Vulvar Cancer Research Articles

Introduction: Vulvar malignancy is a rare gynaecological malignancy and understanding the determinants of vulvar cancer outcomes is essential for improving patient care and guiding future research in this field. The management of vulvar malignancy ranges from wide local excision to radical vulvectomy for early-stage and advanced disease managed by external beam radiotherapy with concurrent chemotherapy. Aim: To determine the Overall Survival (OS) and Disease-Free Survival (DFS) among patients with vulvar cancer. Materials and Methods: This was a retrospective cohort study of patients with vulvar malignancy who underwent treatment over a 10-year period (from January 2011 to December 2020) at a tertiary cancer centre in South India, Department of Gynaec Oncology, Malabar Cancer Centre (Postgraduate Institute of Oncology Sciences and Research), Thalassery, Kerala, India. Details such as age, Performance Status (PS), tumour histology, stage, intent of treatment, type of treatment and recurrence were collected from case records. The Kaplan-Meier test was used to estimate OS and DFS. Results: A total of 29 patients were analysed; the mean age was 67.03 years (ranging from 48 to 93 years). A total of 3 (10.34%) patients were premenopausal and 26 (89.66%) were postmenopausal. A total of 24 (82.8%) cases were squamous cell carcinoma and 3 (10.34%) were adenocarcinoma. A total of 12 (41.4%) patients received curative intent treatment, 13 (44.8%) received palliative intent treatment and 4 (13.79%) received best supportive care. The five-year OS was 28% for all stages, with a median OS of 23.16 months. The five-year OS for curative intent patients was 50%, while for palliative intent patients, it was 15.4%. Out of the nine cases that underwent surgery, 1 (11.1%) had local recurrence, 1 (11.1%) had regional nodal recurrence and one had a distant site recurrence. The estimated five-year DFS was 63.5%. Conclusion: The present study highlights that early-stage diagnosis and curative intent treatment significantly improve survival outcomes in vulvar cancer. Patients treated with curative intent had a five-year OS of 50% and a DFS of 63.5%, compared to a 15.4% OS in palliative cases. Advanced stage at presentation and older age were associated with poorer prognosis. These findings underscore the need for early detection and individualised, multimodal treatment strategies to optimise outcomes.

Distinct Patterns of GLUT1 Expression in Human Papillomavirus Associated and Human Papillomavirus Independent Vulvar Intraepithelial Neoplasia and Squamous Cell Carcinoma.

Cyclin D1 Overexpression Predicts Poor Disease-Specific Survival in Human Papillomavirus-Independent Vulvar Squamous Cell Carcinoma.

Robotic Assisted Inguinal Sentinel Lymph Node Sampling for Treatment of Early Stage Vulvar Cancer.

To provide information including the trend of gynecological malignancies in Japan, we hereby present the Annual Patient Report for 2022 and the Annual Treatment Report for 2017, on the outcomes of patients who started treatment in 2017. The Japan Society of Obstetrics and Gynecology maintains an annual tumor registry, where information on gynecological malignancies from various participating institutions is gathered. The data of patients whose treatment with gynecologic malignancies was initiated in 2022 were analyzed retrospectively. Survival of the patients who started treatment with cervical, endometrial, and ovarian cancer in 2017 was analyzed by using the Kaplan-Meier, log-rank, and Wilcoxson tests. Treatment was initiated in 2022 for 8039 patients with cervical cancer, 14 518 with endometrial cancer, 8524 with ovarian, tubal, and peritoneal cancer, 2360 with ovarian borderline tumors, and with the others (270 vulvar cancer, 179 vaginal cancer, 539 uterine sarcoma, 48 uterine adenosarcoma, 158 trophoblastic diseases). This clinicopathological information was summarized as the Patient Annual Report. The 5-year survival rates of the patients who initiated treatment in 2017 were as follows. For cervical cancer, the rates were 93.0%, 76.1%, 59.5%, and 28.3% for Stages I, II, III, and IV, respectively. For endometrial cancer, the rates were 94.9%, 88.8%, 72.7%, and 28.9% for Stages I, II, III, and IV, respectively. For ovarian cancer, the rates were 91.7%, 76.6%, 54.4%, and 45.2% for Stages I, II, III, and IV, respectively. The annual tumor report is an important survey that provides knowledge on gynecological malignancy trends in Japan.

