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Fellon CM, Elsensohn AN, Kraus CN, Virgen CA. Vulvar Squamous Cell Carcinoma Guidelines May Benefit From Consideration of Tissue-Sparing Techniques as Treatment Options. J Clin Oncol 2024; 42:2723-2724. [PMID: 38776487 DOI: 10.1200/jco.24.00572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Corey M Fellon
- Corey M. Fellon, BS, Albany Medical College, Albany, NY; Ashley N. Elsensohn, MD, MPH, Loma Linda University, Department of Dermatology, Loma Linda, CA, Loma Linda University, Department of Pathology, Loma Linda, CA; Christina N. Kraus, MD, University of California, Irvine, Department of Dermatology, Irvine, CA; and Cesar A. Virgen, MD, PhD, Department of Dermatology, Brigham and Women's Hospital, Boston, MA, Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, Harvard Medical School, Boston, MA
| | - Ashley N Elsensohn
- Corey M. Fellon, BS, Albany Medical College, Albany, NY; Ashley N. Elsensohn, MD, MPH, Loma Linda University, Department of Dermatology, Loma Linda, CA, Loma Linda University, Department of Pathology, Loma Linda, CA; Christina N. Kraus, MD, University of California, Irvine, Department of Dermatology, Irvine, CA; and Cesar A. Virgen, MD, PhD, Department of Dermatology, Brigham and Women's Hospital, Boston, MA, Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, Harvard Medical School, Boston, MA
| | - Christina N Kraus
- Corey M. Fellon, BS, Albany Medical College, Albany, NY; Ashley N. Elsensohn, MD, MPH, Loma Linda University, Department of Dermatology, Loma Linda, CA, Loma Linda University, Department of Pathology, Loma Linda, CA; Christina N. Kraus, MD, University of California, Irvine, Department of Dermatology, Irvine, CA; and Cesar A. Virgen, MD, PhD, Department of Dermatology, Brigham and Women's Hospital, Boston, MA, Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, Harvard Medical School, Boston, MA
| | - Cesar A Virgen
- Corey M. Fellon, BS, Albany Medical College, Albany, NY; Ashley N. Elsensohn, MD, MPH, Loma Linda University, Department of Dermatology, Loma Linda, CA, Loma Linda University, Department of Pathology, Loma Linda, CA; Christina N. Kraus, MD, University of California, Irvine, Department of Dermatology, Irvine, CA; and Cesar A. Virgen, MD, PhD, Department of Dermatology, Brigham and Women's Hospital, Boston, MA, Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, Harvard Medical School, Boston, MA
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2
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Van Arsdale A, Turker L, Chang YC, Gould J, Harmon B, Maggi EC, Meshcheryakova O, Brown MP, Luong D, Van Doorslaer K, Einstein MH, Kuo DYS, Zheng D, Haas BJ, Lenz J, Montagna C. Structure and transcription of integrated HPV DNA in vulvar carcinomas. NPJ Genom Med 2024; 9:35. [PMID: 38898085 PMCID: PMC11187145 DOI: 10.1038/s41525-024-00418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/02/2024] [Indexed: 06/21/2024] Open
Abstract
HPV infections are associated with a fraction of vulvar cancers. Through hybridization capture and DNA sequencing, HPV DNA was detected in five of thirteen vulvar cancers. HPV16 DNA was integrated into human DNA in three of the five. The insertions were in introns of human NCKAP1, C5orf67, and LRP1B. Integrations in NCKAP1 and C5orf67 were flanked by short direct repeats in the human DNA, consistent with HPV DNA insertions at sites of abortive, staggered, endonucleolytic incisions. The insertion in C5orf67 was present as a 36 kbp, human-HPV-hetero-catemeric DNA as either an extrachromosomal circle or a tandem repeat within the human genome. The human circularization/repeat junction was defined at single nucleotide resolution. The integrated viral DNA segments all retained an intact upstream regulatory region and the adjacent viral E6 and E7 oncogenes. RNA sequencing revealed that the only HPV genes consistently transcribed from the integrated viral DNAs were E7 and E6*I. The other two HPV DNA+ tumors had coinfections, but no evidence for integration. HPV-positive and HPV-negative vulvar cancers exhibited contrasting human, global gene expression patterns partially overlapping with previously observed differences between HPV-positive and HPV-negative cervical and oropharyngeal cancers. A substantial fraction of the differentially expressed genes involved immune system function. Thus, transcription and HPV DNA integration in vulvar cancers resemble those in other HPV-positive cancers. This study emphasizes the power of hybridization capture coupled with DNA and RNA sequencing to identify a broad spectrum of HPV types, determine human genome integration status of viral DNAs, and elucidate their structures.
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Affiliation(s)
- Anne Van Arsdale
- Department of Obstetrics Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Lauren Turker
- Department of Obstetrics Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
- Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Yoke-Chen Chang
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08901, USA
| | - Joshua Gould
- Broad Institute, Cambridge, MA, 02142, USA
- Cellarity, Cambridge, MA, 02140, USA
| | - Bryan Harmon
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Elaine C Maggi
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
- Twist Biosciences, South San Francisco, CA, 94080, USA
| | - Olga Meshcheryakova
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Maxwell P Brown
- Broad Institute, Cambridge, MA, 02142, USA
- Verve Therapeutics, Boston, MA, 02215, USA
| | - Dana Luong
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Koenraad Van Doorslaer
- School of Animal and Comparative Biomedical Sciences, College of Agriculture and Life Sciences BIO5 Institute, University of Arizona, Tucson, AZ, 85721, USA
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Women's Health, Rutgers New Jersey Medical School, Newark, NJ, 07102, USA
| | - Dennis Y S Kuo
- Department of Obstetrics Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Deyou Zheng
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | | | - Jack Lenz
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Cristina Montagna
- Department of Obstetrics Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08901, USA.
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3
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Brassetti A, Chiacchio G, Anceschi U, Bove A, Ferriero M, D'Annunzio S, Misuraca L, Guaglianone S, Tuderti G, Mastroianni R, Tedesco F, Cacciatore L, Proietti F, Flammia SR, De Nunzio C, Cozzi G, Leonardo C, Galosi AB, Simone G. Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review. Minerva Urol Nephrol 2024; 76:278-285. [PMID: 38920009 DOI: 10.23736/s2724-6051.24.05532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL). EVIDENCE ACQUISITION On April 9th, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("robotic assisted" OR "robot-assisted" OR "robotic") AND ("inguinal lymph node dissection" OR "lymphadenectomy") AND ("penile cancer" OR "vulvar cancer"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement. EVIDENCE SYNTHESIS Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients. CONCLUSIONS The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Chiacchio
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy -
| | - Umberto Anceschi
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Simone D'Annunzio
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Salvatore Guaglianone
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simone R Flammia
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Andrea B Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
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4
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Geisler AN, Ganz JE. WNL we never looked: vulvar carcinoma incidence after screening cutoff. Int J Womens Dermatol 2024; 10:e127. [PMID: 38179153 PMCID: PMC10763985 DOI: 10.1097/jw9.0000000000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 01/06/2024] Open
Abstract
The incidence of vulvar carcinoma increases with age, though elderly women receive less aggressive cancer therapies and fewer strategies aimed at cancer prevention. Furthermore, elderly women dual enrolled in Medicaid-Medicare experience poor survival rates for vulvar carcinoma. Herein, we provide recommendations for the prevention of and guidelines for the multidisciplinary care of vulvar carcinoma. Prevention of vulvar carcinoma can be categorized into primary, secondary, and tertiary prevention. Primary prevention consists of vaccination, secondary prevention consists of screening, and tertiary prevention is aimed at the management of premalignant and early-stage lesions.
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Affiliation(s)
- Amaris N. Geisler
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Jodi E. Ganz
- Olansky Dermatology and Aesthetics, Atlanta, Georgia
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5
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Kwolek DG, Gerstberger S, Tait S, Qiu JM. Ovarian, Uterine, and Vulvovaginal Cancers: Screening, Treatment Overview, and Prognosis. Med Clin North Am 2023; 107:329-355. [PMID: 36759101 DOI: 10.1016/j.mcna.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine screening protocols do not detect these malignancies; thus, the recognition of risk factors and evaluation of worrisome symptoms are essential for early detection and improved prognoses. Treatment is managed by gynecologic oncologists, and often involves a combination of surgery, chemotherapy, and possible radiation treatments. Survivor care is managed by the primary-care clinician: expert attention to the mental, physical, and sexual health of each patient will ensure the best outcomes and quality of life.
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Affiliation(s)
- Deborah Gomez Kwolek
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Stefanie Gerstberger
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sarah Tait
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanna M Qiu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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6
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Vulvar squamous cell carcinoma guidelines do not include tissue-sparing techniques as a treatment option. Int J Womens Dermatol 2023; 9:e078. [PMID: 36908581 PMCID: PMC9995084 DOI: 10.1097/jw9.0000000000000078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/11/2023] [Indexed: 03/14/2023] Open
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7
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Guideline-Discordant Care in Early-Stage Vulvar Cancer. Obstet Gynecol 2022; 140:1031-1041. [PMID: 36357957 DOI: 10.1097/aog.0000000000004992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe the use of National Comprehensive Cancer Network guideline-concordant inguinofemoral lymph node (LN) evaluation in individuals with early-stage vulvar cancer. METHODS This retrospective cohort study identified patients with T1b and T2 vulvar squamous cell carcinoma diagnosed between 2012 and 2018 using the National Cancer Database. Factors associated with LN evaluation were examined using logistic regression analyses, adjusting for patient, disease, and facility-level characteristics. Kaplan-Meier survival analysis using log rank test and Cox regression was performed for the entire cohort and a subgroup of older patients , defined as individuals aged 80 years or older. RESULTS Of the 5,685 patients with vulvar cancer, 3,756 (66.1%) underwent guideline-concordant LN evaluation. In our adjusted model, age 80 years or older (odds ratio [OR], 0.30; 95% CI 0.22-0.42) and Black race (OR 0.72; 95% CI 0.54-0.95) were associated with lower odds of LN evaluation. High-volume hospitals were associated with increased odds of LN evaluation compared with low-volume hospitals (OR 1.62; 95% CI 1.28-2.05). Older individuals who did not undergo LN evaluation had significantly worse overall survival than those with pathologically negative LNs (hazard ratio [HR] 0.45; 95% CI 0.37-0.55) and similar overall survival as those with pathologically positive LNs (HR 1.05; 95% CI 0.77-1.43). CONCLUSION Guideline-concordant LN evaluation for early-stage vulvar squamous cell carcinoma is low. Lower utilization is associated with older age, Black race, and care at a low-volume hospital.
