Vulva and vagina

Chapter 9b discusses carcinoma of the vulva, which is primarily a surgical disease best treated by wide surgical resection, radical vulvectomy, and inguinal lymph node dissection based on presenting stage. Rarely, locally advanced primary disease may be presented for primary radiotherapy treatment. Postoperative radiotherapy is recommended for tumours invading >7 mm in a vertical direction. The first station regional lymph nodes in the inguinal region are best treated by radical surgical dissection, but fixed inoperable lymph nodes may benefit from primary radiotherapy which may be followed where appropriate by surgery if there is a residual mass. Postoperative radiotherapy should be considered for women having more than one node involved with metastatic tumour at surgery. This must be balanced against the increased risk of lymphoedema where both surgery and radiotherapy are delivered to the groins. Chemoradiation using cisplatin or 5-FU/mitomycin C-based schedules has been reported but no randomized comparison with radiotherapy alone has been undertaken; whilst high response rates are seen there is a considerable increase in acute toxicity.