Scribd Logo
Upload

Welcome to Scribd!

  • 71 views

    Vulvar Cancer: Clinical Manifestations, Diagnosis, and Pathology

    Uploaded by

    Ade Yonata
    This document discusses vulvar cancer including its clinical manifestations, diagnosis, and pathology. It notes that vulvar cancer comprises 5% of female genital tract cancers with an incidence of 2.5 per 100,000 women. Risk factors include HPV infection, smoking, vulvar dystrophy, prior cervical cancer or VIN. Patients typically present with a unifocal vulvar lesion. Diagnosis is made by vulvar biopsy of any suspicious lesions identified by visual inspection or with acetic acid application.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Vulvar Cancer: Clinical Manifestations, Diagnosis, and Pathology

    Uploaded by

    Ade Yonata
    71 views2 pages
    This document discusses vulvar cancer including its clinical manifestations, diagnosis, and pathology. It notes that vulvar cancer comprises 5% of female genital tract cancers with an incidence of 2.5 per 100,000 women. Risk factors include HPV infection, smoking, vulvar dystrophy, prior cervical cancer or VIN. Patients typically present with a unifocal vulvar lesion. Diagnosis is made by vulvar biopsy of any suspicious lesions identified by visual inspection or with acetic acid application.

    Original Description:

    Vulvar Cancer

    Original Title

    Vulvar Cancer

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses vulvar cancer including its clinical manifestations, diagnosis, and pathology. It notes that vulvar cancer comprises 5% of female genital tract cancers with an incidence of 2.5 per 100,000 women. Risk factors include HPV infection, smoking, vulvar dystrophy, prior cervical cancer or VIN. Patients typically present with a unifocal vulvar lesion. Diagnosis is made by vulvar biopsy of any suspicious lesions identified by visual inspection or with acetic acid application.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    71 views2 pages

    Vulvar Cancer: Clinical Manifestations, Diagnosis, and Pathology

    Uploaded by

    Ade Yonata
    This document discusses vulvar cancer including its clinical manifestations, diagnosis, and pathology. It notes that vulvar cancer comprises 5% of female genital tract cancers with an incidence of 2.5 per 100,000 women. Risk factors include HPV infection, smoking, vulvar dystrophy, prior cervical cancer or VIN. Patients typically present with a unifocal vulvar lesion. Diagnosis is made by vulvar biopsy of any suspicious lesions identified by visual inspection or with acetic acid application.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 2

    Vulvar cancer: Clinical manifestations, diagnosis, and

    pathology

    Vulvar cancer: Clinical manifestations, diagnosis, and pathology


    Authors
    John C Elkas, MD, JD
    Jonathan S Berek, MD, MMS
    Section Editors
    Barbara Goff, MD
    Arno J Mundt, MD
    Deputy Editor
    Sandy J Falk, MD
    Disclosures
    All topics are updated as new evidence becomes available and our peer review process is
    complete.
    Literature review current through: Oct 2012. | This topic last updated: Apr 16, 2012.
    INTRODUCTION Vulvar cancer is the fourth most common gynecologic cancer
    (following cancer of the uterine corpus, ovary, and cervix) and comprises 5 percent of
    malignancies of the female genital tract [1]. Annually in the United States, there are
    approximately 4340 new cases and 940 deaths from this disease. Although the rate of
    invasive vulvar carcinoma has remained stable over the past two decades, the incidence
    of in situ disease (vulvar intraepithelial neoplasia) has more than doubled.
    The clinical presentation, diagnosis, histology, and staging evaluation of women with
    vulvar cancer will be reviewed here. Treatment and prognosis are discussed separately.
    (See "Vulvar cancer: Staging, treatment, and prognosis".)
    EPIDEMIOLOGY AND RISK FACTORS The age-adjusted incidence of vulvar cancer
    in the United States was 2.5 per 100,000 women, based upon 1997 to 2004 data from a
    national cancer database [2]. Vulvar carcinoma is encountered most frequently in
    postmenopausal women. The mean age at diagnosis is 65, but may be falling. This was
    illustrated in a study of 78 women diagnosed with vulvar cancer between 1979 and 1993
    in which the average age at presentation dropped from 69 to 55 during this interval [3].
    Risk factors for vulvar cancer include cigarette smoking, vulvar dystrophy (eg, lichen
    sclerosus), vulvar or cervical intraepithelial neoplasia, human papillomavirus (HPV)
    infection, immunodeficiency syndromes, a prior history of cervical cancer, and northern
    European ancestry [4,5].
    Two independent pathways of vulvar carcinogenesis are felt to currently exist, the first
    related to mucosal HPV infection and the second related to chronic inflammatory (vulvar
    dystrophy) or autoimmune processes [6]. HPV has been shown to be responsible for 60
    percent of vulvar cancers [7]. Specifically, HPV 16 and 33 are the predominant subtypes
    accounting for 55.5 percent of all HPV-related vulvar cancers [8].
    The increasing incidence of HPV-related vulvar intraepithelial neoplasia among young
    women may account for the fall in mean age of diagnosis of vulvar cancer discussed
    above. HPV DNA is found more commonly in vulvar cancers of young women who smoke
    as compared to older nonsmokers [7]. Early detection and treatment of vulvar
    intraepithelial neoplasia may prevent the development of cancer. This may explain why