Raising Awareness of Lichen Sclerosus

IntroductionElectrothermal bipolar vessel sealing devices (EBVS) and ultrasonic devices (US) – collectively known as advanced hemostasis devices (AHDs) – are considered equally feasible in laparoscopic procedures. However, US devices have been demonstrated to be more susceptible to abnormal heat accumulation when activation cycles are rapidly repeated, causing results from laparoscopic procedures to be poorly translated to vulvar cancer surgery. In this study, we aimed to determine whether EBVS and US are comparable in terms of peri- and postoperative morbidity in vulvar cancer surgery.MethodsThis retrospective single-center study comprised patients who underwent a primary vulvectomy, partial vulvectomy, or radical local resection with an AHD in Tampere University Hospital, Finland, in 2011–2023. Our primary outcome measure was the Clavien-Dindo grade, which measures the incidence and severity of postoperative complications in the early (30-day) postoperative period. Secondary outcome measures were blood loss, postoperative blood transfusions, operative time, the total volume of groin drain output, and length of hospital stay.ResultsEighty-six patients were included (EBVS n = 45, US n = 41). Postoperative complications (Clavien-Dindo grades II – V) were significantly less common in the EBVS group compared to the US group (60% vs 85% in the EBVS and US groups, respectively; p = 0.015). The difference was driven by a discrepancy in grade II complications (49% vs 71%), which consisted primarily of infections in both groups. In a multivariable regression analysis adjusting for the extent of surgery, the use of an EBVS device was independently associated with a lower likelihood of postoperative complications compared to US (aOR 0.3, 95%CI 0.1–0.9 for EBVS vs US; p = 0.030). Both the amount of operative blood loss (median (IQR) 50 (45–200) ml vs 150 (88–400) ml; p = 0.005) and length of hospital stay (median (interquartile range) 6 (4–8) vs. 8 (6–10) days; p = 0.002) were lower in the EBVS group, but surgical device did not independently predict the highest quartile of either variable. The amount of postoperative blood transfusions, operative time, or groin drain output did not significantly differ between the groups.ConclusionsThe data from this study suggests electrothermal bipolar vessel sealing devices could reduce early postoperative complications, especially those related to the surgical site, in vulvar cancer surgery compared to ultrasonic devices. Prospective studies are needed to ensure the generalizability of the results.

Image-guided surgical navigation for inguinal sentinel lymph node procedures in vulvar cancer.

A laparoscopic approach has been incorporated into the surgical management of a great variety of gynecologic pathologies during the decades following the first description of the method. As knowledge and experience about the use of laparoscopy is accumulating, it is gradually being recognized as an oncologically safe and effective option for the surgical management of various types of gynecological cancer, and the indications for its applications are increasing, as controversial topics are resolved through research. Endometrial cancer is the gynecological malignancy with the most straightforward indications of laparoscopy in its treatment, since a minimally invasive approach is considered the standard of care for both the surgical treatment of early-stage disease and surgical staging through sentinel lymph node biopsy. The role of laparoscopy was significantly decreased in the surgical management of cervical cancer after the publication of the LACC trial which reported worse survival outcomes for patients treated with laparoscopy, and laparotomy has emerged as the preferred approach. However, laparoscopy can be acceptable for carefully selected cases of early-stage cervical cancer and has also been introduced as an effective method for the surgical staging of the disease. The use of laparoscopy in the diagnostic and therapeutic management of ovarian cancer is not fully established but is receiving growing attention, as increasing evidence supports the safety of this approach, especially in the treatment of early-stage disease, where it is considered an acceptable alternative approach to laparotomy. Finally, as laparoscopic advancements are continuously achieved, new indications for laparoscopy have been explored for both vulvar and breast cancer. Future research will identify and highlight new ways to further integrate laparoscopy into the diagnostic and therapeutic management of gynecological malignancies.

