Squamous Cell Vulvar Cancer Research Articles

Treatment of squamous cell vulvar cancer with the anti-EGFR tyrosine kinase inhibitor Tarceva

Background. The purpose of this case report is to describe the first experience with erlotinib (Tarceva) in the treatment of locally advanced vulvar cancer. Case. Two elderly patients presented with locally advanced vulvar cancer. Surgery was not a suitable method of treatment for either of them because of multiple medical co-morbidities and stage of disease. One patient had disease progression on standard chemoradiation. Erlotinib, an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, was tried in both cases and dramatic responses were observed. Conclusion. Therapy targeted to EGFR may be effective in the treatment of locally advanced vulvar cancer. This new therapeutic approach deserves further evaluation in carefully designed studies.

C-reactive protein serum levels are closely associated with lymph node status, but not with prognosis in patients with vulvar cancer

Objective To evaluate whether C-reactive protein (CRP) serum levels can be used as prognostic parameter in patients with vulvar cancer. Study design CRP serum levels were measured at the time of first diagnosis of squamous cell vulvar cancer. Sixty-seven patients were enrolled; results were correlated to clinical data. Results Mean CRP serum levels in patients with vulvar cancer were 0.8 (0.80) mg/dL. CRP serum levels were significantly associated with lymph node involvement ( p = 0.003), but not with tumor stage ( p = 0.03), histological grade ( p = 0.86) and patients’ age ( p = 0.64). Univariate analysis showed lymph node involvement, tumor stage and histological grade, but not CRP serum levels and patients’ age to be associated with overall survival. A multivariable analysis determined only lymph node involvement as independent prognostic parameter for disease-free interval and overall survival. Conclusion CRP serum levels are closely associated with lymph node status but cannot be used as prognostic parameter in patients with vulvar cancer.

Tumor Lysis Syndrome Associated With Reduced Immunosuppression in a Lung Transplant Recipient

Tumor lysis syndrome usually occurs after Initiation of chemotherapy or radiation therapy in cancer patients with a moderate to high tumor burden. To our knowledge, the occurrence of this syndrome after discontinuation or reduction of an immunosuppressive regimen has not been reported in the literature. We describe a patient who had undergone lung transplantation and who was receiving immunosuppression and experienced an episode of acute pancreatitis. During the course of the work-up, the patient was found to have a B-cell lymphoma (posttransplantation lymphoproliferative disease). His tacrolimus dosage was decreased, and azathioprine was discontinued. The patient subsequently developed tumor lysis syndrome. Other than the decrease in immunosuppression, we found no other factor that could have accounted for this syndrome.

O.389 Cervical lymph nodes in patients with malignant head/neck tumours – Comparison of ultrasound and CT

To evaluate the reliability of sentinel node assay in early stage vulvar cancer patients by using preoperative lymphoscintigraphy.Technetium-99m colloid albumin was injected intradermally around the tumor for lymphoscintigraphic mapping and intraoperative hand-held gamma probe detection of sentinel nodes. For all patients, sentinel node biopsy was followed by inguinofemoral lymphadenectomy, regardless of the sentinel lymph node status.From December 2008 until May 2011, 25 consecutive patients with T1 or T2 stage of vulvar squamous cell cancer were enrolled. The median age of patients was 69 years (range, 48–79). The detection of sentinel lymph node was successful in all 25 patients. A total of 36 sentinel lymph nodes were harvested and metastatic carcinoma was identified in 12 sentinel nodes from 8 patients. There was 1 patient with metastatic non-sentinel lymph node despite the negative sentinel node. Two patients with negative sentinel nodes proven by routine histopathological examination were positive by immunohistochemical staining. The sensitivity, specificity and negative predictive value of sentinel node assay with immunohistochemistry included were 89%, 100%, and 94%, respectively.Lymphoscintigraphy and sentinel lymph node biopsy under gamma-detecting probe guidance proved to be an easy and reliable method for the detection of sentinel node in early vulvar cancer. Immunohistochemical analysis improves the sensitivity for the detection of regional micrometastases. The sentinel node assay is highly accurate in predicting the status of the remaining inguinofemoral lymph nodes. Our results indicate that patients best suited to SLN assay have had a simple punch biopsy to confirm the diagnosis rather than a previous tumor excision. This technique represents a true advance in the selection of patients for less radical surgery.