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8
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Vue NC, Gaulin NB, Horne ZD, Liang S, Krivak TC. Fertility-sparing treatment of locally advanced vulvar squamous cell carcinoma in a young patient. Gynecol Oncol Rep 2022; 43:101067. [PMID: 36158735 PMCID: PMC9489490 DOI: 10.1016/j.gore.2022.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Locally advanced vulvar cancer has been diagnosed in a young patient who desires fertility. Treatment of vulvar cancer in young patients will need to consider future reproductive planning. Fertility-sparing radiation techniques for treatment of vulvar cancer are effective in achieving long-term disease control.
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9
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Squamous Cell Carcinoma of the Vulva: A Survival and Epidemiologic Study with Focus on Surgery and Radiotherapy. J Clin Med 2022; 11:jcm11041025. [PMID: 35207308 PMCID: PMC8880528 DOI: 10.3390/jcm11041025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Vulvar squamous cell carcinoma (SCC) is the most frequent vulvar neoplasia. While the primary role of surgery is widely accepted, large population studies are needed to compare survival between diverse treatment modalities and to identify independent prognostic factors to help council patients and guide oncological treatment. The U.S. National Cancer Index, Surveillance, Epidemiology and End Results (SEER) program data between 2000 and 2018 was screened for all squamous cell carcinoma affecting the vulva. Raw data was processed with IBM SPSS. Demographic, clinical-pathological and treatment data were studied. Overall survival (OS) was calculated using the Kaplan–Meier method and subgroups were compared using the log rank test. A multivariate cox regression was conducted to identify independent prognostic factors. A total of 11,360 patients were identified with a median age of 65. Median overall survival was 101 months. Surgery as a primary treatment is the therapeutic sequence associated with the best overall survival. Multivariate cox-regression did not meet proportional hazard assumption. Age, pathological grade, stage at diagnosis, treatment sequence and the use of chemotherapy were identified as independent prognostic factor. Surgery alone is the treatment sequence offering the best overall survival. Surgery should be offered to all eligible patients.
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10
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Ouh YT, Kang D, Kim H, Lee JK, Hong JH. Prevalence and Treatment of Vulvar Cancer From 2014-2018: A Nationwide Population-Based Study in Korea. J Korean Med Sci 2022; 37:e25. [PMID: 35075824 PMCID: PMC8787801 DOI: 10.3346/jkms.2022.37.e25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vulvar cancer is one of the rare gynecologic malignancies. Despite the recent increasing trend of vulvar cancer in western countries due to the increased infection of human papillomavirus, there has been no study for population-based incidence of vulvar cancer in Korea. We aimed to investigate the prevalence and treatment of vulvar cancer in South Korea between 2014 and 2018. METHODS Data from patients diagnosed and treated with vulvar cancer between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (National In-Patient Sample) in South Korea. RESULTS A total of 4,636,542 women were identified through the HIRA-NIS database from 2014 to 2018, of which 259 patients were diagnosed and treated for vulvar cancer. The mean age diagnosed with vulvar cancer was 62.82 (± 14.30) years in 2014, 64.19 (± 16.79) years in 2015, and 67.40 (± 14.41) years in 2016. In terms of treatment modalities, the most frequent treatment was surgery only without chemotherapy or radiation therapy. In the age-specific prevalence analysis, vulvar cancer was the most prevalent among those over 70 years old. According to multiple regression analysis, patients' age was significantly associated with the prevalence of vulvar cancer. Vulvar cancer was more prevalent in women with low socioeconomic status (SES) compared to those with high SES in 2018 (OR, 4.242; P < 0.001). CONCLUSION Considering the high prevalence of vulvar cancer in the elderly, it is necessary to establish a new strategy for early screening and treatment.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, Korea
| | - Hoseob Kim
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Seoul, Korea.
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11
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Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas. Biomedicines 2022; 10:biomedicines10010150. [PMID: 35052829 PMCID: PMC8773579 DOI: 10.3390/biomedicines10010150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Mucosal melanomas (MM) are rare tumors, being less than 2% of all diagnosed melanomas, comprising a variegated group of malignancies arising from melanocytes in virtually all mucosal epithelia, even if more frequently found in oral and sino-nasal cavities, ano-rectum and female genitalia (vulva and vagina). To date, there is no consensus about the optimal management strategy of MM. Furthermore, the clinical rationale of molecular tumor characterization regarding BRAF, KIT or NRAS, as well as the therapeutic value of immunotherapy, chemotherapy and targeted therapy, has not yet been deeply explored and clearly established in MM. In this overview, focused on anorectal and genital MM as models of rare melanomas deserving of a multidisciplinary approach, we highlight the need of referring these patients to centers with experts in melanoma, anorectal and uro-genital cancers treatments. Taking into account the rarity, the poor outcomes and the lack of effective treatment options for MM, tailored research needs to be promptly promoted.
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12
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Malandrone F, Bevilacqua F, Merola M, Gallio N, Ostacoli L, Carletto S, Benedetto C. The Impact of Vulvar Cancer on Psychosocial and Sexual Functioning: A Literature Review. Cancers (Basel) 2021; 14:cancers14010063. [PMID: 35008225 PMCID: PMC8750175 DOI: 10.3390/cancers14010063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The diagnostic and therapeutic pathway of vulvar cancer impacts severely on the psychosocial and psychosexual equilibrium of women affected by it. The current literature shows the presence of depressive and anxious symptoms in association with physical, psychological and behavioural alterations in sexuality as well as deterioration of partner relationship. The aim of this article is to highlight the difficulties and challenges faced by women diagnosed and treated for vulvar cancer to provide early recognition and appropriate assistance. By implementing an integrated care model, it should be possible to detect unmet needs and improve the quality of life of these women. Abstract Women who are diagnosed and treated for vulvar cancer are at higher risk of psychological distress, sexual dysfunction and dissatisfaction with partner relationships. The aim of this article is to provide a review of the psychological, relational and sexual issues experienced by women with vulvar cancer in order to highlight the importance of this issue and improve the quality of care offered to these patients. A review of the literature was performed using PubMed, CINAHL, PsycINFO, and the Cochrane Library. The results are presented as a narrative synthesis and highlight the massive impact of vulvar cancer: depressive and anxiety symptoms were more frequent in these women, and vulvar cancer may have a negative effect on sexuality from a physical, psychological and behavioural point of view. Factors that may negatively affect these women’s lives are shame, insecurity or difficulties in self-care and daily activities. This review highlights the psychosocial and psychosexual issues faced by women diagnosed and treated for vulvar cancer, although more studies are needed to better investigate this field of interest and to identify strategies to relieve their psychological distress. Care providers should implement an integrated care model to help women with vulvar cancer recognise and address their unmet needs.
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Affiliation(s)
- Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy
| | - Federica Bevilacqua
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
| | - Mariagrazia Merola
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy
| | - Niccolò Gallio
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
| | - Sara Carletto
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy
| | - Chiara Benedetto
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
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MacDuffie E, Sakamuri S, Luckett R, Wang Q, Bvochara-Nsingo M, Monare B, Bazzett-Matabele L, Moloi T, Ralefala T, Ramogola-Masire D, Shin SS, Zetola NM, Grover S. Vulvar cancer in Botswana in women with and without HIV infection: patterns of treatment and survival outcomes. Int J Gynecol Cancer 2021; 31:1328-1334. [PMID: 34493586 DOI: 10.1136/ijgc-2021-002728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/28/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Vulvar cancer is a rare gynecological malignancy. However, the incidence of human papillomavirus (HPV)-associated vulvar disease is increasing, particularly in low- and middle-income countries. HIV infection is associated with an increased risk of HPV-associated vulvar cancer. We evaluated treatment patterns and survival outcomes in a cohort of vulvar cancer patients in Botswana. The primary objective of this study was to determine overall survival and the impact of treatment modality, stage, and HIV status on overall survival. METHODS Women with vulvar cancer who presented to oncology care in Botswana from January 2015 through August 2019 were prospectively enrolled in this observational cohort study. Demographics, clinical characteristics, treatment, and survival data were collected. Factors associated with survival including age, HIV status, stage, and treatment were evaluated. RESULTS Our cohort included 120 women with vulvar cancer. Median age was 42 (IQR 38-47) years. The majority of patients were living with HIV (89%, n=107) that was well-controlled on antiretroviral treatment. Among women with HIV, 54.2% (n=58) were early stage (FIGO stage I/II). In those without HIV, 46.2% (n=6) were early stage (stage I/II). Of the 95 (79%) patients who received treatment, 20.8% (n=25) received surgery, 67.5% (n=81) received radiation therapy, and 24.2% (n=29) received chemotherapy, either alone or in combination. Median follow-up time of all patients was 24.7 (IQR 14.2-39.1) months and 2- year overall survival for all patients was 74%. Multivariate analysis demonstrated improved survival for those who received surgery (HR 0.26; 95% CI 0.08 to 0.86) and poor survival was associated with advanced stage (HR 2.56; 95% CI 1.30 to 5.02). Survival was not associated with HIV status. CONCLUSIONS The majority of women with vulvar cancer in Botswana are young and living with HIV infection. Just under half of patients present with advanced stage, which was associated with worse survival. Improved survival was seen for those who received surgery.