    the incidence of invasive vulvar cancer has remained stable even though the incidence of
    vulvar intraepithelial neoplasia has increased. (See "Vulvar intraepithelial neoplasia".)
    CLINICAL MANIFESTATIONS The signs and symptoms of all histological types of
    vulvar malignancy are similar. Most patients present with a unifocal vulvar plaque, ulcer,
    or mass (fleshy, nodular, or warty) on the labia majora; the labia minora, perineum,
    clitoris, and mons are less frequently involved (picture 1 and picture 2 and picture 3). In
    10 percent of cases, the lesion is too extensive to determine the actual site of origin
    (picture 4) [9].
    Lesions are multifocal in 5 percent of cases; thus, all vulvar and perianal skin surfaces,
    as well as the cervix and vagina, should be evaluated. A synchronous second
    malignancy, most commonly cervical neoplasia, is found in up to 22 percent of patients
    with a vulvar malignancy [10].
    Pruritus is a common complaint associated with most vulvar disorders; it is especially
    prevalent when there is an underlying vulvar dystrophy (eg, lichen sclerosus or
    squamous cell hyperplasia). We biopsy patients with lichen sclerosus if there is a
    suspicious lesion or the lesions are refractory to topical therapy.
    Vulvar bleeding or discharge, dysuria, or an enlarged lymph node in the groin are less
    frequently encountered symptoms, and suggestive of advanced disease. On the other
    hand, many patients are asymptomatic at the time of diagnosis. (See "Dermatitis of the
    vulva" and "Vulvar lichen sclerosus".)
    DIAGNOSIS Vulvar cancer is a histologic diagnosis made based upon a vulvar biopsy.
    Visual inspection of the vulva is performed based upon vulvar complaints or during a
    routine pelvic examination. Findings that are suspicious for preinvasive or invasive vulvar
    disease include any lesion that is raised or fungating as well as pigmented areas. If a
    lesion is not grossly evident, but there is clinical suspicion of vulvar neoplasia, a five
    percent acetic acid solution should be applied and the vulva examined with direct visual
    inspection and using a colposcope (or a handheld magnifying glass if a colposcope is not
    available). The concentrated acetic acid solution should be applied copiously with
    prolonged contact to the keratinized vulvar squamous epithelium. This allows the cells to
    fully dehydrate and will define acetowhite lesions and their underlying vascular changes.
    Acetowhite areas with abnormal vascular patterns should be biopsied.
    (See "Colposcopy".)
    All areas of concern should be individually biopsied as cancer may be seen in areas with
    multifocal vulvar intraepithelial neoplasia. The biopsy should be taken from the area(s) of
    the lesion that appears most abnormal. If multiple abnormal areas are present, then
    multiple biopsies should be taken to "map" all potential sites of vulvar pathology.
    Pathologic evaluation may not be possible for specimens taken from areas of extensive
    necrosis.

    Subscribe uptodate for more

    You might also like