Vulval Cancer

Diagnosis

• Vulval cancer is relatively uncommon in Hong Kong.
• Patients typically present with symptoms such as vulval ulcers, pain or persistent itchiness.
• Diagnosis is usually made through a wedge biopsy or excisional biopsy, depending on the tumour’s size.
• Histological examination is critical for confirming the diagnosis and determining the most appropriate treatment approach.

Assessment

• For vulval cancer patients, the extent of the disease determines the treatment mode.
• Pre-operative assessments include basic blood tests, tumour marker levels, and chest X-rays.
• Surgery is the primary treatment for most cases, with lymph node removal depending on the depth of cancer invasion and tumour size.
• Imaging studies are valuable for detecting metastatic disease.
• In cases of locally advanced or metastatic disease, primary surgical treatment may not be appropriate.

• Surgical treatment is the mainstay for vulval cancer.
• Radical excision of the vulval lesion, with or without bilateral groin node dissection is the most commonly performed operation.
• Some cases may require post-operative radiotherapy.
• For locally advanced diseases, pre-operative radiotherapy or chemoradiation may be beneficial.

After completion of treatment, patients should be followed up regularly to 

• Deal with the side-effects and complications arising from the treatment
• Monitor the disease status 

Side-effects and Complications from Treatment 

• Extensive operation involves the removal of and insults to normal structures, e.g. lower limb oedema after pelvic lymphadenectomy
• Chemotherapy side-effects can be long-lasting, e.g. numbness over extremities after chemotherapy using platinum agents
• Patients who have received radiotherapy can also develop post-treatment complications 

Monitoring of Disease Status 

• Physical examination
• Vaginal cytology
• Blood test for tumour markers
• Repeated imaging studies if necessary. It helps pick up recurrent diseases