection, provided they are candidates for surgery; for local recurrence of the vulva, we offer a new excision, but accept it, the complications that are associated with re-excision (are colostomy, urinary diversion), Rt with or without Qt-Rt is a reasonable option. In metastatic disease, Qt and if they are not candidates or reject it, refer to palliative care is appropriate. If they progress after first-line Qt, palliative care is a reasonable alternative to Qt, especially in patients with severe morbidities. Conclusion: The management of malignant neoplasms of the non-squamous cell vulva depends on the histological type, but in general, surgery is the primary treatment.
Vulvar cancer; Rare tumors; Diagnosis; Pathology; Imaging; Treatment; Surgery; Chemotherapy; Radiotherapy
Hernandez VMV. Clinical, Pathological, Preventive and Therapeutic Aspects in Vulvar Cancer. Ann Gynecol Obstetr Res. 2020; 3(1): 1014.