The vulvar cancer is a malignant tumor from the vulvar skin, mucous membrane, and its appendant organs and greater vestibular gland; the incidence rate accounts for 2–5% of the female genital tumors; the International Federation of Gynecology and Obstetrics (FIGO) reported that the incidence rate of vulvar cancer in Western women is 2–5/100,000.

Its etiology is not yet clear; it may be related to viral infection (human papillomavirus 16, 18, and 31 are more common), sexually transmitted diseases, low immunity, and chronic skin diseases (such as vulvar dystrophy). The vulvar cancer mostly occurs in postmenopausal women, and the average onset age is 52 years. The vulvar cancer is located in the body surface and can be diagnosed definitely based on medical history, symptoms, signs, and biopsy examination. The lesions can involve the vulva, perineum, or areas around the anus and can be divided into midline type and lateral type. The cancers in labia majora are most common, followed by the cancers in labia minora, clitoris, posterior commissure of the perineum, perineum, and urethra.

The main pathological type is the squamous cell carcinoma, accounting for more than 80%, which is followed by the malignant melanoma (4.5%), basal cell carcinoma (2.5%), Paget’s disease (2.5%), adenocarcinoma (2.5%), and sarcoma (2%).

Currently, the clinical and pathological staging system for the vulvar cancer is the standard established by the International Federation of Gynecology and Obstetrics (FIGO) in 2009 (FIGO 2009).

The lymphatic drainages from the labia majora and labia minora, clitoris, posterior commissure of the perineum, and perineum firstly enter into the superficial inguinal lymph nodes and then enter into the deep inguinal lymph nodes. All lymphatic drainages are aggregated into Cloquet’s lymph nodes and pass through this place to enter into the pelvic lymph nodes. In addition, the lymphatic vessels still have channels to enter into external iliac lymph nodes via the pubic symphysis or enter into obturator lymph nodes via the dorsal vein of the clitoris. When the lesions involve the urethra, bladder, vagina, or rectum, other lymphatic drainages can directly enter into the pelvic lymph nodes.

The lymph node metastases are related to the size and location of the cancer focus, the relationship with neighboring organs, tissue differential degree, tumor infiltration depth, the presence or absence of lymphatic and vascular invasion, and the clinical stage.

The vulvar cancer is mainly treated with surgery:

Because of poor tolerance to radiotherapy, the vulvar tissue cannot be treated preferably by radiotherapy even though it is sensitive to radiotherapy pathologically to a certain extent. At present, the radiotherapy is generally used as the palliative treatment or the supplement of the surgical treatment, for example, the postoperative radiotherapies on the inguinal area and the area outside the pelvic cavity in patients with inguinal lymph node metastases are carried out to reduce the possibility of recurrence and metastasis, and the patients with huge masses invading the adjacent organs undergo preoperative radiotherapy or adjuvant chemotherapy to shrink the tumor to increase the resection rate and preserve the corresponding viscera function to improve the quality of life. In European countries with mature radiotherapy technologies, the radiotherapy interpolated among tissues is performed; it is reported that the effect is good, but it is limitedly carried out in China.