VULVAR CARCINOMA
Ruling In Factors
• Age (80% occurring in >50 years
old)
• Infection (HPV DNA is detected in
50 to 70 percent of invasive
lesions but is seen in > 90
percent of
vulvar intraepithelial neoplasia
(VIN) lesions )
• Smoker (Women who have
smoked have 35 fold increase in
developing vulvar cancer)
• Women with VIN and vulvar
cancer commonly present with
pruritus and a visible lesion
Red, or pigmented and may be
raised or flat
• Tenderness of the area.
• Manifestations can persist or weeks or
months be more diagnosis, as many
patients may be embarrassed or may
not recognize the significance of their
symptoms.
• These women would have been examined
several times and diagnosed with
candidiasis, but experience no relief of
symptoms with antifungal treatments or
topical steroids. Any time a pruritic area
of the vulva does not respond
to topical antifungal creams—particularly
in the postmenopausal woman.
• (+) 6cm left labial lesion, tender, white
discharge
• (+) 1-2 cm mass on right labial area
Vulvar Cancer
• Cancer of the vulva may arise from the skin, subcutaneous
tissues, glandular elements of the vulva, or the mucosa of the
lower third of the vagina
• It is uncommon, accounting for about 5% of gynaecologic
cancers.
• Approximately 90% of these tumors are squamous cell
carcinoma
• It is primarily a disease of the elderly. Peak incidence in the
60s. Average age at time of diagnosis is 65yrs
• Patients with vulvar cancer often present with long histories
of vulvar pruritus, pain, and bleeding. Focal lesions tend to
be merely inflamed and erythematous in early cancers and
heaped up or ulcerated in later stages. They may also present
with a vulvar mass that may be fleshy, nodular, or warty.
• The presence of bleeding, discharge, or a clear
mass is strongly suggestive of invasive carcinoma
• Although lesions can appear anywhere on the
vulva, most are on the labia majora
• The spread of disease is primarily via the
lymphatics to the superfcial inguinal lymph nodes,
with a smaller degree of spread via direct
extension to vagina, urethra, and anus
Carcinoma of the vulva
Stage grouping

FIGO stage T N M
0 Tis N0 M0
IA T1A N0 M0
IB T1B N0 M0
II T2 N0 M0
III T1 N1 M0
T2 N1 M0
T3 N1 M0
IVA T1 N2 M0
T2 N2 M0
T3 N2 M0
T4 Any N M0
IVB Any T Any N M1