Vulvar Cancer
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Introduction[edit | edit source]
Vulvar cancer is an uncommon malignancy and the fourth most common gynecologic cancer[1] that usually affects post-menopausal women, and it can be misdiagnosed and considered an inflammatory condition so it is important to be familiar with vulvar malignancies. It forms a mass or ulcer on the vulva and usually causes itching. The incidence of vulvar cancer is increasing in the last decades. The two main categories of vulvar cancer; HPV dependant vulavr cancer that is common in younger women, and independant HPV that is found in women after menopause[2].
Anatomy Background[edit | edit source]
The vulva refers to the outer part of the external female genitalia, it includes the entrance to the vagina and the internal reproductive tract in addition to the urethra opening. It forms from c labia majora (outer lips), labia minora (inner lips), and clitoris.
Vulval Warts are a growth of epithelium caused by HPV infection and usually transmitted between sexual partners but they don not develop to a cancer.
Incidence[edit | edit source]
The incidence of vulvar cancer has increased by an average of 4.6% every 5 years in the last decades, in 2018 there was about 1200 reported case of death because of vulvar cancer. Vulvar squamous cell carcinoma is the most common vulvar cancer and represents about 90% of all vulvar cancer and occurs in 2-7 of every 100,000 women, the second most is vulvar melanoma representing about 5%-10% of all vulvar malignancies[3].
Histological Types[edit | edit source]
Vulvar squamous cell carcinoma (VSCC)
Also referred to as vulvar intraepithelial neoplasia VIN, divided into; usual-type VIN or vulvar high-grade squamous intraepithelial lesions (HSILs), it is associated with HPV infection more common in young, and has a higher risk of progress to invasive SCC but it is slowly progrss, and tends to be multifocal. the second type is differentiated VIN (dVIN) it is not HPV dependant and with a higher recurrence rate, worse prognosis, and rapid progression to invasive VSCC.
Vulvar melanoma
It is the second most common vulvar cancer, starts on the skin of the vulva, most commonly to be found in the labia majora and clitoral area, and most common in white women usually starting in their 5th to 7th decades of life. The area is sun- protected so, the genetic studies suggest it is more similar to what happens in acral lentiginous melanoma, the melanocytes in the skin become malignant and the tumor continues to grow and spread until surgical excision of the tumor.
Vulvar basal cell carcinoma (BCC)
It represents only about 2%-4% of all vulvar cancers, with a good prognosis and low risk to develop metastasis. Chronic irritation, pelvic radiation, immunosuppression, or trauma might be risk factors to develop BCC. The lesion may be pigmented and the majority of BCC treated with surgical excision. There is also vulvar extramammary Paget disease which is rare to present in cases.
Clinical Presentataion[edit | edit source]
Pruritus, burning, pain, or bleeding
The skin may be, white, erythematous, or pigmented in color for
Risk factors[edit | edit source]
- Immunosuppression.
- Smoking.
- History of cervical cancer.
- Aging is considered a risk factor.
- HPV infection.
Staging of Vulvar Cancer[edit | edit source]
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Management[edit | edit source]
- numbered list
- x
References[edit | edit source]
- ↑ Olawaiye AB, Cuello MA, Rogers LJ. Cancer of the vulva: 2021 update. International Journal of Gynecology & Obstetrics. 2021 Oct;155:7-18.
- ↑ Alkatout I, Schubert M, Garbrecht N, Weigel MT, Jonat W, Mundhenke C, Günther V. Vulvar cancer: epidemiology, clinical presentation, and management options. International journal of women's health. 2015;7:305.
- ↑ Tan A, Bieber AK, Stein JA, Pomeranz MK. Diagnosis and management of vulvar cancer: A review. Journal of the American Academy of Dermatology. 2019 Dec 1;81(6):1387-96.
