Vulvar Cancer Women’s Hospital,School of Medicine Zhejiang University

General Considerations Vulvar cancer is uncommon USA:3,800 new cases and 800 deaths annually Representing 3%-5% of malignancies of the female genital tract The peak incidence of onset is in the age 60-80 years Recently, the incidence appears to be increasing

Etiology unknown Associated factors HPV STD Chronic vulvar dystrophy

Pathology Histological type squamous cell carcinoma melanoma sarcoma basal cell adenocarcinoma bartholin gland squamous adenocarcinoma undifferentiated

Pathology Main focus Changes around focus： skin incrassation, increased or decreased pigmentation

Clinical manifestation symptoms vuval pruritus mass advanced stage feature sign Tumor focus positive lymph nodes

Routes of Spread Vulvar cancer spreads by the following routes： Direct extension,to involve adjacent structures such as the vagina,urethra,and anus Lymphatic embolization to the regional inguinal and femoral lymph nodes Hematogenous spread to distant sites,including the lungs,liver,and bone

Diagnosis histology History & symptoms sign Assistant examinations cytology image cystoscopy proctoscopy

Staging(FIGO,2009)

Treatment （1） Principle: surgery combined with radiotherapy ,chemotherapy

Treatment （2） Early stage： individual，conservative surgery when good prognosis was ensured advanced stage combined therapy，improve survival

Treatment （3） SOGC Clinical Practice Guidelines

Radical vulvectomy

Treatment （4） radiotherapy sensitive：squamous acanecr Side effects of irradiation to vulva indication radiotherapy prior to surgery adjuvant radiotherapy after surgery residual or relapse tumor

Treatment （5） chemotherapy Advanced stage, relapse drugs DDP ，CP BLM 5-Fu ADM

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%

Follow-up Prognostic factors： Lymph metastasis Invasive Depth Tumor size Location Stage Treatment

Follow-up Follow-up Year 1： 1-2 monthly Year 2 ： 3 monthly