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Vulvar Cancer

Updated : February 7, 2024





Background

Per the Surveillance, Epidemiology, and End Results Program, vulvar cancer accounts for 0.3% of all new cancer cases in the United States each year, with a rate of 2.6 per 100,000 women. Diagnosis is often achieved between the sixth and eighth decades of life and is frequently detected early in the disease.

Most vulvar malignancies are the less prevalent subtypes of basal cell carcinoma, squamous cell carcinomas, extramammary Paget disease, and vulvar melanoma. The core of vulvar cancer treatment remains surgery, with medicinal and radiological oncology playing an increasingly essential role in preventing relapse and improving outcomes.

Epidemiology

The most frequent type of vulvar cancer is squamous cell carcinoma. According to SEER statistics, vulvar cancer is most typically diagnosed between the ages of 65 and 74, with an average diagnosis age of 69 years. According to the same statistics, sixty percent of diagnoses are localized and have an 85% 5-year survival rate.

Vulvar melanoma is the second greatest prevalent vulvar cancer, accounting for 5% of all vulvar tumors. It primarily affects White women aged 50 to 70. Vulvar melanoma has a comparable median age at diagnosis of 68 years; however, roughly 8.4% present with progressive disease and have a poorer survival rate.

Anatomy

Pathophysiology

Vulvar cancer accounts for 90% of all vulvar malignancies and is caused by one of two distinct routes. According to the standard two-hit concept for cancer formation, 30-40 % of vulvar cancer cases are related to high-risk human papillomavirus. HPV oncoproteins E6 & E7 are known to inactivate the RB and p53 tumor suppressor proteins, respectively.

The absence of these genes that suppress tumors results in uncontrolled hyperproliferation. Another mechanism involves inflammatory alterations that occur in cells with intact p53 states but lack the cyclin-dependent kinase inhibitor 2A, leading to uncontrolled cell cycle development and cancer.

Etiology

Increasing age, infection with the human papillomavirus, smoking, vulvar inflammatory disorders, past pelvic radiation, and immunodeficiency are all factors that increase the risk of vulvar cancer.

Genetics

Prognostic Factors

The lymphatic progression of vulvar cancer occurs primarily in homolateral superficial inguinal lymphatic nodes and deep femoroinguinal lymph nodes. In individuals with vulvar cancer, the lymphatic nodal state is the most effective predictive indicator for overall survival.

Adjuvant radiation improves progression-free survival in node-positive patients. At five years, the overall recurring rate of vulvar cancer is 37%. Patients who have distant metastases have a poor prognosis.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK567798/

Vulvar Cancer

Updated : February 7, 2024




Per the Surveillance, Epidemiology, and End Results Program, vulvar cancer accounts for 0.3% of all new cancer cases in the United States each year, with a rate of 2.6 per 100,000 women. Diagnosis is often achieved between the sixth and eighth decades of life and is frequently detected early in the disease.

Most vulvar malignancies are the less prevalent subtypes of basal cell carcinoma, squamous cell carcinomas, extramammary Paget disease, and vulvar melanoma. The core of vulvar cancer treatment remains surgery, with medicinal and radiological oncology playing an increasingly essential role in preventing relapse and improving outcomes.

The most frequent type of vulvar cancer is squamous cell carcinoma. According to SEER statistics, vulvar cancer is most typically diagnosed between the ages of 65 and 74, with an average diagnosis age of 69 years. According to the same statistics, sixty percent of diagnoses are localized and have an 85% 5-year survival rate.

Vulvar melanoma is the second greatest prevalent vulvar cancer, accounting for 5% of all vulvar tumors. It primarily affects White women aged 50 to 70. Vulvar melanoma has a comparable median age at diagnosis of 68 years; however, roughly 8.4% present with progressive disease and have a poorer survival rate.

Vulvar cancer accounts for 90% of all vulvar malignancies and is caused by one of two distinct routes. According to the standard two-hit concept for cancer formation, 30-40 % of vulvar cancer cases are related to high-risk human papillomavirus. HPV oncoproteins E6 & E7 are known to inactivate the RB and p53 tumor suppressor proteins, respectively.

The absence of these genes that suppress tumors results in uncontrolled hyperproliferation. Another mechanism involves inflammatory alterations that occur in cells with intact p53 states but lack the cyclin-dependent kinase inhibitor 2A, leading to uncontrolled cell cycle development and cancer.

Increasing age, infection with the human papillomavirus, smoking, vulvar inflammatory disorders, past pelvic radiation, and immunodeficiency are all factors that increase the risk of vulvar cancer.

The lymphatic progression of vulvar cancer occurs primarily in homolateral superficial inguinal lymphatic nodes and deep femoroinguinal lymph nodes. In individuals with vulvar cancer, the lymphatic nodal state is the most effective predictive indicator for overall survival.

Adjuvant radiation improves progression-free survival in node-positive patients. At five years, the overall recurring rate of vulvar cancer is 37%. Patients who have distant metastases have a poor prognosis.

https://www.ncbi.nlm.nih.gov/books/NBK567798/

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