Onkológia 6/2007

DIAGNOSIS AND MANAGEMENT OF VULVAR CANCER

Aim: The aim of this article is to give an overview of the management of vulvar cancer. Methods: Review the literature from database Medline using Key words vulvar cancer, surgical therapy, radiotherapy, sentinel node with the emphasis on diagnostics and primary therapy. Results: Surgery is the cornerstone of treatment for early stage squamous cell vulvar cancer (with wide local excision and uni- or bilateral inguinofemoral lymphadenectomy via separate incisions as standard treatment). Primary radiotherapy may be an alternative for the inguinofemoral lymphadenectomy. The sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with 99mtechnetium-labeled nanocolloid and Patent Blue®) is a promising staging technique for patients with vulvar cancer. The clinical implementation of the sentinel lymph node procedure and the role of additional histopathological techniques of the sentinel lymph nodes have to be investigated. In the cases of advanced vulvar cancer chemoradiation eventually followed by surgery is the treatment of first choice for these patients. Conclusions: The radical surgical approach in the treatment of vulvar cancer patients has led to a favorable prognosis for the majority of the patients with early stage cancer. However, the morbidity is impressive, leading to more individualized treatment. The sentinel lymph node procedure and primary radiotherapy are promising methods to reduce morbidity of treatment, but their safety needs to be studied in clinical trials.

Keywords: vulvar cancer, diagnosis, surgical therapy, radiotherapy, sentinel node