Cancer of the Vulva — A Review

Abstract

Cancer of the Vulva: a review In reporting on cancer of the vulva, we should keep in mind some important aspects of its epidemiology and its early detection. Most of the papers on the subject refer to vulvar cancer as a rare disease, accounting for 4 to 5% of all malignant neoplasms of the female genital tract and less than 1% of women's cancers. The incidence varies from 1 to 3.6 cases per 100,000 women, with peak incidence at ages 70-79 years. Even though the incidence increases with age, the proportion of young patients with vulvar cancer has greatly increased due to its association with infection with human papillomavirus (HPV). The risk of developing cancer of the vulva is related to behavioral, reproductive, hormonal and genetic aspects. Factors that increase risk include other genital cancers, chronic inflammatory diseases of the vulva, smoking, history of genital warts and vulvar intraepithelial neoplasia (VIN). We can consider that, given the epidemiological evidence, there are two etiologic pathways for vulvar cancer: one related to older patients, in the seventh or eighth decades of life, associated with mutations in TP53 and non-neoplastic epithelial disorders such as chronic inflammation or vulvar lichen, shows precursor lesions of differentiated VIN; the other is more common in young patients, accounts for approximately 43-60% of squamous carcinoma of the vulva, is associated with HPV infection, and is a common precursor lesion of VIN. Eighty-five to ninety percent of vulvar cancers are squamous in origin (squamous cell carcinoma); however, when considering the embryological origin of the vulva-the three germ layers-different histologic types can compose neoplasms affecting the region.