Vulvar cancer, VC

Notes
  • Any cancer of skin can as well affect vulva.

##Majority of VCs are squamous cell types and they could be any of the following cancers

  • Squamous cell carcinoma
  • Adenocarcinoma
  • Basal cell carcinoma
  • Epidermoid cysts
  • Melanoma
  • Sarcoma
  • Undifferentiated carcinoma

##Risk factors for VC include:

  • Atrophic vulvitis
  • Arteriosclerosis
  • Chronic granulomatous diseases
  • Cigarette smoking
  • Condylomata accuminata
  • Diabetic vulvitis
  • Human papilloma virus (HPV) infection
  • Hypertension
  • Kraurosis
  • Leukoplakia
  • Lichen sclerosus
  • Squamous carcinoma of the vagina or cervix
  • Squamous hyperplasia
  • Vulvar intraepithelial neoplasia
  • Statistics: VC accounts for 5 - 8% of cancers of the female genital tract; In USA it is the 4th most common gynecologic cancer; the most predominant age is 65-75yrs
Symptoms
  • Vulvar pruritus
  • Painful ulcer oozing of serous fluid
  • Bleeding ulcer
  • Scaly ulcer
  • Inguinal lymph node enlargement
  • Elevated, raised, thickened/or nodular lesions on the vulva
Diagnosis
  • Excisional biopsy
  • Colposcopy of the vulva (after application of 2% Acetic acid)

## If necessary:

  • Fine needle aspiration (FNA) cytology of suspicious inguinal lymph nodes
  • Chest X-ray
  • Pelvic X-ray
  • CT scan
  • MRI scan

## Routine laboratory tests:

  • FBC
  • Renal function tests
  • Liver function tests (LFTs)
  • VDRL
  • HIV test
  • Random blood sugar
Differential
  • Atopic dermatitis
  • Bacterial vaginosis
  • Bowenoid papulosis
  • Candidiasis
  • Contact dermatitis
  • Chancroid
  • Cyst
  • Dermatofibroma
  • Dermatophyte
  • Dysplastic nevi
  • Ectopic breast tissue
  • Erythrasma
  • Fibroma
  • Genital warts
  • Granuloma inguinale
  • Herpes simplex
  • Hidradenoma papilliferum
  • Hyperkeratosis
  • Kaposi's sarcoma
  • Lichen sclerosis et atrophicus
  • Lichen planus
  • Lipoma
  • Lymphogranuloma venereum
  • Melanoma
  • Molluscum contagiosum
  • Neurodermatitis
  • Neurofibroma
  • Post-inflammatory hypopigmentation
  • Psoriasis
  • Reiter's disease
  • Skin tag
  • Syringoma
  • Syphilis
  • Trichomoniasis
  • Vitiligo
Prevention
  • Self-examination of the vulva
  • Regular gynecological checkups to detect and treat pre-cancerous conditions
  • Vaccination against HPV
  • Cessation of smoking
  • Use of condoms in case of suspected partner with HPV
Management

## Surgery

  • Local excision (in case of the in situ lesions).
  • Wide local excision (superficially invasive tumour less than 3mm full thickness).
  • Radical or partial vulvectomy (complete or incomplete excision of the vulva)
  • The excision extending down to deep perineal fascia (when required)

##> Adjuvant radiotherapy

  • In case of the excision margin being less than 1cm, the vulva is included in the radiation field.
  • Cases of irresectable primary tumour
  • Palliative irradiation in case of metastasized tumour

##> Chemotherapy

  • Adjuvant therapy in cases of irresectable primary tumours

## Drugs that are used in the low-resource settings:

  • 5-FU and mitomycin-C OR
  • 5-FU and cisplatin

## Other drugs include the following:

  • Bleomycin
  • Paclitaxel
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