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Affiliation(s)
- Emily MacDuffie
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sruthi Sakamuri
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Luckett
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana.,Princess Marina Hospital, Gaborone, Botswana
| | - Qiao Wang
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
| | | | | | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana.,Princess Marina Hospital, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, USA
| | - Thabo Moloi
- Princess Marina Hospital, Gaborone, Botswana
| | | | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Sanghyuk S Shin
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Nicola M Zetola
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Princess Marina Hospital, Gaborone, Botswana.,Botswana-UPenn Partnership, Gaborone, Botswana.,Department of Medicine, University of Botswana, Gaborone, Botswana
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14
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Albert A, Lee A, Allbright R, Vijayakumar S. Vulvar melanoma: an analysis of prognostic factors and treatment patterns. J Gynecol Oncol 2021; 31:e66. [PMID: 32808496 PMCID: PMC7440982 DOI: 10.3802/jgo.2020.31.e66] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/10/2020] [Accepted: 04/26/2020] [Indexed: 02/03/2023] Open
Abstract
Objective Melanoma comprises 5% to 10% of vulvar cancers and prognosis is poor. The purpose of this study was to identify prognostic factors and treatment patterns for vulvar melanoma using the National Cancer Database (NCDB). Methods The NCDB was queried for patients with invasive vulvar melanoma from 2004–2015. Descriptive statistics were generated to describe clinical and treatment details. Multivariable Cox regression and the Kaplan-Meier method were used to examine overall survival (OS). Results 1,917 patients with vulvar melanoma met inclusion criteria. Median follow-up time was 32 months (range, 0–151 months). Older age, larger tumor size, advanced disease stage, increased Charlson-Deyo comorbidity score, and care at a non-academic center were independent predictors for decreased OS. Surgical management of the primary site, lymph node surgery, and insurance provided a significant survival benefit. Use of immunotherapy for vulvar melanoma has increased over time. Two-year OS with immunotherapy in patients with distant metastatic disease was higher, although this did not reach statistical significance (33% vs. 12%, p=0.054). Conclusions Vulvar melanoma has a poor prognosis for those with regional and distant metastatic disease. Extent of disease, tumor size, and patient age are important prognostic factors. Other favorable factors included insurance and surgical management. The use of immunotherapy has increased over time and may improve survival in those with distant disease. These data support further investigation into the role of immunotherapy for vulvar melanoma to optimize outcomes.
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Affiliation(s)
- Ashley Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Anna Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Allbright
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
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15
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Akkol EK, Dereli FTG, Sobarzo-Sánchez E, Khan H. Roles of Medicinal Plants and Constituents in Gynecological Cancer Therapy: Current Literature and Future Directions. Curr Top Med Chem 2021; 20:1772-1790. [PMID: 32297581 DOI: 10.2174/1568026620666200416084440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022]
Abstract
Gynecologic cancers, including cervical, primary peritoneal, ovarian, uterine/endometrial, vaginal and vulvar cancers and gestational trophoblastic disease, are characterized by abnormal cell proliferation in female reproductive cells. Due to the variable pathology of these cancers and the lack of appropriate screening tests in developing countries, cancer diagnosis can be reported in advanced stages in most women and this situation adversely affects prognosis and clinical outcomes of illness. For this reason, many researchers in the field of gynecological oncology have carried out many studies. The treatment of various gynecological problems, which cause physical, biological and psychosocial conditions such as fear, shame, blame and anger, has been important throughout the history. Treatment with herbs has become popular nowadays due to the serious side effects of the synthetic drugs used in treatment and the medical and economical problems caused by them. Many scientists have identified various active drug substances through in vivo and in vitro biological activity studies on medicinal plants from the past to the present. While the intrinsic complexity of natural product-based drug discoveries requires highly integrated interdisciplinary approaches, scientific and technological advances and research trends clearly show that natural products will be among the most important new drug sources in the future. In this review, an overview of the studies conducted for the discovery of multitargeted drug molecules in the rational treatment of gynecological cancers is presented.
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Affiliation(s)
- Esra Küpeli Akkol
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, Etiler 06330, Ankara, Turkey
| | | | - Eduardo Sobarzo-Sánchez
- Instituto de Investigación e Innovación en Salud, Facultad de Ciencias de la Salud, Universidad Central de Chile, 8330507 Santiago, Spain
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University, Mardan 23200, Pakistan
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16
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Lakhman Y, Vargas HA, Reinhold C, Akin EA, Bhosale PR, Huang C, Kang SK, Khanna N, Kilcoyne A, Nicola R, Paspulati R, Rauch GM, Shinagare AB, Small W, Glanc P. ACR Appropriateness Criteria® Staging and Follow-up of Vulvar Cancer. J Am Coll Radiol 2021; 18:S212-S228. [PMID: 33958115 DOI: 10.1016/j.jacr.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Abstract
Vulvar cancer is an uncommon gynecologic tumor and one of several human papillomavirus-associated malignancies. Squamous cell carcinoma is the most prevalent histologic subtype of vulvar cancer, accounting for the majority of cases. Imaging plays an important role in managing vulvar cancer. At initial diagnosis, imaging is useful to assess the size and extent of primary tumor and to evaluate the status of inguinofemoral lymph nodes. If recurrent disease is suspected, imaging is essential to demonstrate local extent of tumor and to identify lymph node and distant metastases. In this publication, we summarize the recent literature and describe the panel's recommendations about the appropriate use of imaging for various phases of patient management including initial staging, surveillance, and restaging of vulvar cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, New York, New York, Chief, Body Imaging Service, Memorial Sloan Kettering Cancer Center
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | | | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Stella K Kang
- New York University Medical Center, New York, New York
| | - Namita Khanna
- Emory University, Atlanta, Georgia, Society of Gynecologic Oncology
| | | | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois, Professor and Chairman, Department of Radiation Oncology, Loyola University, Director, Cardinal Bernardin Cancer Center
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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17
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Correa AF. Technical management of inguinal lymph-nodes in penile cancer: open versus minimal invasive. Transl Androl Urol 2021; 10:2264-2271. [PMID: 34159108 PMCID: PMC8185661 DOI: 10.21037/tau.2020.04.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Inguinal lymphadenectomy (ILND) remains the standard of care for patients with invasive squamous cell carcinoma of the penis, dictating patient prognosis, adjuvant therapies, and surveillance strategies. Importantly the performance of an ILND has been shown to improve cancer-specific outcomes, providing a modifiable factor for patients with an aggressive malignancy. Surprisingly, the procedure remains underutilized, mainly due to the high surgical morbidity associated with the procedure. The open lymphadenectomy technique has undergone several modifications over the last 30 years to minimize its associated surgical morbidity, but wound-related complications remain significant. Minimally invasive surgery (MIS) techniques have been recently introduced to help mitigate wound-related complications associated with open lymphadenectomy, with promising results. In this review, we highlight the importance of ILND, present a detail review of the surgical and oncological outcomes associated with open, laparoscopic and robotic ILND for patients with penile cancer.
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Affiliation(s)
- Andres Felipe Correa
- Department of Surgery, Division of Urology, Cooper University Hospital, Camden, NJ, USA
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18
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Age, treatment and prognosis of patients with squamous cell vulvar cancer (VSCC) - analysis of the AGO-CaRE-1 study. Gynecol Oncol 2021; 161:442-448. [PMID: 33648748 DOI: 10.1016/j.ygyno.2021.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite an increasing incidence with simultaneous decreasing age of onset, vulvar squamous cell carcinoma (VSCC) is still a disease that mainly effects the elderly population. Data on the association of age with prognosis and treatment patterns in VSCC are sparse. METHODS This is an analysis of the AGO-CaRE-1 cohort. Patients with VSCC (FIGO stage ≥1B), treated at 29 cancer centers in Germany from 1998 to 2008, were included in a centralized database (n = 1618). In this subgroup analysis patients were analyzed according to age [<50 yrs. (n = 220), 50-69 yrs. (n = 506), ≥70 yrs. (n = 521)] with regard to treatment patterns and prognosis. Only patients with documented age, surgical groin staging and known nodal status were included (n = 1247). Median follow-up was 27.5 months. RESULTS At first diagnosis, women ≥70 yrs. presented with more advanced tumor stages (<0.001), larger tumor diameter (<0.001), poorer ECOG status (<0.001), more frequent HPV negative tumors (p = 0.03) as well as a higher rate of nodal involvement (<0.001). Disease recurrence occurred significantly more often in elderly patients (p = 0.001) and age as well as ECOG status, microscopic residual resection, tumor stage, grading, and (chemo)radiation were independent prognostic factors for death or recurrence in multivariate analysis. 2-year disease-free survival rates were 59.3% (≥70 yrs), 65.8% (50-69 yrs) and 81.1% (<50 yrs), respectively (p < 0.001). CONCLUSIONS Older women with VSCC present with advanced tumor stages at first diagnosis and have an increased risk of recurrence as well as a decreased 2-year DFS in comparison to younger patients. Potential reasons could be self-awareness and/or more aggressive tumor biology due to HPV independent disease.
