Cancer of the vulva

Staging 1.1.Anatomy Primary siteCases should be classified as carcinoma of the vulva when the primary site of growth is in the vulva.Any lesion that involves both the vagina and vulva (i.e.crosses the hymenal ring) should be classified as a carcinoma of the vulva.Tumors that present in the vulva as secondary growths, from either a genital or extragenital site, should be excluded.Malignant melanoma should be reported separately.There must be histologic confirmation of the cancer. Nodal stationsThe inguinal and femoral nodes are the first sites of regional spread. Metastatic sitesPatients who have extrapelvic metastases or who have involvement of pelvic lymph nodes (external, hypogastric, obturator, and common iliac) are classified as having stage IVB disease. Surgical staging classificationThe staging system for vulvar cancer has been based on surgical findings since 1988.The final diagnosis is dependent upon thorough histopathologic evaluation of the operative specimen (vulva and lymph nodes).Various modifications have been made over time, with a subdivision of Stage I added in 1994.The FIGO staging of vulvar carcinoma was last changed in 2009 by the FIGO Committee on Gynecologic Oncology [1], to give better prognostic discrimination between stages (Table 1).Table 2 compares the FIGO staging with the Union of International Cancer Control "TNM" classification. Histopathologic typesApproximately 80% of cases are squamous cell carcinomas, and many cases, particularly in younger women, are HPV related.Melanomas are the second most common cancer seen in cancer centers, although community-based studies have reported basal cell carcinomas to be the second most common vulvar cancer [2].The histopathologic types are: • squamous cell carcinoma • melanoma • verrucous carcinoma • Paget's disease of vulva • adenocarcinoma, not otherwise specified (NOS) • basal cell carcinoma, NOS • Bartholin's gland carcinoma.1.2.2.Histopathologic grades (G) • GX: Grade cannot be assessed • G1: Well differentiated • G2: Moderately differentiated • G3: Poorly or undifferentiated.