Management of Squamous Cell Cancer of the Vulva

ObjectivesTo review and make recommendations regarding the management of early and advanced squamous cell cancer of the vulva. OptionsRadical vulvectomy and groin dissection or more conservative surgery in early squamous cell vulvar cancer; chemotherapy and radiation followed by consideration of surgery in advanced disease. OutcomesRisk of inguinal lymph node metastases, risk of tumour recurrence, patient morbidity, patient survival. EvidenceFollows the quality of evidence assessment of the Canadian Task Force on the Periodic Health Examination (Table 1). Recommendations1.Stage IA lesions (≤ 2cm diameter and≤1mm stromal invasion) can be managed by radical local tumour excision without inguinofemoral node dissection. (II-2B)2.Stage IB unilateral lesion (≤ 2cm diameter, > 1mm stromal invasion and ≥ 1cm from the midline) is treated by radical wide local excision completed by an ipsilateral inguinofemoral node dissection; a central lesion (within 1cm from the midline) requires bilateral inguinofemoral node dissection. (II-2B)3.Patients with either three or more micrometastases in the groin with node size>10mm, with extracapsular spread, or with bilateral microscopic groin metastases should receive postoperative bilateral groin and pelvic radiation. (II-2B)4.Advanced cancer of the vulva should be treated with primary radiation and concomitant chemotherapy, followed by consideration of surgical resection. (II-2B)

Management of vulvar cancers

Aim The radical surgical approach in the treatment of vulvar cancer patients has led to a favorable prognosis for the majority of the patients with early stage squamous cell cancer. However, the morbidity is impressive, leading to more individualized treatment. The aim of this review is to give an overview of the management of vulvar cancer. Methods We have reviewed the literature on the modifications in treatment of vulvar cancer with the emphasis on surgery and radiotherapy for primary disease. Results While surgery is the cornerstone of treatment for early stage squamous cell vulvar cancer (with wide local excision and uni- or bilateral inguinofemoral lymphadenectomy via separate incisions as standard treatment), until now there has been a limited role for primary radiotherapy although this may be an attractive alternative for the inguinofemoral lymphadenectomy in the future. The sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with 99mtechnetium-labeled nanocolloid and Patente Blue) is a promising staging technique for patients with vulvar cancer. The clinical implementation of the sentinel lymph node procedure and the role of additional histopathological techniques of the sentinel lymph nodes have to be investigated. In advanced vulvar cancer, chemoradiation followed by surgery should be regarded as the treatment of first choice for these patients. Conclusions Due to the rarity of vulvar cancer it is quite clear that further studies will have to be performed by international collaborative groups. The sentinel lymph node procedure and primary radiotherapy are promising methods to reduce morbidity of treatment, but their safety needs to be studied in clinical trials.

A Common Interleukin-6 Promoter Polymorphism in Patients With Vulvar Cancer

Besides its important role in immune response and inflammatory processes the cytokine interleukin-6 (IL-6) is crucially involved in carcinogenesis. A common polymorphism within the gene encoding IL-6 (IL6) is known to alter IL-6 protein expression and has been associated with patients' prognosis in various malignancies. No data are available with respect to vulvar cancer. Therefore, we determined the prognostic potential of the common -174(G-->C) single nucleotide polymorphism in the promoter region of IL6 in a series of patients with this disease. The IL6 promoter polymorphism was investigated in 81 Caucasian patients with surgically treated squamous cell vulvar cancer using pyrosequencing. Results were correlated with clinical data. No association was ascertained between the IL6 promoter polymorphism and the investigated clinicopathologic parameters, ie, tumor stage, lymph node involvement, tumor grade, and patient's age at diagnosis. In an univariate analysis, lymph node involvement and patients' age at diagnosis were associated with patient prognosis. In a multivariate analysis, including tumor stage and lymph node involvement as established prognostic factors and the IL6 promoter polymorphism, lymph node involvement, and the presence of at least one mutant allele, but not tumor stage, were associated with increased disease-free and overall survival. Our data suggest that the IL6 -174(G-->C) promoter polymorphism might serve as an additional prognostic parameter in patients with vulvar cancer.