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19
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Barlow EL, Jackson M, Hacker NF. The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study. Cancers (Basel) 2020; 12:cancers12113375. [PMID: 33202675 PMCID: PMC7697402 DOI: 10.3390/cancers12113375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
For the last 30 years at the Royal Hospital for Women, unifocal vulvar squamous cancers have been treated by radical local excision, aiming to achieve a histopathological margin of ≥8 mm, equating to a surgical margin of 1 cm. The need for a margin of this width has recently been challenged. We aimed to determine the long-term outcome following this conservative approach, and the relationship between vulvar recurrences and surgical margins. Data were obtained retrospectively on 345 patients treated primarily with surgery for squamous vulvar cancer between 1987 and 2017. Median follow-up was 93 months. Five-year disease-specific survival was 86%. Of 78 vulvar recurrences, 33 (42.3%) were at the primary site and 45 (57.7%) at a remote site. In multivariable analysis, a margin < 5 mm showed a higher risk of all vulvar (Hazard ratio (HR), 2.29; CI, 1.12-4.70), and primary site recurrences (subdistribution hazard ratio (SHR), 15.20; CI, 5.21-44.26), while those with a margin of 5 to <8 mm had a higher risk of a primary site recurrence (SHR, 8.92; CI, 3.26-24.43), and a lower risk of remote site recurrence. Excision margins < 8 mm treated by re-excision or radiation therapy had a significantly decreased risk of recurrence. Guidelines should continue to recommend a surgical margin of 1 cm.
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Affiliation(s)
- Ellen L. Barlow
- Gynaecological Cancer Centre, Royal Hospital for Women, Sydney 2031, Australia;
- Correspondence: ; Tel.: +61-2-93826184
| | - Michael Jackson
- Radiation Oncology Department, Prince of Wales Hospital, Sydney 2031, Australia;
- Prince of Wales Clinical School, University of New South Wales, Sydney 2052, Australia
| | - Neville F. Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, Sydney 2031, Australia;
- School of Women’s & Children’s Health, University of New South Wales, Sydney 2052, Australia
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20
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Abstract
OBJECTIVE Medical societies have over the years moved away from recommending routine pelvic examinations in older, asymptomatic women above age 65. Consequently, vulvar examination is a largely neglected component of the physical examination, unless sent to a specialist for gynecological evaluation. In recognition of these recommendations, we analyzed US trends in vulvar cancer incidence, age, and stage at diagnosis, survival, and association with human papillomavirus (HPV). METHODS Cases of vulvar and cervical cancer from 1992 to 2014 were extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results and Centers for Disease Control's data on age at diagnosis, stage of disease, and HPV-association were analyzed and compared. Incidence and mortality rates were extracted and calculated. RESULTS From 1992-2014, there was a 14.3% increase in vulvar cancer rates. The absolute average incidence rate was 2.25, with HPV still being seen in vulvar carcinomas in women 65 years and above. Cervical cancer mortality rates declined by 34.2%, while vulvar cancer death rates were unchanged. We show increased intervals for cervical cancer screening is associated with later stage vulvar cancer detection. The proportion of vulvar cancer cases diagnosed in women age <50 steadily decreased, from 42.05% of cases in 1992-1996 to 19.75% of total cases in 2012-2015. Meanwhile, vulvar cancer cases diagnosed in women > 65 yo increased from 36.62% of cases in 1992-1996 to 49.82% of cases in 2012-2015. CONCLUSION The incidence of vulvar cancer increases with age, with the median age of diagnosis 67 years, with HPV (+) tumors occurring into 70's and 80's. Though medical societies do not routinely recommend an external genital examination in women 65 years and above, we show this is a missed opportunity to improve cancer outcomes in some older females.
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21
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Tumor-free margins and local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol 2020; 158:555-561. [PMID: 32624236 DOI: 10.1016/j.ygyno.2020.06.503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/22/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the relation of pathologic tumor-free margins and local recurrence in patients who underwent primary surgery for vulvar squamous cell carcinoma. METHODS In this retrospective analysis, patients with stage I-III vulvar squamous cell carcinoma who underwent primary surgery between 2000 and 2018 were identified from the Mayo Clinic Cancer Registry. RESULTS A total of 335 patients were included and divided into three groups according to tumor-free margins: group 1 (<3 mm, n = 32); group 2 (≥3 to <8 mm, n = 151); group 3 (≥8 mm, n = 152). The median follow-up time was 73 months (range 2-240). A total of 78 (23.3%) patients developed local recurrence. With the inverse propensity score weighing method adjusting baseline characters, margins <8 mm had inferior local control (HR 1.98, 95% CI 1.13-3.41). The 5-year local disease-free survival (DFS) was 48.2%, 81.5% and 84.6% for group 1, 2 and 3 respectively (p < 0.001). There were no differences in groin lymph nodes relapse (p = 0.850), distant metastases (p = 0.253), or disease-specific survival (DSS) (p = 0.289) among the three groups. Margins <8 mm, midline involvement, multifocal disease, precancerous lesions on margins and depth of invasion >1 mm were found to be poor prognosticators for local DFS in univariate analysis. Multifocal disease was the strongest predictor for local recurrence in multivariate analysis (HR 4.32, 95% CI 2.67-6.99). CONCLUSION Patients undergoing primary surgery for vulvar squamous cell carcinoma with tumor free-margins <8 mm have a higher local recurrence rate.
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22
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Gaulin NB, Lesnock JL, Tian C, Osei-Bonsu K, Jacobs A, Richard SD, Krivak TC, Miller EM, Shriver CD, Casablanca Y, Maxwell GL, Darcy KM. Survival disparities in vulvar cancer patients in Commission on Cancer®-accredited facilities. Gynecol Oncol 2020; 157:136-145. [PMID: 31954540 DOI: 10.1016/j.ygyno.2019.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate survival disparities and prognostic factors in vulvar cancer by age at diagnosis. METHODS Women who underwent surgery and were diagnosed with stage I-IV vulvar cancer from 2004 to 2014 in the National Cancer Database were eligible. Proportions were compared using Chi-Square test. Survival was evaluated using Cox analysis. RESULTS There were 18,207 eligible women. Median age at diagnosis was 64 years, and 31% diagnosed ≥75 years old were categorized as elderly. Most vulvar cancers were diagnosed at stage I and with squamous histology. Diagnosis with higher stage or non-squamous histology was more common in elderly vs. non-elderly patients (P < 0.001). Survival was 3.5 times worse in the elderly than the non-elderly (P < 0.0001). Risk of death for each 5-year increment in age increased by 22% for non-elderly and 43% for elderly patients (P < 0.0001). The prognostic value of comorbidity score, stage, regional node assessment and histology was smaller in elderly vs. non-elderly women (each P < 0.05). Adjuvant chemoradiotherapy (CTRT) use in the elderly vs. non-elderly was rare for stage I-II disease (3% vs. 2%) and more common for stage III-IV disease (6% vs. 43%), respectively (P < 0.0001). The survival disadvantage for elderly patients persisted following no adjuvant therapy, radiotherapy or chemotherapy alone, or CTRT (P < 0.0001). In stage III-IV disease, survival was superior following CTRT vs. radiotherapy when diagnosed <75 years (HR = 0.80, 95% CI = 0.69-0.93) but not in the elderly (HR = 0.99, P > 0.05). CONCLUSIONS Age-associated risk of death increased at different rates in vulvar cancer and was larger in elderly vs. non-elderly patients. The impact of other prognostic factors was smaller in elderly vs. non-elderly women. The survival benefit of CTRT over radiotherapy in stage III-IV did not extend to the elderly.
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Affiliation(s)
- Nicole B Gaulin
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Jamie L Lesnock
- Division of Gynecologic Oncology, University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA, USA.
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | - Kathryn Osei-Bonsu
- Virginia Commonwealth University, Inova Fairfax Medical Campus, Falls Church, VA, USA.
| | - Allison Jacobs
- Virginia Commonwealth University, Inova Fairfax Medical Campus, Falls Church, VA, USA.
| | - Scott D Richard
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Thomas C Krivak
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Eirwen M Miller
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Craig D Shriver
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
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23
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Wohlmuth C, Wohlmuth-Wieser I. Vulvamalignome: eine interdisziplinäre Betrachtung. J Dtsch Dermatol Ges 2019; 17:1257-1276. [PMID: 31885177 DOI: 10.1111/ddg.13995_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
Vulvamalignome stellen die vierthäufigste Gruppe von gynäkologischen Krebserkrankungen dar. Erste Ansprechpartner sind typischerweise niedergelassene Dermatologen und Gynäkologen. Mit der jeweiligen Fachexpertise findet die Diagnose und Therapie idealerweise interdisziplinär zwischen spezialisierten Dermatoonkologen und gynäkologischen Onkologen statt. Vulvamalignome sind überwiegend Erkrankungen des höheren Lebensalters, obwohl alle histologischen Subtypen auch bei Frauen unter 30 Jahren vorkommen. Die Diagnose erfolgt oft verzögert. Eine genaue Kartierung von Biopsien (Mapping) ist von großer Bedeutung, da Lokalisation und Entfernung von der Mittellinie in Abhängigkeit von der zugrunde liegenden Histologie das operative Vorgehen bestimmen. Plattenepithelkarzinome machen mehr als 76 % der Vulvamalignome aus und vulväre intraepitheliale Neoplasien (VIN) sind dabei wichtige Vorstufen. Der zweithäufigste Typ der Vulvakarzinome ist das Basalzellkarzinom. Melanome machen 5,7 % der vulvären Malignome aus und ihre Prognose ist schlechter als die der kutanen Melanome. Die meisten Studien zu Checkpoint-Inhibitoren und zielgerichteten Therapien haben Patientinnen mit vulvären Melanomen nicht ausgeschlossen. Die vorliegende Evidenz wird im folgenden diskutiert. Die Methode der Wahl bei lokal resezierbaren Vulvamalignomen ist die Exzision. Angesichts ihrer Seltenheit sollte die Behandlung in spezialisierten Zentren erfolgen, um eine optimale Krankheitskontrolle zu erreichen und Kontinenz und sexuelle Funktion bestmöglich zu erhalten.
