Clinical experience in gynecological cancer management. b) Vulvar cancer: report from the Gynecologic Institutes of Padua University (1963-1989).
A review of the case series of our Institute from 1963 to 1989 (197 patients) permits some considerations and conclusions on the clinical management of vulvar cancer. In the aim of prophylaxis, prevention and early detection, personalized screening must be systematically performed in clinical practice by the Gynecologist. Surgical Pathological Staging (post-surgical FIGO stages) is mandatory for the exact knowledge of local tumor spread, lymph nodal involvement, aggressiveness factors and possible neoplastic multicentricity. In our experience operability is now 93%, with pathological radicality in 93% of operated cases. In early stages lymph nodal involvement is low (8.6% in tumor less than 2 cm; post surgical FIGO stage I) but it is very high in advanced cases. Surgery is the treatment of choice both in early and advanced stages. The increasing incidence of early vulvar cancer in young women has obliged us to reduce the cost to the patient of the surgical strategy to avoid mutilation in order to improve the quality of life without endangering survival. With this aim, since 1975 we have been performing an enlarged non mutilant radical vulvectomy which allows a better post operative period, with a low rate of complications and the preservation of anatomo-functional integrity. Furthermore 5 year survival rate appears unchanged while the quality of life greatly improves in cases treated by non mutilant operation. In any case of invasive tumor bilateral systemic inguinal lymphadenectomy must be performed and frozen biopsies are useful for planning the best surgical strategy. Integrated therapies are useful in advanced cases and in lymph nodal involvement. Close follow-up is mandatory.
Institute of Gynecology, University of Padua.
A
A
Onnis
M
M
Marchetti
T
T
Maggino
J
J
De Toffoli
D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*