Vulvar cancer: epidemiology, clinical presentation, and management options

Abstract

EpidemiologyVulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders.HistologySquamous cell carcinoma (SCC) is the most common malignant tumor of the vulva (95%).Clinical featuresPruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain.TherapyThe gold standard for even a small invasive carcinoma of the vulva was historically radical vulvectomy with removal of the tumor with a wide margin followed by an en bloc resection of the inguinal and often the pelvic lymph nodes. Currently, a more individualized and less radical treatment is suggested: a radical wide local excision is possible in the case of localized lesions (T1). A sentinel lymph node (SLN) biopsy may be performed to reduce wound complications and lymphedema.PrognosisThe survival of patients with vulvar cancer is good when convenient therapy is arranged quickly after initial diagnosis. Inguinal and/or femoral node involvement is the most significant prognostic factor for survival.

Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer

“…Vulvar cancer represents approximately 4-5% of all gynecological tumors [1,2,3]. It is usually classified into two groups: the first is associated with human papillomavirus (HPV) infection and usually occurs in younger patients; the second is not HPV associated and is observed mostly in elderly patients with 'lichen sclerosus' as a predisposing risk factor [2,4]. There are several histological types, whereas squamous cell carcinoma (SCC) is the most common (95%) [4,5].…”

“…It occurs predominantly in postmenopausal women, and the age-specific incidence increases with age [5]. The prognosis is strongly correlated to lymph node involvement and the stage of the disease [4]. Almost 50% of patients have advanced disease at presentation [6].…”

“…External beam radiotherapy (EBRT), brachytherapy, and chemotherapy are either adjuvant or standalone treatment options. Over the last 2 decades, the use of primary radiotherapy for patients with stage III-IVA vulvar cancer increased from 18% in 1988 to 30% by 2008 [7], but even in combined therapy, 10-20% of women with early-stage disease and 50-70% in advanced stages may return [2,4,5,8]. Local recurrences are the most frequent pattern of failure, while less common are those located in the groin [9].…”

Papilomavírus Humano: Prevenção E Diagnóstico

“…[33][34][35] Enquanto, que a técnica de Southern Blot consiste na transferência de DNA desnaturado de um gel de agarose para uma membrana (em geral de nylon ou material semelhante), onde ele poderá ser analisado com o uso de uma sonda de DNA ou de RNA, considerado como o "padrão ouro" na detecção do HPV, porém a sua execução rotineira é laboriosa. 26,35 O teste de PCR consiste em fazer várias cópias de DNA ou RNA, possibilitando uma análise genética, mesmo com pouquíssimo material disponível, além do mais o teste possui grande sensibilidade, contudo, o teste deve ser associado com a citologia oncótica para reduzir os erros nos diagnósticos citológicos.…”

Non-invasive diagnostic techniques in the diagnosis of squamous cell carcinoma

“…The most common vulvar malignancy is squamous cell carcinoma (over 90% of malignant tumors). 71 The literature about application of non-invasive techniques in differential diagnosis of intraepithelial neoplasia and squamous cell carcinoma is sparse and based mainly on case reports. Dermoscopy has been shown to be a helpful diagnostic aid in a case of Bowen's disease of the vulva that progressed to invasive SCC.…”