Article Text
Abstract
Introduction The suspected cancer pathway is designed to aid faster diagnosis. Due to vulval cancer being rare and the limited exposure of healthcare professionals to vulval pathology, we speculate that this has a negative impact on its prompt diagnosis. We reviewed our practice over a five-year period to identify what could be improved to make the diagnosis of vulval cancer more efficient. We hope these findings will guide service development.
Methods Retrospective review of all vulval cancers diagnosed at Chelsea and Westminster Hospital NHS Foundation Trust between January 2019 and December 2023 inclusive.
Results There were 30 vulval cancers diagnosed in the specified time frame (age range 29-95, mean 67 years; performance status range 0-3). Most were squamous cell cancers (n=25). Figure 1 shows the cancer subtypes. All except three were referred onto cancer centres for treatment. Only 20/30 (67%) were referred on the gynaecology suspected cancer pathway. The remainder were seen in vulval dermatology (7), general gynaecology (2), colorectal clinic (1), acute gynaecology (1). Presenting symptoms varied as shown in figure 2. Two patients were diagnosed following routine follow up for VIN. 21/30 (70%) were diagnosed following a biopsy in clinic. The remainder underwent examination under anaesthesia (EUA). Only 7/30 (23%) had medical photography and this contributed to 3 patients undergoing EUA given discordant clinic biopsy results.
Conclusion/Implications Vulval cancer is rare. Efficient diagnosis may be achieved by increased education and awareness. As a trust we have set up multidisciplinary weekend vulval clinics with this in mind. Medical photography should be standard practise.