Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T18:30:03.034Z Has data issue: false hasContentIssue false

26 - Vulva

Published online by Cambridge University Press:  23 December 2009

By
Louise Hanna  and
Malcolm Adams
Edited by
Louise Hanna ,
Tom Crosby  and
Fergus Macbeth
Louise Hanna
Affiliation:
Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
Malcolm Adams
Affiliation:
Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
Louise Hanna
Affiliation:
Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Hospital, Cardiff
Get access

Summary

Introduction

Carcinoma of the vulva is an uncommon disease. Approximately 75% of patients with vulval cancer are cured, but effective management requires the expertise of a multidisciplinary team to support patients through the physical and psychosexual morbidity that is associated with radical treatment.

Range of vulval tumours

Table 26.1 shows the large range of benign and malignant tumours which may affect the vulva (adapted from WHO, 2003).

Anatomy

The vulva is the name given to the female external genitalia. The anatomical subsites are as follow:

  • Mons pubis, the rounded hair-bearing region in front of the pubis.

  • Labia majora, the hair-bearing skin extending from the mons pubis.

  • Labia minora, the non-hair-bearing folds of skin that meet posteriorly at the fourchette.

  • Clitoris, situated in the midline at the anterior ends of the labia minora.

  • Vestibule, the triangular-shaped skin between the labia minora.

Incidence and epidemiology

The annual incidence of vulval cancer in the UK is 3.5 in 100,000 women (National Statistics, 2005). Approximately 880 cases are diagnosed in England each year. Vulval cancer makes up about 5% of all gynaecological cancers. Cancer mortality is approximately one-quarter of patients diagnosed. Disease incidence increases with age; presentation is very rare in women under the age of 30, with peak incidence occurring in women over the age of 70. The highest incidence occurs in underdeveloped countries.

Carcinoma of the vulva

Risk factors and aetiology

Squamous carcinoma is the most common malignant tumour of the vulva.

Type
Chapter
Information
Practical Clinical Oncology , pp. 296 - 303
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Benedet, J. L., Bender, H., Jones, H. 3rdet al. (2000). Federation Internationale de Gynecologie et d'Obstetrique staging classifications and clinical practice guidelines in the management of gynaecologic cancers. Int. J. Gyneco. Obstet., 70, 209–62.Google Scholar
Board of the Faculty of Clinical Oncology, Royal College of Radiologists. (2006). Radiotherapy Dose-Fractionation. London: Royal College of Radiologists.
Cunningham, M. J., Goyer, R. P., Gibbons, S. K.et al. (1997). Primary radiation, cisplatin and 5-fluorouracil for advanced squamous carcinoma of the vulva. Gynecol. Oncol., 66, 258–61.CrossRefGoogle ScholarPubMed
Faul, C. M., Mirmow, D., Huang, Q.et al. (1997). Adjuvant radiation for vulvar carcinoma: improved local control. Int. J. Radiat. Oncol. Biol. Phys., 38, 381–9.CrossRefGoogle ScholarPubMed
Hacker, N. F., Leuchter, R. S., Berek, J. S.et al. (1981). Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions. Obstet. Gynecol., 58, 574–9.Google ScholarPubMed
Hacker, N. F., Berek, J. S., Juillard, G. J.et al. (1984). Preoperative radiation therapy for locally advanced vulvar cancer. Cancer, 54, 2056–61.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Heaps, J. M., Fu, Y. S., Montz, F. J.et al. (1990). Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol. Oncol., 38, 309–14.CrossRefGoogle ScholarPubMed
Homesley, H. D., Bundy, B. N., Sedlis, A.et al. (1986). Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet. Gynecol. 68, 733–40.Google ScholarPubMed
Homesley, H. D., Bundy, B. N., Sedlis, A.et al. (1991). Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study). Am. J. Obstet. Gynecol., 164, 997–1003.CrossRefGoogle Scholar
Koh, W. J., Wallace, H. J. 3rd, Greer, B. E.et al. (1993). Combined radiotherapy and chemotherapy in the management of local-regionally advanced vulvar cancer. Int. J. Radiat. Oncol. Biol. Phys., 26, 809–16.CrossRefGoogle ScholarPubMed
Landoni, F., Maneo, A., Zanetta, G.et al. (1996). Concurrent preoperative chemotherapy with 5 fluorouracil and mitomycin C and radiotherapy (FUMIR) followed by limited surgery in locally advanced and recurrent vulvar carcinoma. Gynecol. Oncol., 61, 321–7.CrossRefGoogle ScholarPubMed
Lupi, G., Raspagliesi, F., Zucali, R.et al. (1996). Combined preoperative chemoradiotherapy followed by radical surgery in locally advanced vulvar cancer. A pilot study. Cancer, 77, 1472–8.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Moore, D. H., Thomas, G. M., Montana, G. S.et al. (1998). Preoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology Group. Int. Radiat. Oncol. Biol. Phys., 42, 79–85.CrossRefGoogle ScholarPubMed
National Statistics. (2005). In Cancer Statistics and Registrations, series MB1 no. 34, London: Office for National Statistics, p. 64.
Podratz, K. C., Symmonds, R. E., Taylor, W. F.et al. (1983). Carcinoma of the vulva: analysis of treatment and survival. Obstet. Gynecol., 61, 63–74.Google Scholar
Scheistroen, M. and Trope, K. (1993). Combined bleomycin and irradiation in preoperative treatment of advanced squamous cell carcinoma of the vulva. Acta Oncol. 32, 657–61.CrossRefGoogle ScholarPubMed
Selman, T. J., Luesley, D. M., Acheson, N.et al. (2005). A systematic review of the accuracy of diagnostic tests for inguinal lymph node status in vulvar cancer. Gynecol. Oncol., 99, 206–14.CrossRefGoogle ScholarPubMed
Stehman, F. B., Bundy, B. N., Dvoretsky, P. M.et al. (1992). Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet. Gynecol., 79, 490–7.Google Scholar
Thomas, G., Dembo, A., DePetrillo, A.et al. (1989). Concurrent radiation and chemotherapy in vulvar carcinoma. Gynecol. Oncol., 34, 263–7.CrossRefGoogle ScholarPubMed
International Union Against Cancer. (2002). In tumour nodes metastases Classification of Malignant Tumours, Ed. Sobin, L. H. and Ch. Wittekind, , 6th edn. New York: Wiley-Liss.Google Scholar
Wagenaar, H. C., Colombo, N., Vergote, I.et al. (2001). Bleomycin, methotrexate, and CCNU in locally advanced or recurrent, inoperable, squamous-cell carcinoma of the vulva: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Cooperative Group Study. European Organization for Research and Treatment of Cancer. Gynecol. Oncol., 81, 348–54.CrossRefGoogle ScholarPubMed
Wahlen, S. A., Slater, J. D., Wagner, R. J.et al. (1995). Concurrent radiation therapy and chemotherapy in the treatment of primary squamous cell carcinoma of the vulva. Cancer, 75, 2289–94.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
World Health Organisation. (2003). In World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Breast and Female Genital Organs, ed. Tavassoli, F. A. and Devilee, P.. Lyon: IARC Press, Chap. 7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Vulva
    • By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.027
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Vulva
    • By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.027
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Vulva
    • By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.027
Available formats
×