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Affiliation(s)
- Christoph Wohlmuth
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.,Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, ON, Kanada.,Department of Obstetrics and Gynecology, University of Toronto, ON, Kanada
| | - Iris Wohlmuth-Wieser
- Universitätsklinik für Dermatologie und Allergologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
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Wohlmuth C, Wohlmuth-Wieser I. Vulvar malignancies: an interdisciplinary perspective. J Dtsch Dermatol Ges 2019; 17:1257-1276. [PMID: 31829526 PMCID: PMC6972795 DOI: 10.1111/ddg.13995] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
Vulvar cancer represents the fourth most common gynecologic malignancy and is often encountered by the general Dermatologist or Gynecologist. Dermatooncologists and Gynecologic Oncologists share expertise in this field and the diagnosis and treatment should ideally be interdisciplinary. All subtypes are typically seen in the later decades of life, although all histologic subtypes have been described in women younger than 30 years. The diagnosis is often delayed. Exact mapping of biopsies is of high importance, as the location and distance from the midline guides the surgical approach depending on the underlying histology. Squamous cell carcinoma accounts for more than 76 % of vulvar cancer with vulvar intraepithelial neoplasia being an important precursor. Basal cell carcinoma is the second most common vulvar malignancy. Melanoma accounts for 5.7 % of vulvar cancer and has a worse prognosis compared to cutaneous melanoma. Most of the trials on checkpoint inhibitors and targeted therapy have not excluded patients with vulvar melanoma and the preliminary evidence is reviewed in the manuscript. Surgery remains the primary treatment modality of locally resectable vulvar cancer. In view of the rarity, the procedure should be performed in dedicated cancer centers to achieve optimal disease control and maintain continence and sexual function whenever possible.
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Affiliation(s)
- Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.,Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, ON, Canada
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Recurrent Vulvar Melanoma – a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2019-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Melanoma rarely develops in the genital area. It is responsible for 5% of all vulvar malignancies. Postmenopausal women are usually more affected and the main differential diagnosis is vulvar melanosis and vulvar nevi. There are limited numbers of studies on dermoscopic features of mucosal melanoma, particularly early-stage lesions. Dermoscopic criteria have been described for the diagnosis of vulvar melanosis, and observational studies have been conducted to define the dermoscopic features of nevi and melanoma on the vulva. We are presenting the case of a 69-year old female with suspected recurrence of vulvar melanoma who previously had surgical removal of mucosal lentiginous melanoma on the left labia minor in June 2017. Five months after the primary melanoma surgery, the patient noticed de novo pigmentation at the left and right labia minor and urethral opening. On clinical examination, irregular light-brown pigmentation with ill-defined borders was evident on the labia minora of the vulva and around the external urethral orifice. On dermoscopy, irregular pigmented network, with white scar-like and structureless pinkish areas was evident. Incisional biopsy of the vulvar mucosa revealed melanoma in situ, confirming the local recurrence. CT scans of the head, thorax, abdomen and pelvis and gynaecological examination revealed no secondary deposits. Ultrasound of the regional inguinal lymph nodes revealed enlarged suspected pathologic involvement of the lymph nodes in both inguinal regions. Lymph node fine needle aspiration of lymph nodes in the left and right inguinal area revealed pleomorphic infiltrate of lymphoid cells with hemosiderin or melanoma pigment in the cytoplasm. Cystoscopic findings were within normal range. Interdisciplinary tumour board indicated wide excision of melanoma with margins of 1 cm and resection of the urethra, as well as biopsy of the enlarged left inguinal lymph node. Histopathological analysis of the resected mucosa revealed lentiginous spread of melanocytes showing moderate atypia, with focal pagetoid spread, without mitoses and ulceration and without invasion of lamina propria. The resection margins were tumour-free. Non-specific lymphadenitis was diagnosed on lymph node histopathological analysis. The patient was regularly monitored by a dermatologist and urologist, and had no recurrence. The accurate and prompt diagnosis is essential in the case of the vulvar melanoma which has unfavourable and unpredictable prognosis, with a tendency of local recurrences and regional and distant metastases in the case of invasive melanoma. In order not to miss early mucosal melanoma, dermatologists and gynaecologists should not avoid biopsy of lesions that demonstrate any clinical or dermoscopic feature of atypical melanocytic lesion, especially in case of the development of irregular pigmentation that expands and changes over time, the appearance of a solitary amelanotic papule or nodule requires excision or, in case of large diameter lesions, incision biopsies. Larger studies are needed to define more rigorously clinical and dermoscopic criteria that accurately distinguish early mucosal melanomas from benign skin lesions.
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Zongo N, Korsaga Somé N, Ouédraogo S, Ouédraogo AS, Zamané H, Zida M, Ouangre E, Sanou A, Niampa P, Lompo OM, Traoré A, Dem A. [Cancer of the vulva: Diagnostic stages, treatment and survival in a country with limited resources (Burkina Faso)]. Bull Cancer 2019; 106:1057-1063. [PMID: 31542167 DOI: 10.1016/j.bulcan.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Vulvar cancer is rare and belatedly diagnosed in Africa. We describe its diagnostic stages, therapeutic and evolution features in a country with limited resources. METHODOLOGY Forty-seven cases of vulvar cancer diagnosed between 2013 and 2018 in Burkina Faso, were analyzed retrospectively. The diagnostic stages, therapeutic and evolution terms were considered. Survival was calculated through the Kaplan Meier Method and compared using the Logrank technique. RESULTS Stages IA and IB accounted for 10.6%. Radiotherapy was not available and chemotherapy was done in 9 cases. Full vulvectomy with bilateral inguino-femoral dissection was performed in 11 cases. Average survival was 41 months with a median of 52 months. The difference in survival according to the diagnostic stages were highly significant statistically (P=0.000). DISCUSSION Cancer of the vulva is rare and raises major therapeutic difficulties in countries with limited resources. Surgery is the only affordable weapon. Evolution would be better if radiochemotherapy was possible. CONCLUSION Radiochemotherapy cannot be done due to the lack of a radiotherapy unit and the high cost of cytotoxics. Surgery is largely palliative and/or mutilating. Survival is modest. An early diagnosis could help promote conserving treatments.
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Affiliation(s)
- Nayi Zongo
- CHU Yalgado, Ouedraogo, chirurgie viscérale, Ouagadougou, Burkina Faso.
| | - Nina Korsaga Somé
- CHU Yalgado Ouedraogo, dermatologie vénérologie, Ouagadougou, Burkina Faso
| | - Smaila Ouédraogo
- CHU Yalgado Ouedraogo, Santé publique, Ouagadougou, Burkina Faso
| | | | - Hyacinthe Zamané
- CHU Yalgado, Ouedraogo, gynéco-obstétrique, Ouagadougou, Burkina Faso
| | - Maurice Zida
- CHU Yalgado, Ouedraogo, chirurgie viscérale, Ouagadougou, Burkina Faso
| | - Edgard Ouangre
- CHU Yalgado, Ouedraogo, chirurgie viscérale, Ouagadougou, Burkina Faso
| | - Adama Sanou
- CHU Yalgado, Ouedraogo, chirurgie viscérale, Ouagadougou, Burkina Faso
| | - Pascal Niampa
- CHU Yalgado Ouedraogo, dermatologie vénérologie, Ouagadougou, Burkina Faso
| | | | - Adama Traoré
- CHU Yalgado Ouedraogo, dermatologie vénérologie, Ouagadougou, Burkina Faso
| | - Ahmadou Dem
- Institut de cancérologie Joliot Curie de Dakar, Sénégal
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Lakhwani P, Agarwal P, Mahajan JA, Goel A, Pande P, Mehta S, Kumar K. Surgical Management of Carcinoma Vulva-Case Series and Review of Literature. Indian J Surg Oncol 2019; 10:324-328. [PMID: 31168257 PMCID: PMC6527639 DOI: 10.1007/s13193-019-00887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022] Open
Abstract
The objective of this study was to study the risk factors, management protocols, and the outcome of vulvar cancer cases over a period of 2 years in a tertiary care hospital. This is a case series of early-stage vulvar cancer in the Department of Surgical Oncology in BL Kapur Superspeciality Hospital from Jan 2016 to date. Five patients with histologically proven diagnosis of early-stage vulvar cancer were included. The mean age for the diagnosis of vulvar cancer was 58 years and the peak incidence was seen in postmenopausal age group. All of the cases were squamous cell carcinomas in stage IB except one which was a basisquamous variant. All cases were treated primarily with surgery and vulvar flap reconstruction. Adjuvant therapy was not given in any case. Cases were followed from 6 months to date, and no recurrence noted. The limitations of the study were rarity of disease and less number of cases. As all the cases in our study were in early stage of disease (stages I and II), surgical treatment in the form of modified radical vulvectomy with B/L inguinofemoral lymph node dissection and oncoplastic procedure was the treatment modality chosen for all the patients.