Squamous cell carcinoma antigen serum levels as prognostic parameter in patients with early stage vulvar cancer

Objective. To determine whether SCC-Ag serum levels can be used as a prognostic parameter in surgically treated early stage vulvar cancer. Methods. SCC-Ag serum levels were measured preoperatively in 61 surgically staged patients with squamous cell vulvar cancer (UICC pT1 and pT2). Results were correlated to clinical data. Results. Mean (standard deviation) SCC-Ag serum levels in patients with vulvar cancer were 1.5 (1.99) ng/mL. SCC-Ag serum levels were significantly higher in patients with pT2 vulvar cancer (2.2 [2.6] ng/mL) compared with patients with pT1 vulvar cancer (1.0 [1.2] ng/mL, P = 0.034). SCC-Ag serum levels were not associated with lymph node involvement ( P = 0.1), tumor grade ( P = 0.6), and patients' age ( P = 0.5). Multivariate Cox regression models considering tumor stage, lymph node involvement, patients' age, and SCC-Ag serum levels as covariates showed that lymph node involvement ( P = 0.04 and P = 0.01) and tumor stage ( P = 0.006 and P = 0.009), but not SCC-Ag serum levels ( P = 0.8 and P = 0.6), and patients' age ( P = 0.08 and P = 0.22) are prognostic factors for disease-free and overall survival, respectively. Conclusion. SCC-Ag serum levels cannot be used as an additional prognostic parameter in patients with surgically treated early stage vulvar cancer.

Clinically Identifying Women With Vulvar Lichen Sclerosus at Increased Risk of Squamous Cell Carcinoma

This retrospective case review was undertaken to identify the women with lichen sclerosus who are at greatest risk for developing squamous cell carcinoma. Between 1992 and 2000, 46 women with squamous cell carcinoma of the vulva associated with lichen sclerosus were treated at the authors' institution. Controls were 213 women with lichen sclerosus only who were treated during the same time period. Women with squamous cell vulvar cancer were a median 75 years of age (87% over 60 years) and control subjects were a median 63 years of age (58% over age 60) (P = 0.0001). Ninety-three percent of women with vulvar cancer and 80% of control subjects reported having pruritus, irritation, and soreness for 3 years. Nearly half of the patients had used or were using topical steroid treatment. Hyperplastic skin changes were significantly more common in patients with squamous cell vulvar carcinoma than in women with lichen sclerosus alone (P = 0.02). There was no difference between the 2 groups in the condition of the labia minora or clitoris. Twenty-two percent of the women with squamous cell carcinoma of the vulva had squamous hyperplasia and 67% had cellular atypical. In comparison, 8% and 5% of control subjects had these changes. One patient in the control group developed vulvar cancer. She was among the patients who had squamous hyperplasia and cellular atypical. After logistic regression analysis of possible risk factors for squamous cell carcinoma of the vulva in patients with lichen sclerosus, clinical squamous hyperplasia was the only variable that was predictive of vulvar squamous cell cancer.

A polymorphism of the interleukin-1 receptor antagonist plays a prominent role within the interleukin-1 gene cluster in vulvar carcinogenesis

Objective. The interleukin-1 (IL-1) family, that is, IL-1α and β and the IL-1 receptor antagonist (IL-1RA), is known to modulate various tumorgenic and tumorcidal effects in humans. Its biological function in squamous cell carcinogenesis of various anatomical sites has been stressed. Although various studies showed a certain association between genes encoding the IL-1 family and human malignancies, no data with respect to vulvar cancer have been published to date. Methods. We ascertained four polymorphisms of the IL-1α gene ( IL1A C[−889]T), the IL-1β gene ( IL1B promoter C[-511]T and IL1B exon 5 position +3953), and the IL-1RA gene ( IL1RN intron 2) in 68 patients with surgically treated squamous cell vulvar cancer and 228 healthy Caucasian controls. Results. Presence of the minor allele of the IL1RN polymorphism was found to be protective for vulvar cancer [odds ratio (OR) = 0.5, P = 0.03], the other investigated polymorphisms showed no association with the disease and the investigated clinicopathological parameters. In a multivariate analysis, only the established prognosticators were associated with patients' survival. Conclusion. We are the first to report on polymorphisms in genes encoding cytokines in patients with vulvar cancer. Reflecting its biological role, the common IL1RN intron 2 polymorphism seems to play a prominent role within the IL-1 gene cluster with respect to vulvar carcinogenesis.

Metalloelastase (MMP-12) expression by tumour cells in squamous cell carcinoma of the vulva correlates with invasiveness, while that by macrophages predicts better outcome.

