Ms. LC reports that she first noticed itching and discomfort in the vulvar area about six months ago. The symptoms have progressively worsened, with the development of an ulcerative lesion that is painful and bleeding intermittently. She has a history of diabetes and hypertension but no prior gynaecological issues. She is postmenopausal and has not had regular gynaecological examinations. There is no known family history of cancer.

Ms. LC lives in a rural area near Lusaka and works as a subsistence farmer. She has limited access to healthcare facilities and has not had a Pap smear or any other gynaecological screening in recent years. She does not smoke or consume alcohol. Her diet consists mainly of locally grown produce.

On examination, Ms. LC has a large, painful, ulcerative lesion on the left side of her vulva with significant swelling and erythema. The surrounding skin is indurated. No other systemic abnormalities are noted.

A biopsy of the vulvar lesion confirms the presence of squamous cell carcinoma. Further imaging, including a pelvic ultrasound and CT scan, shows local invasion but no distant metastasis.

Invasive squamous cell carcinoma of the vulva, staged as locally advanced.

1. Surgical Treatment:
- Refer to a gynaecologic oncologist for surgical evaluation and possible wide local excision or radical vulvectomy depending on the extent of local invasion.
2. Radiation Therapy:
- Consider radiation therapy if surgery is not feasible or if there is significant local disease remaining after surgery.
3. Chemotherapy:
- Discuss the option of chemotherapy, especially if there is residual or recurrent disease after primary treatment.
4. Palliative Care:
- Provide pain management, wound care, and nutritional support.
- Offer psychological support to help Ms. LC cope with the emotional impact of the diagnosis and treatment.

- Schedule regular follow-up visits to monitor treatment response, manage side effects, and conduct imaging studies to check for disease progression or recurrence.