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Affiliation(s)
- Prerna Lakhwani
- B.L Kapur Super speciality Hospital, Pusa Road, Delhi, India
| | - Priya Agarwal
- B.L Kapur Super speciality Hospital, Pusa Road, Delhi, India
| | | | - Ashish Goel
- B.L Kapur Super speciality Hospital, Pusa Road, Delhi, India
| | - Pankaj Pande
- B.L Kapur Super speciality Hospital, Pusa Road, Delhi, India
| | - Sandeep Mehta
- B.L Kapur Super speciality Hospital, Pusa Road, Delhi, India
| | - Kapil Kumar
- B.L Kapur Super speciality Hospital, Pusa Road, Delhi, India
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Mise à jour concernant la prise en charge du cancer de la vulve : les recommandations de l’Assistance publique–hôpitaux de Paris. Bull Cancer 2019; 106:371-378. [DOI: 10.1016/j.bulcan.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/15/2019] [Accepted: 01/23/2019] [Indexed: 01/09/2023]
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Mousavi A, Yousefnezhad A, Modarres-Gilani M, Akhavan S, Sheikh-Hasani S. Vulvar cancer in Iran: Retrospective study over 20 years (1998-2018). J Family Med Prim Care 2019; 8:1465-1469. [PMID: 31143740 PMCID: PMC6510090 DOI: 10.4103/jfmpc.jfmpc_145_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background We did not have any data about vulvar cancer - as a fourth cause of gynecological cancer in the worldwide - in our country. Study Design Our study is designed to evaluate the frequency, stage and outcome of patients with vulvar cancer. Materials and Methods In this retrospective observational study, we studied patients' records with diagnosis of vulvar cancer who referred to department of gynecology oncology, Emam-Khomeini Hospital (EKH), Tehran, Iran, between January 1998 and December 2018. A total of 106 cases of vulvar cancers were found in the records of outpatient oncology clinic of medical university of Tehran university. Survival was estimated using the Kaplan-Meier analysis with SPSS version of 24. Results Mean age of the 106 patients in the study was 59.2 years. The most site of tumor involvement was major labial (39.1%). Vulvar cancer significantly was more in multiparous (P < 0.001) and menopause patients (P < 0.001). Squamous Cell Carcinoma was the most pathology of vulvar cancer (72.2%). Ninety patients (84.9%) had surgery as a primary treatment and 48 (53.3%) of these patients received adjuvant radiotherapy or chemoradiation after surgery. Mean duration of patient's follow up was 82.4 ± 68.3 month. Five-year survival of our patients in all stages was 71%. Conclusions Our findings are located between developed and underdeveloped countries. Our patients are diagnosed nearly in earlier stages of disease and 84.9%t of them had surgery as a primary treatment, so earlier surgery resulted in good survival of patients.
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Affiliation(s)
- Azamosadat Mousavi
- Department of Gynecology Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Yousefnezhad
- Department of Gynecology Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modarres-Gilani
- Department of Gynecology Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Setareh Akhavan
- Department of Gynecology Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Sheikh-Hasani
- Department of Gynecology Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Zhang J, Zhang Y, Zhang Z. Prevalence of human papillomavirus and its prognostic value in vulvar cancer: A systematic review and meta-analysis. PLoS One 2018; 13:e0204162. [PMID: 30256833 PMCID: PMC6157864 DOI: 10.1371/journal.pone.0204162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/03/2018] [Indexed: 01/11/2023] Open
Abstract
The purpose of this study was to estimate the prevalence of human papillomavirus (HPV) in vulvar cancer and determine whether positive HPV in vulvar cancer was associated with a better prognosis. Literature searches of Ovid EMBASE, PubMed, Web of Science and Cochrane Library were performed to identify related studies published from January 2000 to May 2017. A total of 33 studies including 7,721 subjects were selected in this meta-analysis. Overall, the HPV prevalence in vulvar cancer tissue was 34% (95% CI: 28%-39%) with 45% (95% CI: 28%-64%) in Asian populations and 34% (95% CI: 26%-42%) in Caucasian populations. The HPV-positive vulvar cancer was associated with better overall survival (hazard ratio = 0.64, 95% CI: 0.47–0.87; P = 0.004) and recurrence-free survival (hazard ratio = 0.66, 95% CI: 0.45–0.97; P = 0.03) compared with HPV-negative counterpart. HPV status may play an important role in predicting the prognosis of patients with vulvar cancer. The HPV-positive vulvar cancer women might relatively have a better survival than HPV-negative ones.
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Affiliation(s)
- Jianxin Zhang
- Department of Obstetrics and Gynecology, Capital Medical University affiliated Beijing Chaoyang Hospital, Chaoyang District, Beijing, PR. China
| | - Yang Zhang
- Department of Obstetrics and Gynecology, Capital Medical University affiliated Beijing Chaoyang Hospital, Chaoyang District, Beijing, PR. China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Capital Medical University affiliated Beijing Chaoyang Hospital, Chaoyang District, Beijing, PR. China
- * E-mail:
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Trends and Complications of Vulvar Reconstruction After Vulvectomy: A Study of a Nationwide Cohort. Int J Gynecol Cancer 2018; 28:1606-1615. [PMID: 30095703 DOI: 10.1097/igc.0000000000001332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine complications associated with primary closure compared with reconstruction after vulvar excision and predisposing factors to these complications. METHODS Patients undergoing vulvar excision with or without reconstruction from 2011 to 2015 were abstracted from the National Surgical Quality Improvement Program database. Common Procedural Terminology codes were used to characterize surgical procedures as vulvar excision alone or vulvar excision with reconstruction. Patient characteristics and 30-day outcomes were used to compare the 2 procedures. Descriptive and univariate statistics were performed. Adjusted odds ratios and confidence intervals were calculated using a logistic regression model to control for potential confounders. Two-sided α with P < 0.05 was designated as significant. RESULTS A total of 2698 patients were identified; 78 (2.9%) underwent reconstruction. There were no differences in age, race, body mass index, diabetes, hypertension, tobacco use, heart failure, renal failure, or functional status between the 2 groups. American Society of Anesthesiologists class 3 and 4 patients and those with disseminated cancer were more likely to undergo reconstruction (both P < 0.001). On univariate analysis, reconstruction was associated with increased risk of readmission, surgical site infection, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, sepsis, septic shock, unplanned reoperation, longer hospital stay, need for skilled nursing or subacute rehab on discharge, and death within 30 days. On logistic regression analysis, disseminated cancer, American Society of Anesthesiologists classes 3 and 4 and reconstruction remained significant risk factors for readmission and any postoperative complication. CONCLUSIONS Patients undergoing vulvar excision with reconstruction are at increased risk for readmission and postoperative complications compared with those undergoing excision alone. Careful patient selection and efforts to optimize surgical readiness are needed to improve outcomes. Long-term data could help determine if these 30-day outcomes are a reliable measure of surgical quality in vulvar surgery.
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Hami LT, Lampe B, Mallmann P, Forner DM. The Impact of Age on the Prognosis of Vulvar Cancer. Oncol Res Treat 2018; 41:520-524. [DOI: 10.1159/000488800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
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Campaner AB, Fernandes GL, Cardoso FDA, Veasey JV. Vulvar melanoma: relevant aspects in therapeutic management. An Bras Dermatol 2018; 92:398-400. [PMID: 29186258 PMCID: PMC5514586 DOI: 10.1590/abd1806-4841.20174941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 03/12/2016] [Indexed: 11/30/2022] Open
Abstract
Cancer of the vulva accounts for at least 1% of malignant neoplasms among women.
Although rare, vulvar melanoma is the second most common histological type of
vulvar cancer, representing 7-10% of all malignant vulvar neoplasms. Initial
symptoms are non-specific and complete excision of the lesion is indicated in
cases with suspected diagnosis. Prognosis of patients with these neoplasms is
poor and remains unchanged despite the treatment approach. Hemivulvectomy with
lymph node dissection is the current procedure of choice, associated or not with
adjuvant therapies. We report two cases of patients presenting with late
diagnosed vulvar melanoma and the relevant aspects in their therapeutic
management.
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Affiliation(s)
- Adriana Bittencourt Campaner
- Department of Gynecology and Obstetrics at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Gustavo Leme Fernandes
- Department of Gynecology and Obstetrics at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Fernanda de Araujo Cardoso
- Department of Gynecology and Obstetrics at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - John Verrinder Veasey
- Dermatology Clinic at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
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Correa AF, Handorf E, Joshi SS, Geynisman DM, Kutikov A, Chen DY, Uzzo RG, Viterbo R, Greenberg RE, Smaldone MC. Differences in Survival Associated with Performance of Lymph Node Dissection in Patients with Invasive Penile Cancer: Results from the National Cancer Database. J Urol 2017; 199:1238-1244. [PMID: 29248557 DOI: 10.1016/j.juro.2017.11.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE Inguinal lymphadenectomy remains under performed in patients with invasive penile cancer. Using a large national cancer registry we assessed temporal trends in inguinal lymphadenectomy performance and evaluated the impact of the procedure on survival in patients in whom inguinal lymphadenectomy was an absolute indication (T1b-4 N0/x-1) according to NCCN® (National Comprehensive Cancer Network®) Guidelines®. MATERIALS AND METHODS We queried the National Cancer Database for all cases of nonmetastatic, T1b-4 N0/x-1 squamous cell carcinoma of the penis from 2004 to 2014. Multivariable logistic regression models adjusting for patient, demographic, and clinicopathological characteristics were used to examine the association between available covariates and receipt of inguinal lymphadenectomy. Cox proportional hazards regression analysis was then done to assess the impact of clinical and pathological variables on overall survival. Propensity score weighted analysis was performed to assess the effect of inguinal lymphadenectomy on overall survival. RESULTS A total of 2,224 patients met analysis criteria, of whom 606 (27.2%) underwent inguinal lymphadenectomy. Following adjustment the procedure was more likely in younger patients, those who presented with palpable adenopathy (cN1), those treated at an academic facility and those with a more contemporary diagnosis. On survival analysis controlling for all known and measured confounders inguinal lymphadenectomy was associated with improved overall survival (HR 0.79, 95% CI 0.74-0.84, p <0.001). CONCLUSIONS At hospitals that report to the National Cancer Database the overall rate of inguinal lymphadenectomy in patients with invasive penile cancer was only 27.2%. Inguinal lymphadenectomy was associated with increased overall survival, justifying the procedure as an important quality metric for performance reporting in patients with invasive penile cancer.
