eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Surgical Treatment of Vulvar Cancer: Follow-up

Author: Robert V Higgins, MD, Clinical Associate Professor, Department of Obstetrics/Gynecology, University of North Carolina School of Medicine; Vice-Chairman of Academic Affairs, Associate Director of Gynecologic Oncology, Residency Director, Department of Obstetrics and Gynecology, Carolinas Medical Center
Coauthor(s): R Wendel Naumann, MD, Clinical Assistant Professor of Obstetrics and Gynecology, University of North Carolina at Chapel Hill; Associate Director, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Carolinas Medical Center; James Hall, MD, Director, Division of Gynecologic Oncology, Clinical Associate Professor, Department of Obstetrics and Gynecology, Carolinas Medical Center, University of North Carolina
Contributor Information and Disclosures

Updated: Nov 20, 2008

Outcome and Prognosis

Overall survival for patients with vulvar carcinoma is excellent, especially in those with early-stage disease. Experience with modern treatment from the Mayo clinic shows that the overall survival rate for women with vulvar carcinoma is 75%, compared to an 89% actuarial survival rate for age-matched controls. The 5-year survival rates after surgery for vulvar cancer are as follows:

  • Stage I - 90%
  • Stage II - 81%
  • Stage III - 68%
  • Stage IV - 20%

Future and Controversies

A prophylactic quadrivalent vaccine was approved by the Food and Drug Administration (FDA) in 2006 for the prevention of anogenital lesions including genital warts, vulvar and vaginal intraepithelial neoplasia, and cervical lesions associated with HPV 6, 11, 16, and 18. The first study to demonstrate the efficacy with HPV type 16 vaccine was reported by Koutsky and colleagues in 2002.27  This vaccine contained virus-like particles (VLPs) that do not contain viral DNA. Two studies were subsequently published examining the efficacy of the quadrivalent vaccine. These studies demonstrated significant vaccine efficacy in decreasing the incidence of anogenital lesions caused by HPV 6, 11, 16, and 18.28,29  

In the summer of 2008, the FDA approved marketing of the quadrivalent vaccine for the prevention of vulvar and vaginal cancer.30

Based on work in breast cancer and melanoma, a sentinel lymph node (SLN) can be identified and can be predictive of patients who will have other involved nodes. The technique of SLN dissection is attractive in vulvar carcinoma since most women will have negative lymph nodes. If the sentinel node dissection proves to be sufficiently sensitive, full groin node dissection could be limited only to women with positive lymph nodes. Currently, only a few early reports document the efficacy of this technique. A sentinel node can be identified in approximately 85% of women with isosulfan blue dye and 100% with the injection of Tc-99 labeled albumin. Early reports examining the sensitivity of this technique appear promising. The GOG is currently studying the feasibility and the sensitivity of sentinel lymph node dissection in women with vulvar carcinoma.31

The combination of chemotherapy with radiation in cervical cancer has produced marked improvement in survival for locally advanced disease. This concept appears to also be effective in locally advanced vulvar carcinoma. Chemotherapy combined with radiation also may improve the cure rate in women with positive groin node findings, but acceptance of routine chemoradiation in women with positive node findings will probably require prospective evaluation.

 


More on Surgical Treatment of Vulvar Cancer

Overview: Surgical Treatment of Vulvar Cancer
Workup: Surgical Treatment of Vulvar Cancer
Treatment: Surgical Treatment of Vulvar Cancer
Follow-up: Surgical Treatment of Vulvar Cancer
Multimedia: Surgical Treatment of Vulvar Cancer
References
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References

  1. Basset A. Traitement chirurgical operatoire de l'epithelima primitif du clitoris indications-technique-resultats. Rev Chir. 1912;46:546.

  2. Way S. Carcinoma of the vulva. Am J Obstet Gynecol. Apr 1960;79:692-7. [Medline].

  3. Morley GW. Infiltrative carcinoma of the vulva: results of surgical treatment. Am J Obstet Gynecol. 1976;124:874-878.

  4. Taussig FJ. Cancer of the Vulva. Am J Obstet Gynecol. 1940;40:764.

  5. Hacker NF, Leuchter RS, Berek JS, et al. Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions. Obstet Gynecol. Nov 1981;58(5):574-9. [Medline].

  6. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. Mar-Apr 2008;58(2):71-96. [Medline].

