Vulvar carcinoma: dilemma, debates, and decisions

Mitra, Swarupa; Sharma, Manoj Kumar; Kaur, Inderjeet; Khurana, Rishabh; Modi, Kanika Batra; Narang, Ramandeep Singh; Mandal, Ananya; Dutta, Soumya Kanti

doi:10.2147/cmar.s143316

Cited by 28 publications

(35 citation statements)

References 56 publications

(52 reference statements)

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“…In our study, nodal positivity was solely the most important bad predictive and prognostic factor; nevertheless, the final tumor stage, histology, the degree of differentiation, depth of invasion and lymphovascular invasion (LVI) also decide the survival outcome in literature [13][14][15]. The reason for the minimal inguinal and pelvic lymphadenectomy wounds morbidity could be due to Ray's 'River flow' incision (two parallel curvilinear incisions) [5,6] technique for ilioinguinal dissection.…”

Section: Discussionmentioning

confidence: 68%

Vulvar cancer: surgical management and survival trends in a low resource setting

Kumar

Ray

Sharma

et al. 2020

J Egypt Natl Canc Inst

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Background: This study aims to analyze risk factors, clinical profiles, treatment protocols, and disease outcomes in histologically proven resectable vulvar cancer (VC) patients according to tumor stage. This is a retrospective analysis of a prospectively collected database of 20 VC patients from May 2014 to June 2019. Results: The mean age of VC diagnosis was 55 years, with a range of 38-84 years. The incidence was four cases per year. The disease incidence was significantly more in post-menopausal (65%) and multiparous (90%) women. According to FIGO staging of vulvar cancer, stages I, II, and III were assigned to 6, 1, and 11 patients respectively. Two patients suffered from stage IVa vulvar melanoma. All patients had undergone surgical interventions. Patients treated with only nonsurgical (chemotherapy/radiotherapy/chemo-radiotherapy) treatment modalities were excluded from the study. Fifteen patients were treated with wide local excision (WLE), bilateral inguinofemoral dissection (B/L IFLND), and primary repair. Four and one patients were treated with radical vulvectomy (RV) and modified radical vulvectomy (MRV) [with or without B/L IFLND and PLND] respectively. Reconstruction with V-Y gracilis myocutaneous and local rotation advancement V-Y fasciocutaneous flaps were done in two patients. Therapeutic groin nodal dissection was performed in 19 patients except in one patient who was treated by palliative radical vulvectomy. In the final histopathology reports, tumor size varies from 0.5 to 6.5 cm (mean 3.35 cm) with the predominance of squamous cell carcinoma (18 out of 20 patients). Only 10 out of 18 eligible patients received adjuvant treatment. Poor patient compliance has been one of the major reasons for adjuvant treatment attrition rate. Systemic and loco-regional metastasis occurred in 3 patients each arm respectively. Poor follow up of patients is the key limitation of our study. Conclusion: Vulvar cancer incidence was significantly high in post-menopausal and multiparous women. The most important prognostic factors were tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.

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Section: Discussionmentioning

confidence: 68%

Vulvar cancer: surgical management and survival trends in a low resource setting

Kumar

Ray

Sharma

et al. 2020

J Egypt Natl Canc Inst

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“…Groin node dissection, which may be avoided in these early stages, because the risk of lymph node metastases is negligible in this group. 1,16 Though surgery is the treatment of choice, adjuvant treatment in form of preoperative or postoperative chemotherapy or radiation or both is also needed.…”

Section: Resultsmentioning

confidence: 99%

“…Chemoradiation may downsize tumor volume, and hence help achieve resectibility of the tumor. 16 However; no randomized trials have been carried out to study this option. 8,9,17,18 Many patients with vulvar carcinoma, especially in countries like India, present as advanced inoperable tumor, as in present study.…”

Section: Resultsmentioning

confidence: 99%

Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva

Parekh

Arora

Patel

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Carcinoma of the vulva is rare cancer, pruritus is the most common and long-lasting reported symptom. It is found to be associated with HPV and HIV infection. Currently, a more individualized and less radical treatment is suggested. In this study we evaluated epidemiology, clinicopathological prognostic factors, HPV distribution and risk factors for metastases to lymph nodes. We also reviewed multidisciplinary clinical management carried out at our institute.Methods: It is a prospective study of 25 biopsy proven cases of Squamous Cell Carcinoma of Vulva, treated at our center from September 2014 to September 2016. We collected the data regarding the clinical presentation, histological details, treatment given, survival and complications. HPV 16 and 18 testing were done using PCR method. Median follow up of the patients are for 24 months.Results: The mean age of patients was 54.6 years. Commonest presentation was perineal itching (36%). HPV 16/18 were positive in 25% of the patients. Radical vulvectomy with bilateral groin dissection was done in 14/25 (56%) patients. Among these 14 patients, 35.7 % (5/14) has lymph node metastases, disease free survival was 63.6% and overall survival was 81.1% for median follow up of 24 months. About one third of the patient presented with locally advanced disease. Six (24%) patients received only chemo radiation as a treatment.Conclusions: HPV and HIV infection increase the risk of vulvar cancer. Individualization of treatment is necessary. The use of preoperative chemoradiation in locally advanced disease might have promising results in future.

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“…The risk of developing primary vulvar cancer is associated with behavioral factors such as smoking, as well as hormonal, reproductive and genetic factors. Other types of genital neoplasia, inflammatory diseases of the vulva, a history of verrucous lesions, immunosuppression and vulvar intraepithelial neoplasia may all contribute towards increasing the risk of vulvar cancer [2].…”

Section: Introductionmentioning

confidence: 99%

“…Melanoma is the second most common histological type. Vulvar adenocarcinoma, however, is extremely rare and in such cases, investigation should be made for metastases, since the primary site may be the rectum, colon, anus, cervix, ovary, endometrium, vagina, skin, breast, lung or bladder [1,2].…”

Section: Introductionmentioning

confidence: 99%

Vulvar Metastases from Colorectal and Gynecological Tumors: Two Case Reports and A Literature Review

Scherre¹,

Cani²,

Gaigher³

et al. 2019

J Med - Clin Res & Rev

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Introduction:Squamous cell carcinoma is the most common histological type of primary vulvar tumor. However, when vulvar tumors are secondary, investigation for the primary site should include the rectum, colon, anus, cervix, ovary, endometrium, vagina, skin, breast, lung and bladder. These secondary lesions may be single or multiple and may vary macroscopically, presenting as maculae, ulcers, papules, nodules, plaques, inflamed lesions or even telangiectasias. Diagnosis is histological, with immunohistochemistry being helpful in clarifying cases. Prognosis tends to be poor and treatment is palliative because of the advanced stage of the primary tumor. Case:The present report describes two clinical cases and discusses their rarity, clinical diagnosis, histopathology findings and the treatment of patients with metastatic vulvar lesions. The data were collected at a hospital in Vitória, Espírito Santo, Brazil. Conclusion:In the female genital tract, the vulva is the least likely site of skin metastasis. However, when present, prognosis tends to be poor, since this finding is an indication of the advanced stage of the primary disease. Therefore, inspection of the vulva is mandatory. If lesions of any morphological type are present in this region, histology should be performed.

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Vulvar carcinoma: dilemma, debates, and decisions

Cited by 28 publications

References 56 publications

Vulvar cancer: surgical management and survival trends in a low resource setting

Vulvar cancer: surgical management and survival trends in a low resource setting

Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva

Vulvar Metastases from Colorectal and Gynecological Tumors: Two Case Reports and A Literature Review

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