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Affiliation(s)
- Andres F Correa
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Department of Urology, Creighton University, Omaha, Nebraska.
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shreyas S Joshi
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Daniel M Geynisman
- Division of Genitourinary Oncology, Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - David Y Chen
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rosalia Viterbo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard E Greenberg
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Campaner AB, Cardoso FDA, Fernandes GL, Veasey JV. Verrucous carcinoma of the vulva: diagnosis and treatment. An Bras Dermatol 2017; 92:243-245. [PMID: 28538888 PMCID: PMC5429114 DOI: 10.1590/abd1806-4841.20174929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
Vulvar cancer accounts for less than 1% of malignancies in women. Verrucous
carcinoma of the vulva is a rare histological variation, comprising less than 1%
of vulvar cancer cases. Although it is characterized as being locally invasive,
the condition is not associated with metastatic spreading. Lesions present in
the form of a verrucous, ulcerated, and bleeding tumor that can reach large
dimensions. This type of tumor can be mistaken for condylomata, both
macroscopically and microscopically. We report the case of an 81-year-old
patient with a large vulvar tumor presented for eight years, initially
considered as a Buschke-Löwenstein tumor. The patient underwent radical
vulvectomy with a V-Y advancement flap technique. This type of tumor should be
considered by clinicians dealing with condylomatous ulcerative lesions that do
not respond to the usual treatment.
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Affiliation(s)
- Adriana Bittencourt Campaner
- Department of Gynecology and Obstetrics at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Fernanda de Araujo Cardoso
- Department of Gynecology and Obstetrics at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Gustavo Leme Fernandes
- Department of Gynecology and Obstetrics at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - John Verrinder Veasey
- Dermatology Clinic at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
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Kumari R, Desai AD, Patel BM, Parekh CD, Patel SM, Mankad M. Neo-adjuvant Therapy in Locally Advanced Vulvar Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zongo N, Korsaga-Somé N, Banata Gang-Ny A, Ouangré E, Zida M, Ouédraogo AS, Bambara AH, Bambara AT, Traore SS, Niamba P, Traoré A, Dem A. Cancer of the vulva in Burkina Faso: a hospital-based case series. Infect Agent Cancer 2016; 11:33. [PMID: 27489564 PMCID: PMC4971747 DOI: 10.1186/s13027-016-0080-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/26/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Vulvar cancer is a rare gynaecological cancer. In Burkina Faso, the diagnosis of vulvar cancers is delayed and the prognosis is poor. However, no specific study on vulvar cancers has been conducted at the moment. This work aimed to study the characteristics of these cancers. METHODS This is a prospective study on histologically confirmed primary cancers of the vulva diagnosed between 1st January 2013 and 30th June 2015. The demographic and clinical aspects were studied at the Yalgado Ouedraogo University Hospital of Ouagadougou (CHU-YO). RESULTS We noticed 21 cases of vulvar cancers within 30 months, ranking it as the 4th most common gynaecological cancer. The average age of the patients was 55 years (standard deviation +/- 6.3) and the median age was 57 years. Scars resulting from female circumcision, menopause (n = 20) and HIV infection were noticed in 19 cases and 6 cases respectively. The average time from first symptoms to first consultation was 29 months. Pain and ulceration were the main reasons for consultation. The clinical picture was chiefly an ulcero-granulating tumour. There was squamous cell carcinoma in 20 cases and basal carcinoma in 1 case. Fifteen patients were at stage III or IV, where of three patients had metastatic disease. We noticed vitiligo in 9 vulvar cancer cases. CONCLUSION The cancer of the vulva is rare. Women are of menopausal age, are mostly circumcised and HIV-infection is common. A majority of patients sought consultation at advanced stage of disease, and diagnosis was belatedly made. Pain and ulceration were the main reasons for consultation. The sensitization of the population, education for self- examination would allow earlier diagnosis.
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Affiliation(s)
- Nayi Zongo
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Nina Korsaga-Somé
- Division of Dermatology and Venerology, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Amandine Banata Gang-Ny
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Edgar Ouangré
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Maurice Zida
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Aimé Sosthène Ouédraogo
- Division of Pathologic Anatomy, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Aboubacar Hirrhum Bambara
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Augustin Tozoula Bambara
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Si Simon Traore
- Division of General Surgery, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Pascal Niamba
- Division of Dermatology and Venerology, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Adama Traoré
- Division of Dermatology and Venerology, Yalgado Ouédraogo University Hospital of Ouagadougou, 03 BP 7021 Ouagadougou, Burkina Faso
| | - Ahmadou Dem
- Oncology Institute Joliot Curie of Dakar, Dakar, Senegal
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Suh CH, Tirumani SH, Keraliya A, Kim KW, Ramaiya NH, Shinagare AB. Molecular targeted therapy in gynaecologic malignancies: primer for radiologists. Br J Radiol 2016; 89:20160086. [PMID: 27331884 DOI: 10.1259/bjr.20160086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The identification of characteristic genetic alteration in gynaecological malignancies has opened the door for molecular targeted therapy. The purpose of this review is to provide a primer for the radiologist on these agents with emphasis on the role of imaging in treatment response assessment and drug toxicities. The use of targeted therapy in gynaecological malignancies will likely increase in the future and make the role of the radiologist critical in response assessment and detection of toxicities.
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Affiliation(s)
- Chong Hyun Suh
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,2 Department of Radiology, Namwon Medical Center, Namwon-Si, Jeollabuk-Do, Republic of Korea
| | - Sree H Tirumani
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhishek Keraliya
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyung Won Kim
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Nikhil H Ramaiya
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Atul B Shinagare
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Lavorato-Rocha AM, Akagi EM, de Melo Maia B, Rodrigues IS, Botelho MCS, Marchi FA, Fernandes G, Baiocchi G, Soares FA, Rogatto SR, Sato-Kuwabara Y, Rocha RM. An Integrative Approach Uncovers Biomarkers that Associate with Clinically Relevant Disease Outcomes in Vulvar Carcinoma. Mol Cancer Res 2016; 14:720-9. [PMID: 27170308 DOI: 10.1158/1541-7786.mcr-15-0366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
UNLABELLED Vulvar squamous cell carcinoma (VSCC) is a rare disease that has a high mortality rate (∼40%). However, little is known about its molecular signature. Therefore, an integrated genomics approach, based on comparative genome hybridization (aCGH) and genome-wide expression (GWE) array, was performed to identify driver genes in VSCC. To achieve that, DNA and RNA were extracted from frozen VSCC clinical specimens and examined by aCGH and GWE array, respectively. On the basis of the integration of data using the CONEXIC algorithm, PLXDC2 and GNB3 were validated by RT-qPCR. The expression of these genes was then analyzed by IHC in a large set of formalin-fixed paraffin-embedded specimens. These analyses identified 47 putative drivers, 46 of which were characterized by copy number gains that were concomitant with overexpression and one with a copy number loss and downregulation. Two of these genes, PLXDC2 and GNB3, were selected for further validation: PLXDC2 was downregulated and GNB3 was overexpressed compared with non-neoplastic tissue. By IHC, both proteins were ubiquitously expressed throughout vulvar tissue. High expression of GNB3 and low PLXDC2 immunostaining in the same sample was significantly associated with less lymph node metastasis and greater disease-free survival. On the basis of a robust methodology never used before for VSCC evaluation, two novel prognostic markers in vulvar cancer are identified: one with favorable prognosis (GNB3) and the other with unfavorable prognosis (PLXDC2). IMPLICATIONS This genomics study reveals markers that associate with prognosis and may provide guidance for better treatment in vulvar cancer. Mol Cancer Res; 14(8); 720-9. ©2016 AACR.
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Affiliation(s)
| | - Erica M Akagi
- Molecular Morphology Laboratory, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Iara S Rodrigues
- Molecular Morphology Laboratory, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Fabio A Marchi
- NeoGene Laboratory, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecology Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Fernando A Soares
- Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Yukie Sato-Kuwabara
- Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Rafael M Rocha
- Molecular Morphology Laboratory, AC Camargo Cancer Center, São Paulo, Brazil.
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Disparities in Vulvar Cancer Reported by the National Cancer Database: Influence of Sociodemographic Factors. Obstet Gynecol 2016; 126:792-802. [PMID: 26348176 DOI: 10.1097/aog.0000000000001033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether there is an association of patient sociodemographic factors with stage at diagnosis, treatment, and overall survival in patients with vulvar cancer in the National Cancer Database. METHODS This was a retrospective cohort study of patients with primary squamous vulvar carcinoma identified from the National Cancer Database (1998-2004). Multivariate logistic regression was conducted to examine risk factors associated with advanced-stage (stage III or IV) disease at diagnosis. Multivariable Cox regression models were performed to explore risk factors associated with 5-year all-cause mortality. RESULTS Of 11,153 patients, 42.3% (n=4,713) were diagnosed with stage I disease, 24.6% (n=2,745) stage II, 22.9% (n=2,556) stage III, and 10.2% (n=1,139) stage IV. Advanced stage was significantly associated with older age, nonprivate insurance, and treatment at a lower case volume center (P<.01). Of note, roughly 30% of patients with advanced-stage disease did not receive radiation therapy. Within the advanced stages, age 60 years or older and insurance type were associated with decreased survival (P<.01). In stage III disease, only black race and treatment at a community hospital were associated with a lower risk of death (P<.01). CONCLUSION Patient sociodemographic and clinical characteristics are significantly associated with vulvar cancer stage presentation, treatment, and survival. Unfortunately, within this disease, surgical approaches and adjuvant radiation do not appear consistent. LEVEL OF EVIDENCE II.
