Squamous Cell Vulval Carcinoma and Pregnancy — A Review

Abstract

Carcinoma of the vulva accounts for 4% of all female genital tract malignancies. 1 The incidence in the UK is two per 100,000 female population. 2 Vulval cancer is rare in young women with rates of more than one per 100,000 among women aged 25-44 years in the UK. 2 In the US, 15% of vulval cancers are reported to occur in women <50 years of age. 3,4 Prior studies have reported an incidence of 3.3% in women <35 years old, 5 2.3% in women <40 years old and 6.1%in women <45 years old. 6In recent years, an increased incidence of vulval cancer in younger women has been observed. Reports of either vulval carcinoma presenting during pregnancy, 25,[27][28][29] or of pregnancy following treatment for vulval cancer, are rare [29][30][31] because the majority of women with the condition are perimenopausal with completed families, post-menopausal or rendered infertile or of reduced fertility following treatment with radiotherapy and chemotherapy. 31 With the increasing incidence of HPV, VIN and HIV, and a concomitant increase in the incidence of vulval carcinoma in younger women, we are progressively more likely to encounter patients with either vulval carcinoma in pregnancy or pregnancy following treatment for vulval cancer. Given the paucity of available information to assist in managing these patients, and the increased likelihood of seeing this condition, a review of the management strategies in squamous cell vulval cancer associated with pregnancy is timely. MethodWe performed a computerised search (MEDLINE ® /embase ® ) to Squamous Cell Vulval Carcinoma and Pregnancy -A Review AbstractMaternal vulval carcinoma and pregnancy following vulval cancer are rare. However, vulval carcinoma in younger women is increasing, thus we are progressively more likely to encounter patients with either vulval carcinoma in pregnancy, or pregnancy following treatment for vulval cancer. Given the paucity of available information we performed a literature review considering the strategies employed in the management of these women. A computerised search (MEDLINE ® /embase ® ) was performed to identify all registered articles pertaining to squamous cell vulval carcinoma diagnosed or treated in pregnancy, and all cases of pregnancy following treatment for vulval cancer. In addition, cross-references of all selected articles were checked. Twenty-four reports were identified in the literature. In total, 21 cases of vulval carcinoma in pregnancy and 13 cases of pregnancy following vulval cancer were considered. Reports in the literature of vulval cancer associated with pregnancy span a time period of over 65 years making the production of definitive guidelines problematic as significant changes in the management of vulval cancer and changes in obstetrical and neonatal care need to be accounted for. Longer-term maternal and neonatal outcomes are also difficult to substantiate. Centralised data collection would be beneficial in these rare tumours, and in other malignant tumours diagnosed and treated during pregnancy. KeywordsVulval/vulvar carcin...