Vulvar cancer is a malignant neoplasm that occurs in the external female genitalia. It is a rare type of cancer, accounting for about 4-5% of all genital cancer cases. The vulva includes such anatomical structures as the labia majora and minora, the clitoral region, and the vestibule of the vagina. The specificity of the disease is that it can develop from various types of cells, including squamous epithelial cells, and can also be associated with human papillomavirus (HPV) infection. Clinical manifestations of vulvar cancer can vary from itching and pain to formations. Early diagnosis and timely treatment are key factors in achieving a favorable prognosis.
History of the disease and interesting historical facts
The history of vulvar cancer research has many characteristic stages. The first documented case of the disease dates back to the 18th century, when surgeons began to develop methods for surgical removal of tumors. In the 19th century, vulvar amputation operations for cancer began to be actively performed, which barely improved the survival of patients. In the 20th century, the focus shifted to early diagnostics and prevention of HPV-related diseases. It is known that in Sexology and Gynecology of Moscow in 1979, the conclusions on cardiovascular mortality among women with vulvar cancer became the subject of active research. Of particular interest is the discovery of the connection between the carcinogenicity of HPV and vulvar cancer, which opened new horizons for both scientific research and vaccine development.
Epidemiology
According to the World Health Organization, vulvar cancer accounts for about 1% of all oncological diseases in women. In 2018, more than 30 thousand cases of vulvar cancer were recorded worldwide, and this number continues to grow. Statistics on the increase in incidence are also regional. Most cases are observed among women over 65 years old, although in recent decades there has been a trend towards an increase in incidence among the younger generation. According to studies, in developed countries, the incidence rate is 1.5-2.5 cases per 100,000 women per year, while in developing countries this figure reaches 6 cases per 100,000.
Genetic predisposition to this disease
Some studies suggest that women with a family history of vulvar cancer may have a genetic predisposition to the disease. In particular, mutations in the BRCA1 and BRCA2 genes may be associated with an increased risk of developing cancer. However, the main source of carcinogenesis to date is the human papillomavirus, especially its highly oncogenic types such as 16 and 18. More than 70% cases of vulvar cancer are associated with HPV infection, which highlights the importance of vaccination and regular medical examination.
Risk factors for the development of this disease
Risk factors that contribute to the development of vulvar cancer can be divided into physical and chemical:
- Age: The risk increases with age, especially in women over 65 years of age.
- HPV infection: the presence of highly oncogenic types of the virus. This is the most important risk factor.
- Smoking: Tobacco smoking is associated with an increased incidence of vulvar cancer.
- Chronic inflammatory diseases: chronic vulvitis or leukoplakia may precede the development of cancer.
- Immunodeficiency: Women with a weakened immune system have a higher risk of developing cancer.
Diagnosis of this disease
Diagnosis of vulvar cancer begins with a clinical examination, which includes an assessment of visible changes in the vulvar area. Key symptoms may include:
- Itching and burning in the vulva area.
- Formation of ulcers or hardening.
- Painful sensations.
- Changes in skin color or texture of the lining of the vulva.
Laboratory tests may include cytological and histological examination of tissue samples. Radiological examinations such as ultrasound, MRI and CT are used to detect possible metastases. Differential diagnosis should be made by other tumor and inflammatory processes in the external genital area.
Treatment
Treatment for vulvar cancer may involve several methods depending on the stage of the disease:
- General treatment: Depending on the stage, chemotherapy or radiotherapy may be recommended.
- Pharmacological treatment: the use of chemotherapy drugs can be used in non-invasive and late stages of the disease.
- Surgical treatment: The main methods include local excision of the tumor, vulvectomy and lymphadenectomy.
- Other treatments: Immunotherapy and targeted therapy may be used at the end of the line for certain disease subtypes.
List of medications used to treat this disease
There are currently a number of drugs available to treat vulvar cancer, including:
- Paclitaxel
- Cisplatin
- Doxorubicin
- Topotecan
- Monoclonal antibodies (eg, pembrolizumab)
Disease monitoring
Post-treatment monitoring of the patient includes follow-up examinations during the first year. The prognosis depends on the stage of the disease at diagnosis. Complications may include relapses, metastases, and secondary tumors. The main focus should be on psychosocial aspects and quality of life of patients.
Age-related features of the disease
The presentation and course of vulvar cancer can vary significantly depending on age group. In young people, the early stage of the disease is often associated with HPV infection, while older women often seek medical care at a later stage, when treatment is difficult. Older patients may develop comorbidities, which also negatively affects the prognosis.
Questions and Answers
- What is vulvar cancer? Vulvar cancer is a malignant neoplasm that occurs in the area of the external genitalia.
- What are the main risk factors for vulvar cancer? Major risk factors include HPV infection, smoking, age, and the presence of chronic diseases.
- How is vulvar cancer diagnosed? Diagnosis is made through clinical examination, laboratory tests and radiological examinations.
- What treatments are used for vulvar cancer? Treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy.
- What is the prognosis for patients with vulvar cancer? The prognosis depends on the stage of the disease, but early diagnosis significantly increases the likelihood of successful treatment.
