Guideline for Gynecological Malignant Tumors - Primary Complex Therapy in Operable Stages of Malignant Tumors of Vulva
Abstract
Objective: Elaboration of guideline for primary treatment of operable vulvar cancer.Design: Review, consensus between proposers and opponents.Setting: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University andFaculty Hospital Motol, Prague.Method: A retrospective review of published data, analysis of Czech statistics and consensusbetween proposers and opponents.Results: Guideline for the diagnosis remain the same as in the proposal from 1998. We elaboratedpractically new guideline for surgical treatment.
Wide excision or simplex vulvectomy is adequateonly for stage 1a without angioinvasion, free margins have to be 5 mm. Standard surgicalprocedure is radical vulvectomy with inquinofemoral lymphadenectomy in stage 1a with angioinvasion,1b and 2.
In laterally localised lesions it is possible to perform hemivulvectomy or radicalexcision with inquinofemoral lymphadenectomy. Free margins have to be more than 8 mm.An alternative procedure in internally high-risk patients is sentinel node detection with radicalvulvectomy (hemivulvectomy).
Sentinel node detection has to by performed by combined methodof blue dye and radiocoloid Tc 99 simultaneously. Bilateral inquinofemoral lymphadenectomy isindicated in case of positive sentinel node.
Primary radiotherapy is indicated in higher stages, instage 3 we can perform an exenteration with the agreement of patient.Conclusion: Guideline for the treatment of vulva cancer should be directions for clinicians andothers, who participate in the process of treatment of the vulva cancer. Guidelines include allparts of the process (from diagnosis to follow up).
All topics of the guidelines were arise froma voting of the proposers and opponents.