Vulvar Cancer

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 79 Vulvar Cancer

INTRODUCTION

Description: Squamous cell cancer of the vulva generally presents as an exophytic ulcer or hyperkeratotic plaque. It may arise as a solitary lesion or develop hidden within hypertrophic or other vulvar skin changes, making diagnosis difficult and often delayed.

Prevalence: Fewer than 5000 cases per year, 4% of gynecologic malignancies. (The incidence of vulvar cancer increased by approximately 20% between 1973 and 2000, likely related to increased exposure to human papillomavirus [HPV].)

Predominant Age: In situ 40 to 49, invasive 65 to 70.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown. Thought to be associated with human papillomavirus.

Risk Factors: Infection with human papillomavirus (molecular analysis had detected human papillomavirus DNA in 40% of vulvar cancers), smoking, immunosuppression, lichen sclerosus.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Itching, irritation, cracking, or bleeding of the vulva, most common on the posterior two thirds of the labia majus

• Ulcerated exophytic lesion or hyperkeratotic plaque (late in disease)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Hypertrophic vulvar dystrophy

• Lichen sclerosus

Associated Conditions: Hyperplastic vulvar dystrophy.

Workup and Evaluation

Laboratory: No evaluation indicated.

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