Vulvar cancer is rare. There are about 6,000 cases of vulvar cancer a year and 1,110 deaths,” said Benjamin E. Greer, MD, Professor at Fred Hutchinson Cancer Research Center and Co-Chair of the new NCCN Guidelines Panel for Vulvar Cancer. Dr. Greer presented information on the new guidelines at the recent NCCN 21st Annual Conference.
Based on 2 published randomized trials and a number of observational studies, the guidelines incorporate TNM staging based on tumor size, nodal status, extent of positive nodes, and International Federation of Gynecology and Obstetrics (FIGO) staging.
“Survival depends on nodal status,” Dr. Greer continued. He said that estimated survival is 70% to 80% with negative lymph nodes and 30% to 40% with positive lymph nodes in the groin. Over the years, treatment modifications have reduced morbidity and improved quality of life for patients with vulvar cancer. Modifications include regional lymph node management for unilateral cancers, radical local excision, separate groin incision, lymphatic mapping, radiation, chemotherapy, and exenteration.
Homesley HD, Bundy BN, Sedis A, Adcock I. Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 1986;68:733–740.
Kunos C, Simpkins F, Gibbons T et al.. Radiation therapy compared with pelvic node resection for node-positive vulvar cancer: a randomized controlled trial. Obstet Gynecol 2009;114:537–546.