INTRODUCTION :
Carcinoma vulva is a relatively rare disease accounting for 4% of all
gynecological malignancies in United States1. It constitutes 0.3% of all cancers
affecting females and 1.3% of all gynecological malignancies in Chennai2. The
vulva is the anatomic area immediately external to the vagina. It includes the labia
and the perineum. The inguinofemoral nodes are the sites of regional spread.
Tumor involvement of pelvic lymph nodes is considered distant metastasis.
OBJECTIVE : Carcinoma of the vulva is a relatively rare disease accounting for 0.3% of all
cancers affecting females and 1.3% of all gynecological malignancies in Chennai. Aim of the
present study is to analyze the clinical presentations, treatment options, morbidity, failure pattern
and survival for invasive carcinoma of vulva treated in our institution during a period of eight
years and to compare our results with other published series.
MATERIALS AND METHODS : Retrospective analysis of case records of 35 patients who
underwent surgery for invasive carcinoma of the vulva from 2004 to 2011 in the Department of
Surgical Oncology, Government Royapettah Hospital, Chennai.
RESULTS : The mean and median age was 52.5 years and 55 years respectively (range 21-72).
Labia majora was the predominant site of disease (80%). Twenty eight patients underwent
Radical Vulvectomy with Nodal Dissection, 2 underwent Hemivulvectomy with Nodal
Dissection, 2 underwent Simple Vulvectomy, 2 underwent Wide Local Excision and 1
underwent Wide Local Excision with Nodal Dissection. Lymphadenectomy was not done in 4
patients. With a median follow up of 26 months (range 2-67 months), 8 patients (22.9%)
developed recurrence, of which one is systemic, 4 regional and 3 local. The estimated 5 year
Overall Survival (OS) and Disease Free Survival (DFS) for all cases in our series using Kaplan-
Meier analysis was 85.1% and 65.4% respectively. On univariate analysis using log rank test,
advanced stage, lymph node positivity and lymph node positivity with extracapsular spread
(ECS) significantly affected estimated 5 year overall survival.
CONCLUSION : Carcinoma vulva, a relatively rare disease should better be managed in
dedicated cancer centers where treatment can be tailored to individual patients with
multidisciplinary cooperation. The median age in our series was 55 years which is well below the
western world. Extracapsular nodal spread was observed as the strongest prognostic factor for
survival in our series like other international series. Since there has been a dearth of reports
about this disease from our country as well as other developing countries we urge the need for
more studies from various centers and probably well designed multicentric studies keeping in
mind the low prevalence of this disease
