Vulvar cancer is a relatively rare gynecologic malignancy that originates in the external female genitalia. Following successful initial treatment, patients often worry about the disease returning, a process known as recurrence. Understanding the likelihood and pattern of this occurrence is a necessary step in managing life after a diagnosis.
Understanding Recurrence Rates
The chance of vulvar cancer recurring varies significantly among patients, with overall rates generally reported between 12% and 37% after primary therapy. Recurrence is classified based on where the cancer reappears, most commonly at the original site. Local recurrence, where the cancer returns to the vulva or perineum, accounts for the majority of cases (approximately 61% of recurrences).
The initial stage of the cancer plays a very large role in determining the risk of recurrence. Early-stage, localized tumors have the lowest chance of returning, while advanced stages that involve nearby lymph nodes carry a significantly higher risk. When the cancer returns to the groin lymph nodes, it is called regional recurrence and represents about 30% of cases. Distant recurrence, where the cancer spreads to organs far from the vulva, makes up the remaining small percentage of cases, approximately 9%.
Factors Influencing the Likelihood of Recurrence
Several specific features of the original tumor are strong indicators of a patient’s future risk profile. The single most important factor is whether the cancer had spread to the regional lymph nodes at the time of diagnosis. When lymph nodes are found to contain cancer cells, the risk of both regional and distant recurrence increases substantially. This spread is often the primary element guiding decisions about additional treatment after surgery.
The extent of the primary tumor also influences recurrence risk, with larger tumors and higher FIGO stages carrying a greater likelihood of recurrence. Specifically, a tumor diameter exceeding four centimeters or a depth of invasion greater than five millimeters increases the risk. The quality of the surgical removal is another factor, particularly the status of the surgical margins. Positive margins, where cancer cells are found at the edge of the removed tissue, are associated with a higher rate of local recurrence.
The Typical Timeline of Recurrence
When vulvar cancer returns, it most frequently happens soon after the initial treatment is completed. The highest risk period is concentrated within the first few years following primary therapy. The majority of recurrences (between 40% and 80% of all cases) are detected within the first two years, requiring intensive surveillance during this initial period.
The risk remains elevated for the first five years, after which the likelihood of the cancer returning decreases considerably. For patients whose cancer returns to the vulva, the median time to recurrence is around 17 months after the initial treatment. Although recurrence after five years is less common, long-term follow-up remains a necessary part of post-treatment care.
Monitoring and Surveillance After Treatment
A structured follow-up plan is put in place for every patient to detect any signs of recurrence as early as possible. This surveillance schedule is most rigorous in the first two years, coinciding with the highest risk period, and patients are typically seen every three to six months during this initial phase.
For the next three years, up to the five-year mark, the frequency of appointments is usually reduced to every six to twelve months. After five years, patients transition to annual follow-up visits. Each appointment involves a thorough physical examination, including visual inspection of the vulva and anus, and palpation of the groin lymph nodes. Patients are also encouraged to perform self-monitoring and report any new symptoms, such as itching, skin changes, or a new growth, without delay.