MANAGEMENT OF VULVAR CANCER

Background. Current therapy of vulvar malignancies is reviewed with em phasis on screening, etiology, diagnosis, staging, and treatment of pr einvasive and invasive cancer. Methods, Screening procedures, etiologi c possibilities, diagnostic techniques, staging implications, and trea tment approaches are discussed in detail. Results. All malignancies of the vulva should be detected at an early stage, when they are most am enable to curative therapy. Regular examination of all women and incre ased efforts to educate patients should in time reduce patient and phy sician delay in diagnosis. The cause of the disease remains unclear, b ecause the precursor state has not been defined accurately. The impetu s to perform more conservative surgery has been accompanied by the rea lization of the severe psychosexual sequelae associated with radical v ulvectomy. High risk prognostic factors include number of positive gro in lymph nodes and diameter of the primary lesion. Diameter of the lar gest metastasis, intracapsular versus extracapsular nodal tumor locati on, laterality of spread, and deep groin nodal spread may be predictor s of survival. Conclusions. The overall incidence of vulvar malignanci es will not be changed until the pathophysiology of the disease is bet ter understood, Improved survival will depend on earlier and more accu rate diagnosis and treatment, including use of radiation therapy.