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World J Obstet Gynecol. Feb 10, 2016; 5(1): 97-101
Published online Feb 10, 2016. doi: 10.5317/wjog.v5.i1.97
Review of the current surgical management of vulval cancer
Sarah L Platt, Kristyn M Manley, John B Murdoch
Sarah L Platt, Kristyn M Manley, John B Murdoch, Department of Gynaecological Oncology, St. Michael’s Hospital, University Hospitals Bristol NHS Trust, Bristol BS2 8EG, United Kingdom
Author contributions: Platt SL and Manley KM contributed equally to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Murdoch JB reviewed the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sarah L Platt, MBChB, MRCOG, BSc (Hons), Department of Gynaecological Oncology, St. Michael’s Hospital, University Hospitals Bristol NHS Trust, Southwell Street, Bristol BS2 8EG, United Kingdom. sarah.platt@uhbristol.nhs.uk
Telephone: +44-117-3425810 Fax: +44-117-3425792
Received: July 20, 2015
Peer-review started: July 23, 2015
First decision: November 6, 2015
Revised: December 3, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 10, 2016
Abstract

Currently in the United Kingdom, 1200 cases of vulval cancer are diagnosed per annum accounting for 6% of female genital cancers. Although classically a condition that affects older women and associated with lichen sclerosus, there has been a greater incidence of vulval squamous tumours in young women due to the increasing prevalence of promoting human papillomavirus (HPV). The advent of a vaccination programme against HPV 16 and 18, the main aetiological causes of vulval intraepithelial neoplasia and cervical intraepithelial neoplasia, may reduce the incidence in future generations. Primary surgery is the current gold standard treatment and although mortality rates have reduced by 40% since the 1970s, radical vulval resections are associated with significant morbidity such as wound breakdown, infection, lymphoedema and psychosexual consequences. Over the past decade there has been a move to less mutilating procedures in women diagnosed with early vulval cancer. This is in combination with the introduction of new surgical methods such as sentinel lymph node testing, more directed radiotherapy and chemotherapy options. These treatment methods are being assessed in clinical trials to determine their associated recurrence rates, survival rates and morbidity. Most vulval cancers are squamous cell in origin but, there are other histological subtypes including Paget’s disease and vulval melanoma which can require different management approaches. The objective of this paper is to review the current literature on the management of vulval cancer, summarise the new treatments which are being developed and the associated evidence.

Keywords: Vulval cancer, Paget’s disease, Human papilloma virus, Sentinel lymph nodes, Inguinofemoral groin node dissection

Core tip: One thousand and two hundred cases of vulval cancer are diagnosed annually in the United Kingdom. Primary surgery is the current gold standard treatment but radical vulval resections are associated with significant morbidity so there has been a move to less mutilating surgical procedures. Sentinel lymph node testing, more directed radiotherapy and chemotherapy are all currently being assessed in clinical trials and the advent of the HPV vaccination programme may reduce the incidence in future generations. The objective of this paper is to review the current literature on the management of vulval cancer and summarise the new treatments and the associated evidence.