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      Vulvar cancer: epidemiology, clinical presentation, and management options

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          Abstract

          Epidemiology

          Vulvar 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.

          Histology

          Squamous cell carcinoma (SCC) is the most common malignant tumor of the vulva (95%).

          Clinical features

          Pruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain.

          Therapy

          The 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.

          Prognosis

          The 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.

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          Most cited references62

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          Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium.

          Sergio Pecorelli (2009)
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            Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial.

            Robert Mansel, Lesley Fallowfield, Mark Kissin … (2006)
            Sentinel lymph node biopsy in women with operable breast cancer is routinely used in some countries for staging the axilla despite limited data from randomized trials on morbidity and mortality outcomes. We conducted a multicenter randomized trial to compare quality-of-life outcomes between patients with clinically node-negative invasive breast cancer who received sentinel lymph node biopsy and patients who received standard axillary treatment. The primary outcome measures were arm and shoulder morbidity and quality of life. From November 1999 to October 2003, 1031 patients were randomly assigned to undergo sentinel lymph node biopsy (n = 515) or standard axillary surgery (n = 516). Patients with sentinel lymph node metastases proceeded to delayed axillary clearance or received axillary radiotherapy (depending on the protocol at the treating institution). Intention-to-treat analyses of data at 1, 3, 6, and 12 months after surgery are presented. All statistical tests were two-sided. The relative risks of any lymphedema and sensory loss for the sentinel lymph node biopsy group compared with the standard axillary treatment group at 12 months were 0.37 (95% confidence interval [CI] = 0.23 to 0.60; absolute rates: 5% versus 13%) and 0.37 (95% CI = 0.27 to 0.50; absolute rates: 11% versus 31%), respectively. Drain usage, length of hospital stay, and time to resumption of normal day-to-day activities after surgery were statistically significantly lower in the sentinel lymph node biopsy group (all P .05). Sentinel lymph node biopsy is associated with reduced arm morbidity and better quality of life than standard axillary treatment and should be the treatment of choice for patients who have early-stage breast cancer with clinically negative nodes.
            Article 0 comments Cited 327 times – based on 0 reviews     Review now
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              Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis.

              Theodore Kim, Armando E Giuliano, Gary H Lyman (2006)
              Lymphatic mapping with sentinel lymph node biopsy has the potential for reducing the morbidity associated with breast carcinoma staging. It has become a widely used technology despite limited data from controlled clinical trials. A systematic review of the world's literature of sentinel lymph node (SLN) biopsy in patients with early-stage breast carcinoma was undertaken by using electronic and hand searching techniques. Only studies that incorporated full axillary lymph node dissection (ALND), regardless of SLN results, were included. Individual study results along with weighted summary measures were estimated using the Mantel-Haenszel method. The correlations of outcomes with the study size, the proportion of positive lymph nodes, the technique used, and the study quality were evaluated. Between 1970 and 2003, 69 trials were reported that met eligibility criteria. Of the 8059 patients who were studied, 7765 patients (96%) had successfully mapped SLNs. The proportion of patients who had successfully mapped SLNs ranged from 41% to 100%, with > 50% of studies reporting a rate 10%. Significant inverse correlations were observed between the FNR and both the number of patients studied (r = - 0.42; P < 0.01) and the proportion of patients who had successfully mapped SLNs nodes (r = - 0.32; P = 0.009). Lymphatic mapping with SLN biopsy is used widely to reduce the complications associated with ALND in patients with low-risk breast carcinoma. This systematic review revealed a wide variation in test performance. Copyright 2005 American Cancer Society.
              Article 0 comments Cited 169 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Womens Health
                Journal ID (iso-abbrev): Int J Womens Health
                Journal ID (publisher-id): International Journal of Women’s Health
                Title: International Journal of Women's Health
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-1411
                Publication date Collection: 2015
                Publication date (Electronic): 20 March 2015
                Volume: 7
                Pages: 305-313
                Affiliations
                [1 ]Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
                [2 ]Institute for Pathology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
                Author notes
                Correspondence: Ibrahim Alkatout, Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str 3, House 24, 24105 Kiel, Germany, Tel +49 431 597 2100, Fax +49 431 597 2116, Email ibrahim.alkatout@ 123456uksh.de
                Article
                Publisher ID: ijwh-7-305
                DOI: 10.2147/IJWH.S68979
                PMC ID: 4374790
                PubMed ID: 25848321
                SO-VID: c1a03363-79a9-4ab2-894f-ec95497d3e85
                Copyright © © 2015 Alkatout et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License
                License:

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Review

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: vulvar cancer,hpv infection,radical vulvectomy,groin dissection,sentinel lymph node biopsy,overall survival
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: vulvar cancer, hpv infection, radical vulvectomy, groin dissection, sentinel lymph node biopsy, overall survival

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