Clinical staging of carcinoma of the vulva.

Abstract

This study reviews the criteria for staging of epidermoid carcinoma of the vulva as formulated at the 5th International Congress of the International Federation of Obstetricians and Gynecologists (FIGO) in Sydney Australia September 1967 and as approved by the 6th Congress of FIGO in 1970. These criteria have been applied retrospectively to 164 cases previously reported from the University of Texas. Of these 15 1 received treatment at the M.D. Anderson Hospital and Tumor Institution Houston from 1944 to 1968. Classified as Stage 1 were primary tumors confined to the vulva of 2 cm or less in diameter and with no nodes suspicious of tumor involvement. Stage 2 tumors were confined to the vulva were over 2 cm in diameter with or without palpable suspicious nodes. In Stage 3 there spread to adjacent tissues and enlarged fixed confluent or vaginal mucosa and sometimes evidence of distant metastases. Of the 164 records studied 21% were Stage 1 20% were Stage 2 40% Stage 3 and 19% Stage 4. Of the Stage 1 patients 53 were from Anderson Hospital and 44 from other sources. None of these subsequently died of recurrent malignancy. Superficially invasive lesions were 60% of these. Of 48 lesions of 2 cm or less 15% had positive lymph nodes. Of lesions above 2 cm but less than 8 cm node metastases was present in 35% while lesions of 8 cm or more had node metastases in 50%. About a third of inguinal node metastases were not suspicious on clinical examination. Survival rates for Stages 1 and 2 differed only slightly between large and small lesions when suspicious lymph nodes were not present. In 93% of deaths due to recurrent disease death occurred within 3 years. Subsequently deaths due to cancer were overshadowed by deaths from intercurrent disease due to the advanced age of these patients. The FIGO classification is considered a good clinical basis of evaluating prognosis of epidemoid carcinoma of the vulva.