Vulvar cancer spreads by direct extension
Vulvar cancer spreads by direct extension to the adjacent structures, including the vagina and anus, and by lymphatic embolization to the regional lymph nodes. Metastases to the liver, lungs, and bones may occur. The overall incidence of lymph node metastasis of vulvar cancer is about 30%. When inguinal-femoral node metastasis is present, the rate of pelvic node metastasis is about 25%.
The incidence of groin node metastasis is related to the depth of stromal invasion, grade of the tumor, presence of lymphovascular space involvement, clinical node assessment, and age of the patient.
Lesions smaller than 2 cm in diameter with minimal stromal invasion of less than 1 mm have been designated stage IA. If these lesions have no associated lymphovascular space involvement and are well differentiated with neither any infiltrating tumor component nor confluence, there should be minimal possibility of groin node metastasis that would warrant groin dissection in all patients. The major reason for including this subset within stage I is to collect data that might indicate outcome in a large number of patients treated with a variety of operative approaches.
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