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

2. 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 years
Recently, the incidence appears to be increasing

3. Etiology
unknown
Associated factors
HPV
STD
Chronic vulvar dystrophy

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

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

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

8. 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

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

10. Staging(FIGO,2009)

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

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

13. Treatment （3）
SOGC Clinical Practice Guidelines

15. Radical vulvectomy

16. 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

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

18. 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%

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

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