Scleroatrophic lichen (SAL) is a chronic inflammatory disease of the skin and mucous membranes of unknown etiology. The pathogenesis of SAL is very complex and has not been sufficiently studied to date. The most likely theory is that the disease is autoimmune due to a genetic predisposition. Changes in the vulva, characteristic of SAL, are often an accidental finding due to an asymptomatic course in the initial phase of the disease. Nevertheless, timeous diagnosis of the disease by biopsy is important, as it is often associated with high risks of intraepithelial neoplasia or vulvar cancer. Clinical manifestations of SAL significantly reduce the quality of life of women, therefore, known treatment methods are primarily aimed at reducing them. However, most of the treatment methods used do not have the proper effectiveness, long-term effect, and do not restrain the progressive atrophy and fibrosis of vulvar tissues. The methods of personalized and cellular therapy proposed and considered in the review have not been sufficiently studied from the standpoint of long-term results of treatment of SAL. Heterogeneous collagen-containing compositions of SpheroGEL in various forms of execution, according to the results of numerous conducted in vitro, in vivo and randomized clinical trials, make it possible to carry out regenerative therapy of sebum, significantly reduce the severity of its symptoms and improve the aesthetic perception of patients’ own vulva.

BackgroundFemale-specific cancers (FSCs) impose substantial burdens on healthcare systems and economies worldwide. The significant impact of these cancers in the United States warrants further investigation.ObjectiveThis study aimed to analyze trends in incidence and mortality rates of six female-specific cancers (breast, cervical, uterine, ovarian, vaginal, and vulvar cancers) among diverse racial and ethnic groups in the United States, and to evaluate the attributable contributions of major risk factors to the cancer death burden as well as their temporal changes.MethodsIncidence and mortality data were obtained from the SEER (22 registry) database, to examine cross-sectional and temporal trends by race/ethnicity. The burden of FSCs attributable to specific risk factors was estimated based on the Global Burden of Disease 2021 database.ResultsBetween 2017 and 2021, Breast cancer incidence increased across all racial groups, most notably among non-Hispanic White (White) women, while mortality declined. Cervical cancer incidence decreased in most groups but remained stable among American Indians and Alaska Native (AIAN) women. Uterine cancer incidence increased across all racial groups, except for Whites. Incidence and mortality rates for ovarian and vaginal cancers remained stable or decreased, whereas vulvar cancer mortality was highest among White and AIAN women and lowest among non-Hispanic Asian Americans and Pacific Islander (AAPI) women. From 2000 to 2021, risk-attributable deaths decreased for breast, cervical, and ovarian cancers but increased for uterine cancer.ConclusionsSignificant sociodemographic disparities and unfavorable trends persist in the incidence and mortality of all six major female-specific cancers, highlighting the importance for effective prevention and intervention strategies.

Female-specific cancers (FSCs) impose substantial burdens on healthcare systems and economies worldwide. The significant impact of these cancers in the United States warrants further investigation. This study aimed to analyze trends in incidence and mortality rates of six female-specific cancers (breast, cervical, uterine, ovarian, vaginal, and vulvar cancers) among diverse racial and ethnic groups in the United States, and to evaluate the attributable contributions of major risk factors to the cancer death burden as well as their temporal changes. Incidence and mortality data were obtained from the SEER (22 registry) database, to examine cross-sectional and temporal trends by race/ethnicity. The burden of FSCs attributable to specific risk factors was estimated based on the Global Burden of Disease 2021 database. Between 2017 and 2021, Breast cancer incidence increased across all racial groups, most notably among non-Hispanic White (White) women, while mortality declined. Cervical cancer incidence decreased in most groups but remained stable among American Indians and Alaska Native (AIAN) women. Uterine cancer incidence increased across all racial groups, except for Whites. Incidence and mortality rates for ovarian and vaginal cancers remained stable or decreased, whereas vulvar cancer mortality was highest among White and AIAN women and lowest among non-Hispanic Asian Americans and Pacific Islander (AAPI) women. From 2000 to 2021, risk-attributable deaths decreased for breast, cervical, and ovarian cancers but increased for uterine cancer. Significant sociodemographic disparities and unfavorable trends persist in the incidence and mortality of all six major female-specific cancers, highlighting the importance for effective prevention and intervention strategies.

Abstract Human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection worldwide, with high-risk types causing cervical, anal, vulvar, vaginal, penile, and oropharyngeal cancers. In Armenia, cervical cancer is a significant public health issue. In 2024, a woman was diagnosed with cervical cancer every two days and a death occurred every three days. Most cervical cancer cases are preventable through HPV vaccination. However, Armenia has faced challenges with HPV vaccination uptake, partly due to misinformation and vaccine hesitancy among both the public and healthcare workers. In 2022, the World Health Organization (WHO) Regional Office for Europe, the WHO Country Office in Armenia, and Armenia’s Ministry of Health launched an initiative to increase HPV vaccination coverage by training healthcare workers using multidisciplinary medical experts. Consequently, vaccination rates rose dramatically, from 11% first- and complete-dose (two doses) coverage in 2021 to 45% first-dose and 27% complete-dose (two doses) coverage in 2023.

