Vulvar cancer
Prepared with OnCo (onco.cc/prep/vulvar/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
16 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example p16and p53 IHC, Sentinel node status and metastasis size, Depth of invasion, PD-L1 CPS / TMB / MSI, Margin status), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (early (t1, <4 cm, unifocal)), which of the standard options do you recommend and why?
- 6.For my situation (node-positive after surgery), which of the standard options do you recommend and why?
- 7.Am I a candidate for Cisplatin, and what side effects should I expect?
- 8.For my situation (locally advanced (t3 / fixed nodes)), which of the standard options do you recommend and why?
- 9.Am I a candidate for Cisplatin, and what side effects should I expect?
- 10.For my situation (metastatic or recurrent), which of the standard options do you recommend and why?
- 11.Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab or related drugs, and what side effects should I expect?
- 12.Are there clinical trials I could join, for example of Pembrolizumab, Cemiplimab, Lorigerlimab?
- 13.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 14.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 15.I read that “HPV-independent p53-mutant disease recurs often and has no targeted therapy”. How does that affect my plan?
- 16.I read that “Lichen sclerosus surveillance and prevention of malignant transformation”. How does that affect my plan?
The words I may hear
- HPV-positive (p16) head and neck cancer: Throat cancers caused by the human papillomavirus, identified by a p16 stain.
- Combined positive score (CPS): A PD-L1 score that counts stained tumour cells and immune cells together.
Tests and results to bring
Biomarker results to ask for: p16 (HPV) and p53 IHC (molecular subtype), Sentinel node status and metastasis size (≤2 mm vs >2 mm), Depth of invasion (>1 mm for nodal assessment), PD-L1 CPS / TMB / MSI (pembrolizumab), Margin status.
Scans and tests linked to this cancer: Colposcopes and digital cervical screening devices (DYSIS, EVA System, AVE).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Early (T1, <4 cm, unifocal): Radical local excision with 1 cm margin and sentinel lymph node biopsy (GROINSS-V); radiotherapy for sentinel micrometastases ≤2 mm, lymphadenectomy for macrometastases. (Sentinel lymph node biopsy, IMRT / IGRT (modern external beam))
- Node-positive after surgery: Adjuvant radiotherapy to groins and pelvis (± concurrent cisplatin) for ≥2 nodes or extracapsular spread (AGO-CaRE-1 supports chemoradiation). (Cisplatin, IMRT / IGRT (modern external beam))
- Locally advanced (T3 / fixed nodes): Definitive or neoadjuvant chemoradiation with weekly cisplatin (GOG 279: ~70% complete response), reserving exenterative surgery for residual disease. (Cisplatin, IMRT / IGRT (modern external beam))
- Metastatic or recurrent: Carboplatin-paclitaxel ± bevacizumab (by cervical analogy); pembrolizumab for PD-L1 CPS ≥1, TMB-H or MSI-H; clinical trials. (Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab, Pembrolizumab)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.