Vulvar cancer staging is determined through surgery. Treatment typically occurs via this staging procedure and information gained from the procedure helps guide future treatments. The most important predictor of survival is lymph node status, which is determined during the initial surgical procedure.
Other factors important to overall outcome are:
- Size of primary tumor
- Depth of invasion
- Location of tumor
- Lympho-vascular space involvement
- Distant metastasis
In early stage tumors of small size (less than 2 centimeters) and minimal invasion (less than 1 millimeter), the risk of lymph node metastasis is so small that groin nodal dissection can be safely omitted. In all other cases, groin nodal dissections are important to not only predict overall survival but guide post-operative radiotherapy.
In patients that undergo lymph node dissection, 25% of patients with suspicious nodes will be negative for disease, while 25% with non-suspicious nodes will be found to have tumor tissue within the dissected groin nodes. This further reinforces the need for thorough surgical staging in more advanced stages of vulvar cancer.