  7. Moore DH, Thomas GM, Montana GS. Preoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology Group. Int J Radiat Oncol Biol Phys. Aug 1 1998;42(1):79-85. [Medline].

  8. Iversen T, Aas M. Lymph drainage from the vulva. Gynecol Oncol. Oct 1983;16(2):179-89. [Medline].

  9. Clark WH Jr, From L, Bernardino EA, Mihm MC. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. Mar 1969;29(3):705-27. [Medline].

  10. Chung AF, Woodruff JM, Lewis JL Jr. Malignant melanoma of the vulva: A report of 44 cases. Obstet Gynecol. Jun 1975;45(6):638-46. [Medline].

  11. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. Nov 1970;172(5):902-8. [Medline].

  12. Trope C, Johnsson JE, Larsson G, Simonsen E. Bleomycin alone or combined with mitomycin C in treatment of advanced or recurrent squamous cell carcinoma of the vulva. Cancer Treat Rep. Apr-May 1980;64(4-5):639-42. [Medline].

  13. Deppe G, Bruckner HW, Cohen CJ. Adriamycin treatment of advanced vulvar carcinoma. Obstet Gynecol. Jul 1977;50(1 Suppl):13s-14s. [Medline].

  14. Zhang SH, Sood AK, Sorosky JI, et al. Preservation of the saphenous vein during inguinal lymphadenectomy decreases morbidity in patients with carcinoma of the vulva. Cancer. Oct 1 2000;89(7):1520-5. [Medline].

  15. Rouzier R, Haddad B, Dubernard G. Inguinofemoral dissection for carcinoma of the vulva: effect of modifications of extent and technique on morbidity and survival. J Am Coll Surg. Mar 2003;196(3):442-50. [Medline].

  16. Homesley HD, Bundy BN, Sedlis A, Adcock L. Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol. Dec 1986;68(6):733-40. [Medline].

  17. Decesare SL, Fiorica JV, Roberts WS, et al. A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymph nodes in vulvar cancer. Gynecol Oncol. Sep 1997;66(3):425-8. [Medline].

  18. de Hullu JA, Hollema H, Piers DA, Verheijen RH, van Diest PJ, Mourits MJ, et al. Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. J Clin Oncol. Aug 2000;18(15):2811-6. [Medline].

  19. Martínez-Palones JM, Pérez-Benavente MA, Gil-Moreno A, Díaz-Feijoo B, Roca I, García-Jiménez A. Comparison of recurrence after vulvectomy and lymphadenectomy with and without sentinel node biopsy in early stage vulvar cancer. Gynecol Oncol. Dec 2006;103(3):865-70. [Medline].

  20. Yoder BJ, Rufforny I, Massoll NA, Wilkinson EJ. Stage IA vulvar squamous cell carcinoma: an analysis of tumor invasive characteristics and risk. Am J Surg Pathol. May 2008;32(5):765-72. [Medline].

  21. Helm CW, Hatch K, Austin JM, et al. A matched comparison of single and triple incision techniques for the surgical treatment of carcinoma of the vulva. Gynecol Oncol. Aug 1992;46(2):150-6. [Medline].

  22. Judson PL, Jonson AL, Paley PJ, Bliss RL, Murray KP, Downs LS Jr, et al. A prospective, randomized study analyzing sartorius transposition following inguinal-femoral lymphadenectomy. Gynecol Oncol. Oct 2004;95(1):226-30. [Medline].

  23. Berman ML, Soper JT, Creasman WT, et al. Conservative surgical management of superficially invasive stage I vulvar carcinoma. Gynecol Oncol. Dec 1989;35(3):352-7. [Medline].

  24. Stehman FB, Bundy BN, Dvoretsky PM, Creasman WT. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol. Apr 1992;79(4):490-7. [Medline].

  25. Kirby TO, Rocconi RP, Numnum TM, Kendrick JE, Wright J, Fowler W, et al. Outcomes of Stage I/II vulvar cancer patients after negative superficial inguinal lymphadenectomy. Gynecol Oncol. Aug 2005;98(2):309-12. [Medline].

  26. Levenback C, Morris M, Burke TW, et al. Groin dissection practices among gynecologic oncologists treating early vulvar cancer. Gynecol Oncol. Jul 1996;62(1):73-7. [Medline].

  27. Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med. Nov 21 2002;347(21):1645-51. [Medline].