The aim of the study was to evaluate if a teaching session and optional reminders improved frequency of performance of vulvar self-examination (VSE) in a population at increased risk of vulvar cancer. Participants were recruited from Colposcopy and Vulvar Dermatology clinics at a publicly funded academic hospital in Ontario, Canada. Participants completed a questionnaire, were taught how to perform a VSE, and given an information booklet. They had the option to receive phone or electronic health record reminders to complete a VSE over the course of the next 6 weeks. After 6 weeks, participants were contacted to survey their VSE behaviors. Data were analyzed using descriptive statistics. Two hundred nineteen participants completed the study. Prior to the study, 28 participants (13%) had heard of VSE, while 31 (14%) had never looked at their external genitalia before. At a 6-week follow-up, 181 out of 219 participants (83%) completed a VSE, compared to 16% who regularly performed VSEs prior to the intervention (p < .001). There was a statistically significant improvement in self-reported ability to find the labia minora, labia majora and urethra after the intervention. Despite low baseline levels of familiarity with VSE, a simple teaching session, with or without reminders was associated with high performance of VSE in a population at increased risk of vulvar cancer.

Background: Human papillomavirus (HPV) is a major etiological agent in cervical cancer and is increasingly recognized as a driver of other anogenital and head and neck squamous cell carcinomas (HNSCCs). The oncogenic potential of HPV is primarily mediated by high-risk genotypes such as HPV16, HPV18, HPV31, and HPV45, whose E6 and E7 oncoproteins disrupt p53 and retinoblastoma pathways. While the burden of HPV-associated cervical cancer is well documented, data on the prevalence and genotype distribution of HPV in oral, oropharyngeal, vulvar, and vaginal cancers in India remain limited. Objective: To identify the disease burden and determine the prevalence and genotype distribution of high-risk HPV (16, 18, 31, 45) in biopsy-proven squamous cell carcinomas of the cervix, oral cavity, oropharynx, vulva, and vagina. Methods: We conducted a retrospective analysis of 131 patients with squamous cell carcinomas diagnosed between September 2022 and August 2024 at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India. PCR-based HPV detection was employed to determine the presence of high-risk HPV types 16, 18, 31, and 45 targeting the E6/E7 regions of high-risk HPV. Clinical and pathological data, including tumor stage and demographic variables, were analyzed. Results: Overall HPV prevalence was 90.1%. Site-specific positivity was highest in cervical cancers (95.8%) and vulvovaginal cancers (100%), followed by oral (84.2%) and oropharyngeal (66.7%) cancers. HPV16 and HPV31 were the dominant genotypes across all tumor sites, whereas HPV18 and HPV45 were detected at lower frequencies. Cervical cancer cases predominantly presented in advanced stages (FIGO IIB–IIIB), while vulvovaginal cancers were diagnosed at earlier stages. Conclusion: HPV infection, particularly with HPV16/31, is highly prevalent in multiple anogenital and head and neck squamous cell carcinomas in this Indian cohort. These findings reinforce the importance of HPV vaccination programs, highlight the need for comprehensive HPV screening strategies, and suggest that P16 immunohistochemistry (IHC) should be integrated with PCR-based detection to establish oncogenic causality.

Clinical outcome of high-dose-rate interstitial brachytherapy in vulvar cancer: A single institutional experience.

With the rising incidence of life expectancy, obesity, and tumours, understanding the incretory influence of adipose tissue in tumorigenesis becomes increasingly important. As the adipokines leptin and adiponectin are released by fat tissue, we aimed to analyse the expression of their respective receptors in tumours for which an association with obesity is epidemiologically hypothesised. The expression of leptinR and adipoR1 were analysed in cohorts of renal cell cancer (n=391), cervical cancer (n=155), vulvar cancer (n=107), and endometrial cancer (n=90) by immunohistochemistry and correlated with clinicopathological parameters including survival times. Expression of leptinR was high in renal cell cancer (62.2%), vulvar carcinoma (50%), and endometrial cancer (80.5%). High expression was associated with favourable clinicopathological markers and longer overall survival times in renal cell and vulvar cancer. AdipoR1 was only weakly expressed in all four tumour entities and did not show significant associations with clinicopathological parameters or prognosis. High leptinR is a promising biomarker of favourable tumour outcomes in renal cell carcinoma and vulvar carcinoma.

