Vulval cancer

Question 1

List the FIGO staging of vulval cancer

Answer 1

• Stage I: confined to vulva
• Stage II: extension to lower ⅓ urethra, lower ⅓ vagina and anus.
• Stage III: positive inguinofemoral nodes.
• Stage IV: extension to upper ⅔ of urethra and vagina or distant structures including pelvic lymph nodes.

Question 2

Outline your work up and investigations for suspected vulval cancer

Answer 2

• Biopsy
• Cervical smear and colposcopy of cervix and vagina for concurrent lesions.
• Bloods: FBC, U&Es, LFTs, HIV serology
• Imaging: CXR, MRI or CT pelvis, PET-CT.

Question 3

Outline management principles for the different stages of vulval cancer

Answer 3

Stage IA: wide local excision with 1 cm margin.

Stage IB - II:

• Wide local excision +
• Sentinel node procedure + unilateral inguinofemoral lymphadenectomy

Stage III:

• Surgical excision
• Adjuvant pelvic and groin radiotherapy

Stage IV:

• Surgical excision + bilateral inguinofemoral lymphadenectomy/ adjuvant radiotherapy OR primary chemoradiation