  28. [Best Evidence] Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. May 10 2007;356(19):1928-43. [Medline].

  29. The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. May 10 2007;356(19):1915-27. [Medline].

  30. Gardasil [package insert]. Whitehouse Station, NJ: Merck and Co.; 2008. [Full Text].

  31. Stehman FB, Look KY. Carcinoma of the vulva. Obstet Gynecol. Mar 2006;107(3):719-33. [Medline].

  32. Abitbol MM. Carcinoma of the vulva: improvements in the surgical approach. Am J Obstet Gynecol. Oct 15 1973;117(4):483-9. [Medline].

  33. Bauer HM, Ting Y, Greer CE, et al. Genital human papillomavirus infection in female university students as determined by a PCR-based method. JAMA. Jan 23-30 1991;265(4):472-7. [Medline].

  34. Brinton LA, Nasca PC, Mallin K, et al. Case-control study of cancer of the vulva. Obstet Gynecol. May 1990;75(5):859-66. [Medline].

  35. Burke TW, Levenback C, Coleman RL, et al. Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol. May 1995;57(2):215-20. [Medline].

  36. Christopherson W, Buchsbaum HJ, Voet R, Lifschitz S. Radical vulvectomy and bilateral groin lymphadenectomy utilizing separate groin incisions: report of a case with recurrence in the intervening skin bridge. Gynecol Oncol. Jun 1985;21(2):247-51. [Medline].

  37. Gonzalez Bosquet J, Magrina JF, Gaffey TA, Hernandez JL, Webb MJ, Cliby WA, et al. Long-term survival and disease recurrence in patients with primary squamous cell carcinoma of the vulva. Gynecol Oncol. Jun 2005;97(3):828-33. [Medline].

  38. Green MS, Naumann RW, Elliot M, et al. Sexual dysfunction following vulvectomy. Gynecol Oncol. Apr 2000;77(1):73-7. [Medline].

  39. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. Jan-Feb 2000;50(1):7-33. [Medline].

  40. Hacker NF, Berek JS, Lagasse LD. Microinvasive carcinoma of the vulva. Obstet Gynecol. Jul 1983;62(1):134-5. [Medline].

  41. Hacker NF, Berek JS, Lagasse LD, et al. Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynecol. Feb 1984;63(2):155-62. [Medline].

  42. Heaps JM, Fu YS, Montz FJ, et al. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol. Sep 1990;38(3):309-14. [Medline].

  43. Homesley HD, Bundy BN, Sedlis A, et al. Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study). Am J Obstet Gynecol. Apr 1991;164(4):997-1003; discussion 1003-4. [Medline].

  44. Hopkins MP, Reid GC, Morley GW. The surgical management of recurrent squamous cell carcinoma of the vulva. Obstet Gynecol. Jun 1990;75(6):1001-5. [Medline].

  45. Hoskins WJ, Perez CA, Young RC. Principles and Practice of Gynecologic Oncology. 1997.

  46. Kelley JL 3rd, Burke TW, Tornos C, et al. Minimally invasive vulvar carcinoma: an indication for conservative surgical therapy. Gynecol Oncol. Mar 1992;44(3):240-4. [Medline].

  47. Klemm P, Marnitz S, Köhler C, Braig U, Schneider A. Clinical implication of laparoscopic pelvic lymphadenectomy in patients with vulvar cancer and positive groin nodes. Gynecol Oncol. Oct 2005;99(1):101-5. [Medline].

  48. Leminen A, Forss M, Paavonen J. Wound complications in patients with carcinoma of the vulva. Comparison between radical and modified vulvectomies. Eur J Obstet Gynecol Reprod Biol. Dec 2000;93(2):193-7. [Medline].

  49. Lorincz AT, Reid R, Jenson AB, et al. Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. Obstet Gynecol. Mar 1992;79(3):328-37. [Medline].

  50. McCall AR, Olson MC, Potkul RK. The variation of inguinal lymph node depth in adult women and its importance in planning elective irradiation for vulvar cancer. Cancer. May 1 1995;75(9):2286-8. [Medline].

  51. Menczer J, Fintsi Y, Arbel-Alon S. The presence of HPV 16, 18 and p53 immunohistochemical staining in tumor tissue of Israeli Jewish women with cervical and vulvar neoplasia. Eur J Gynaecol Oncol. 2000;21(1):30-4. [Medline].