Impact of disease stage, treatment timing, and demographic disparities on survival in vulvar squamous cell carcinoma: Insights from a Surveillance, Epidemiology, and End Results-based analysis.

To explore women's experiences with follow-up care after gynaecological cancer during the Covid-19 pandemic and identify key elements of aftercare from their perspective. A qualitative study was performed, including five focus group discussions and two individual interviews with 20 participants diagnosed with ovarian (n = 5), cervical (n = 6), endometrial (n = 5) or vulvar cancer (n = 4) who received follow-up care during the Covid-19 pandemic in the Netherlands. Transcripts underwent thematic analysis, guided by the framework of the Picker Principles of Patient-Centred Care. Five themes were generated: (1) continuity of care, (2) absence of family members and carers, (3) meeting my needs, (4) managing my needs and (5) the cancer survivor narrative. The main changes experienced during the Covid-19 pandemic were the introduction to remote healthcare and the absence of family members. An interconnection between themes was found, highlighting that providing a designated, always accessible contact person can be a catalyst for the improvement ofinformation provision and healthcare guidance. In conclusion, this study highlights the need for personalised and patient-centred follow-up that promotes patient empowerment, and how this can be provided by a designated contact person. Findings emphasise the importance of tailored support, involvement of family members, addressing information gaps, and overcoming barriers to self-management. Lastly, the findings provide direction on how to approach follow-up care in the future. This study was done in close collaboration with the patient advocacy group Olijf; their significant input in both the design and conduct of the study is invaluable. Olijf's involvement ensured that the research remained patient-centred and aligned with the real-life concerns and priorities of those affected by gynaecological cancers. The participants in this study, all of whom are gynaecological cancer survivors, played an important role by sharing their experiences, and we extend our gratitude to them. Their insights were critical in shaping the findings of this research.

In recent years, the application of artificial intelligence (AI) in medical image analysis has drawn increasing attention in clinical studies of gynecologic tumors. This study presents the development and prospects of AI applications to assist in the treatment of gynecological oncology. The Web of Science database was screened for articles published until August 2023. "artificial intelligence," "deep learning," "machine learning," "radiomics," "radiotherapy," "chemoradiotherapy," "neoadjuvant therapy," "immunotherapy," "gynecological malignancy," "cervical carcinoma," "cervical cancer," "ovarian cancer," "endometrial cancer," "vulvar cancer," "Vaginal cancer" were used as keywords. Research articles related to AI-assisted treatment of gynecological cancers were included. A total of 317 articles were retrieved based on the search strategy, and 133 were selected by applying the inclusion and exclusion criteria, including 114 on cervical cancer, 10 on endometrial cancer, and 9 on ovarian cancer. Among the included studies, 44 (33%) focused on prognosis prediction, 24 (18%) on treatment response prediction, 13 (10%) on adverse event prediction, five (4%) on dose distribution prediction, and 47 (35%) on target volume delineation. Target volume delineation and dose prediction were performed using deep Learning methods. For the prediction of treatment response, prognosis, and adverse events, 57 studies (70%) used conventional radiomics methods, 13 (16%) used deep Learning methods, 8 (10%) used spatial-related unconventional radiomics methods, and 3 (4%) used temporal-related unconventional radiomics methods. In cervical and endometrial cancers, target prediction mostly included treatment response, overall survival, recurrence, toxicity undergoing radiotherapy, lymph node metastasis, and dose distribution. For ovarian cancer, the target prediction included platinum sensitivity and postoperative complications. The majority of the studies were single-center, retrospective, and small-scale; 101 studies (76%) had single-center data, 125 studies (94%) were retrospective, and 127 studies (95%) included Less than 500 cases. The application of AI in assisting treatment in gynecological oncology remains limited. Although the results of AI in predicting the response, prognosis, adverse events, and dose distribution in gynecological oncology are superior, it is evident that there is no validation of substantial data from multiple centers for these tasks.