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Gien LT, Sutradhar R, Thomas G, Covens A, Elit L, Rakovitch E, Fyles A, Khalifa MA, Liu Y, Barbera L. Patient, tumor, and health system factors affecting groin node dissection rates in vulvar carcinoma: A population-based cohort study. Gynecol Oncol 2015; 139:465-70. [DOI: 10.1016/j.ygyno.2015.09.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/22/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022]
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Kim Y, Kim JY, Kim JY, Lee NK, Kim JH, Kim YB, Kim YS, Kim J, Kim YS, Yang DS, Kim YJ. Treatment outcomes of curative radiotherapy in patients with vulvar cancer: results of the retrospective KROG 1203 study. Radiat Oncol J 2015; 33:198-206. [PMID: 26484303 PMCID: PMC4607573 DOI: 10.3857/roj.2015.33.3.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/01/2015] [Accepted: 08/24/2015] [Indexed: 11/03/2022] Open
Abstract
PURPOSE We evaluated the prognostic factors and clinical outcomes of 56 patients with vulvar cancer treated with curative radiotherapy (RT) or concurrent chemoradiotherapy. MATERIALS AND METHODS Overall survival (OS) and disease-free survival (DFS) were assessed retrospectively. Prognostic factors evaluated included age, International Federation of Gynecology and Obstetrics (FIGO) stage, TNM classification, tumor size, treatment modality, RT duration, and RT field. The association between the tumor human papillomavirus (HPV) status and survival was analyzed in 35 patients. RESULTS During the median follow-up of 2.8 years (range, 0.3 to 18.9 years), 21 patients (37.5%) experienced treatment failure. Fifteen patients (27%) had local failure: nine (16%) local failure only, three (5%) locoregional failure, two (4%) local and distant failure, and one (2%) locoregional and distant failure. Of 56 patients, seven (13%) had persistent disease at the first follow-up at 2 months and all but one died within a year after completing RT. The 5-year OS and DFS were 51.6% and 44.0%, respectively. In multivariate analysis, clinical size ≥3 cm predicted a poor prognostic factor for DFS (p = 0.040) and age (≥70 years) was poor prognostic for DFS (p = 0.032) and OS (p = 0.048). Patients with HPV-positive tumors tended to have better 5-year OS and DFS, but the differences were not significant statistically. CONCLUSION Clinical size ≥3 cm was a significant prognostic factor for DFS. However, age was the most important prognostic factor for DFS and OS in patients treated with curative RT. Further studies are needed to determine which treatment should be considered for old age ≥70 years.
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Affiliation(s)
- Youngkyong Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Ja Young Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nam Kwon Lee
- Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Juree Kim
- Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Sik Yang
- Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Yeon-Joo Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea
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Thomason A, Capps N, Lefler L, Richard-Davis G. Factors Affecting Gynecologic and Sexual Assessment in Older Women: A Lesson for Primary Care Providers. Healthcare (Basel) 2015; 3:683-94. [PMID: 27417790 PMCID: PMC4939570 DOI: 10.3390/healthcare3030683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/19/2015] [Accepted: 08/07/2015] [Indexed: 11/17/2022] Open
Abstract
Guidelines for screening of cervical cancer and pelvic exams for older women have recently changed. These changes may have unexpected sequelae in women over 65 years of age. This manuscript provides a review of gynecologic screening recommendations for older women in the U.S. and potential ramifications of these recent changes. Peer reviewed guidelines from the American College of Obstetrics and Gynecology, U.S. Preventative Task Force Services, the American Cancer Society, The Centers for Disease Control, and multiple original research articles and reviews were reviewed for this manuscript. Women over 65 are at greatest risk to develop late stage diagnoses of cancers, pelvic organ disease, incontinence, and infections. Clinicians will need to acutely consider this fact when communicating and screening this population. We conclude that practitioners should be aware of the new guidelines and should consider including gynecologic health history and symptom analysis as part of annual exams in women of all ages.
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Affiliation(s)
- Ayasha Thomason
- College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
| | - Natalie Capps
- College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
| | - Leanne Lefler
- College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
| | - Gloria Richard-Davis
- College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 518, Little Rock, AR 72205, USA.
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Banas T, Pitynski K, Jach R, Knafel A, Ludwin A, Juszczyk G, Nieweglowska D. Primary Vulvo-Vaginal Cancers: Trends in Incidence and Mortality in Poland (1999-2012). Gynecol Obstet Invest 2015; 80:240-5. [PMID: 26065364 DOI: 10.1159/000381770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 03/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine the incidence, mortality rates and trends of vulvar and vaginal cancers in Poland. METHODS Data were retrieved from the Polish National Cancer Registry. Age-standardised rates (ASRs) of cancer incidence and mortality were calculated by direct standardisation, and joinpoint regression was performed to describe the trends using the average annual percent change (AAPC). RESULTS From 1999 to 2012, the number of diagnosed cases of vulvar cancer was 5,958, and the ASRs of incidence varied from 0.99 to 1.18, with a significant trend towards a decrease (AAPC -0.78; p < 0.05). The ASR of mortality varied from 0.39 to 0.62, with a slight but insignificant increase in trend (AAPC 0.72; p > 0.05). The ASR of vaginal cancer incidence varied from 0.21 to 0.31, while the ASR of mortality ranged from 0.09 to 0.22. This study also proved a significantly falling trend in vaginal cancer mortality (AAPC -4.69; p < 0.05) and a decreasing trend in vaginal cancer incidence (AAPC -1.67; p > 0.05). CONCLUSION The rarity of vulvar and vaginal cancers as well as the decline in their incidence rates should not discourage further research on the epidemiology and treatment of these conditions.
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Affiliation(s)
- Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
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McDuff SGR, Yashar CM. Radiation Therapy in Gynecologic Cancer. Gynecol Oncol 2015. [DOI: 10.1007/978-1-4939-1976-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Beltrão M, Wanderley MSO, de Santana NA, Bruneska D, de Lima Filho JL. Site of infections associated with human papillomavirus. Arch Gynecol Obstet 2014; 291:481-91. [PMID: 25245668 DOI: 10.1007/s00404-014-3480-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most clinically common sexually transmitted infection due to its carcinogenic power and the high number of lesions that it causes at different sites of the human body. MATERIAL AND METHODS Genital tract organs are the most common sites where the virus can be found, but by increasing the sensitivity of diagnostic technique, it is possible to identify viral presence in different regions of the body such as the stomach, the lung, and the urinary tract. These findings break with the traditional HPV skin/genital tropic profile and demonstrate that the virus is capable of infecting a wide variety of cells, tissues, and organs or can, at least, survive in these areas. The widespread presence of the HPV in the human body, often in latent form, led us to consider the hypothesis that HPV latency may be associated with no disease. CONCLUSION This observation raises further questions about the possibility of the virus not causing disease in specific sites of the human body, but rather, behaving like a commensal/opportunistic microorganism.
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Affiliation(s)
- Monique Beltrão
- Laboratory of Imunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235 Cidade Universitária, Recife, PE, CEP 50670-901, Brazil,
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Rauh-Hain JA, Clemmer J, Clark RM, Bradford LS, Growdon WB, Goodman A, Boruta DM, Dizon DS, Schorge JO, del Carmen MG. Management and outcomes for elderly women with vulvar cancer over time. BJOG 2014; 121:719-27; discussion 727. [DOI: 10.1111/1471-0528.12580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- JA Rauh-Hain
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - J Clemmer
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - RM Clark
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - LS Bradford
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - WB Growdon
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - A Goodman
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - DM Boruta
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - DS Dizon
- Department of Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - JO Schorge
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
| | - MG del Carmen
- Division of Gynecologic Oncology; Vincent Obstetrics and Gynecology; Boston MA USA
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EGFR expression in vulvar cancer: clinical implications and tumor heterogeneity. Hum Pathol 2014; 45:917-25. [PMID: 24746196 DOI: 10.1016/j.humpath.2014.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 11/23/2022]
Abstract
Epidermal growth factor receptor (EGFR) protein expression was assessed by immunohistochemistry (IHC) in 150 cases of invasive vulvar squamous cell carcinoma. In addition, gene copy number status by fluorescence in situ hybridization was performed in a smaller set of samples. Results were correlated with patient's clinical data and prognostic factors. EGFR overexpression (2+ and 3+) was observed on the membrane in 24.66% and 21.33% of all cases, respectively. Higher EGFR expression was associated with depth of invasion (P = .0409) and disease recurrence (P = .0401). Cytoplasm staining was found in 21.33% of the cases and was associated with absence of nodal metastasis (P = .0061) and better survival (P = .0199). Intratumor heterogeneity of EGFR IHC staining was frequently observed (55.33%) and was associated with the presence of nodal metastasis (P = .0207) and tumor invasion (P = .0161). Worse survival outcomes have been demonstrated in tumors with EGFR heterogeneity (P = .0434). EGFR gene status evaluated by fluorescence in situ hybridization did not correlate with protein expression evaluated by IHC. In conclusion, EGFR cytoplasm staining has no link with poorer outcome; still, this pattern of staining is even more related to better prognosis. EGFR heterogeneity of staining correlated with more aggressive tumors, and presented to be an important marker of poor prognosis in vulvar squamous cell carcinoma. The usage of small biopsies or even tissue microarrays for vulvar cancer evaluation should be carefully reconsidered for the assessment of EGFR as the results may be misleading. Protein overexpression may be independent on gene amplification, showing that other molecular mechanisms than copy number variation may regulate protein expression of EGFR in vulvar cancer.
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