  52. Miller B, Morris M, Levenback C, et al. Pelvic exenteration for primary and recurrent vulvar cancer. Gynecol Oncol. Aug 1995;58(2):202-5. [Medline].

  53. Piura B, Masotina A, Murdoch J, et al. Recurrent squamous cell carcinoma of the vulva: a study of 73 cases. Gynecol Oncol. Feb 1993;48(2):189-95. [Medline].

  54. Podratz KC, Symmonds RE, Taylor WF. Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol. Jun 1 1982;143(3):340-51. [Medline].

  55. Podratz KC, Symmonds RE, Taylor WF, Williams TJ. Carcinoma of the vulva: analysis of treatment and survival. Obstet Gynecol. Jan 1983;61(1):63-74. [Medline].

  56. Schulz MJ, Penalver M. Recurrent vulvar carcinoma in the intervening tissue bridge in early invasive stage I disease treated by radical vulvectomy and bilateral groin dissection through separate incisions. Gynecol Oncol. Dec 1989;35(3):383-6. [Medline].

  57. Sedlis A, Homesley H, Bundy BN, et al. Positive groin lymph nodes in superficial squamous cell vulvar cancer. A Gynecologic Oncology Group Study. Am J Obstet Gynecol. May 1987;156(5):1159-64. [Medline].

  58. Siller BS, Alvarez RD, Conner WD, et al. T2/3 vulva cancer: a case-control study of triple incision versus en bloc radical vulvectomy and inguinal lymphadenectomy. Gynecol Oncol. Jun 1995;57(3):335-9. [Medline].

  59. Terada KY, Coel MN, Ko P, Wong JH. Combined use of intraoperative lymphatic mapping and lymphoscintigraphy in the management of squamous cell cancer of the vulva. Gynecol Oncol. Jul 1998;70(1):65-9. [Medline].

  60. Wagner W, Prott FJ, Weissmann J. Vulvar carcinoma: a retrospective analysis of 80 patients. Arch Gynecol Obstet. 1999;262(3-4):99-104. [Medline].

  61. Wharton JT, Gallager S, Rutledge FN. Microinvasive carcinoma of the vulva. Am J Obstet Gynecol. Jan 15 1974;118(2):159-62. [Medline].

  62. Wilkinson EJ. Superficial invasive carcinoma of the vulva. Clin Obstet Gynecol. Mar 1985;28(1):188-95. [Medline].

  63. Wilkinson EJ. The 1989 presidential address. International Society for the Study of Vulvar Disease. J Reprod Med. Nov 1990;35(11):981-91. [Medline].

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Further Reading

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Keywords

vulvar cancer, vulvar carcinoma, vulva cancer, vulva carcinoma, vulva cancer treatment, carcinoma in situ of the vulva, vulvar CIS, Bowen disease, Bowen's disease, squamous cell carcinoma of the vulva, vulvar carcinoma, vulvectomy, vulvar malignancy, gynecologic cancer, gynecologic carcinoma, female genital cancer, human papilloma virus infection, HPV infection, sarcoma, leiomyosarcoma, malignant fibrous histiocytoma, epithelioid sarcoma, basal cell carcinoma, verrucous carcinoma, Buschke-Lowenstein giant condyloma, adenocarcinoma

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Contributor Information and Disclosures

Author

Robert V Higgins, MD, Clinical Associate Professor, Department of Obstetrics/Gynecology, University of North Carolina School of Medicine; Vice-Chairman of Academic Affairs, Associate Director of Gynecologic Oncology, Residency Director, Department of Obstetrics and Gynecology, Carolinas Medical Center
Robert V Higgins, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, North Carolina Medical Society, and Society of Gynecologist Oncologists
Disclosure: Merck Speaker's Bureau Honoraria Speaking and teaching

Coauthor(s)

R Wendel Naumann, MD, Clinical Assistant Professor of Obstetrics and Gynecology, University of North Carolina at Chapel Hill; Associate Director, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Carolinas Medical Center
R Wendel Naumann, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American College of Surgeons
Disclosure: Nothing to disclose.

James Hall, MD, Director, Division of Gynecologic Oncology, Clinical Associate Professor, Department of Obstetrics and Gynecology, Carolinas Medical Center, University of North Carolina
James Hall, MD is a member of the following medical societies: American Cancer Society, American College of Obstetricians and Gynecologists, American Medical Association, and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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