Page 7 - ESGO - Vulvar cancer - Complete report_fxd2

5 Summary of guidelines

5.1 Diagnosis and referral

 In any patient suspected for vulvar cancer, diagnosis should be established by a punch/incision biopsy.
Excision biopsy should be avoided for initial diagnosis, as this may obstruct further treatment planning.

 In patients with multiple vulvar lesions, all lesions should be biopsied separately with clear
documentation of mapping.

 All patients with vulvar cancer should be referred to a Gynaecological oncology centre GOC and
treated by a multidisciplinary gynaecological oncology team.

5.2 Staging system

 Vulvar cancer should be staged according to FIGO and/or TNM classification1.

5.3 Preoperative investigations

 Preoperative work-up should at least include clear documentation of clinical exam size of lesion,
distance to the midline/clitoris/anus/vagina/urethra and palpation of lymph nodes. Picture or clinical
drawing is advised see below.

 Evaluation of the cervix/vagina/anus is recommended.
C Prior to sentinel lymph node biopsy, clinical examination and imaging of the groins either by

ultrasound, positron emission tomography - computed tomography PET -CT, or magnetic resonance
imaging MRI are required t o identify potential lymph node metastases.
 Suspicious nodes at palpation and/or imaging should be analysed by fine -needle aspiration FNA or
core biopsy when this would alter primary treatment.

1 Throughout these recommendations advanced stage of disease is defined as clinical T3 and/or N3.

 VULVAR CANCER - GUIDELINES 
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