Human metalloelastase (MMP-12) has been implicated in elastin degradation and macrophage migration in many pathological conditions. It also generates angiostatin, thus having a potential to prevent tumour angiogenesis. It has previously been shown that transformed epithelial cells express MMP-12 in skin cancer. The aim of this study was further to elucidate the role of metalloelastase in squamous cell cancer (SCC) progression. By in situ hybridization, expression of MMP-12 mRNA was detected in 28/33 vulvar SCC samples in CD-68-positive macrophages, while 10 samples had positive cancer cells. By immunohistochemistry, MMP-12 protein was seen in the same area as the mRNA. MMP-12 mRNA expression in tumour cells correlated with more aggressive histology (p = 0.0099). In contrast, macrophage-derived MMP-12 mRNA was more abundant in well-differentiated grade I than grade III tumours (p = 0.01). However, the level of MMP-12 mRNA, regardless of its origin, did not correlate with metastasis or patient survival. No significant correlation was found between macrophage-derived MMP-12 mRNA and a low amount of blood vessels, as quantitated after von Willebrand staining. In agreement with vulvar SCCs in vivo, MMP-12 was expressed in cultured SCC cells by northern and western blot analysis. In HaCaTs and epithelial MCF-10f cells, MMP-12 mRNA was induced by transforming growth factor-beta1 (TGF-beta1) and tumour necrosis factor-alpha (TNF-alpha) as measured by quantitative RT-PCR (TaqMan). Two MMPs capable of generating angiostatin in vivo, matrilysin (MMP-7) and gelatinase B (MMP-9), were also examined in these tumours. MMP-7 mRNA was mainly expressed by epithelial tumour cells, particularly in less differentiated tumours. MMP-9 was usually expressed by neutrophils and macrophages; epithelial protein was predominantly found in grade II/III tumours. These results suggest a dual role for MMP-12 in tumour progression.

Intraoperative Lymphatic Mapping and Sentinel Node Identification With Blue Dye in Patients With Vulvar Cancer

Levenback, Charles; Coleman, Robert L.; Burke, Thomas W.; Bodurka-Bevers, Diane; Wolf, Judith K.; Gershenson, David M.

Squamous Vulvar Cancer: A Clinically Based Individualization of Treatment

Objective. The aim of the study was to evaluate treatment results in 211 patients with previously untreated squamous cell vulvar cancer who were primary managed by surgery at the Gynecologic Oncology Unit of Alexandra Hospital, in terms of en bloc radical vulvectomy (N = 105), modified radical vulvectomy with three different incisions technique (N = 60), and radical hemivulvectomy (N = 46) with inguinofemoral lymphadenectomy.Methods. The surgical stage of disease, nodal status, lesion location and focality, marginal status, tumor size, physical and performance status, surgical modality used, and finally complications and recurrence rates were the analyzed factors for both survival and disease remission.Results. The overall 5-year survival was 70.1%. The 5-year survival for node-positive patients was 53.8% versus 79.7% for node-negative patients. Unifocal lesions had a 5-year survival of 76% compared with 50% of multifocal lesions. Posterolateral lesions had a better 5-year survival than that of anterior central lesions (79.5% vs 54.4%). The marginal status of the surgical specimen was a significant predictor of both survival and recurrence. There was a significant difference in complications related to the en bloc radical vulvectomy in terms of wound breakdown, infection, and wound cellulitis.Conclusions. Modified radical procedures are equally effective with the en bloc radical vulvectomy for the management of early (stage I/II) vulvar cancer. In advanced disease concervative surgery in an individualized approach could also effectively be applied.

Tumor Anemia and Thrombocytosis in Patients with Vulvar Cancer

The aim of our study was to determine the prevalence of tumor anemia and thrombocytosis in patients with vulvar cancer, and to evaluate the prognostic value or pretreatment hemoglobin (Hb) and platelet count regarding disease-free and overall survival of patients with vulvar cancer. We measured pretreatment Hb and platelet count in 62 patients with squamous cell vulvar cancer. The results were correlated to clinical data. Median Hb and platelet count in patients with vulvar cancer were 13.1 g/dl (range 8.3–16.2) and 268,500/μl (range 88,000–778,000), respectively. Cut-off levels of 12 g/dl and 300,000/μl were selected for tumor anemia and tumor thrombocytosis, respectively according to published criteria. Tumor anemia and tumor thrombocytosis were present in 30.6 and 27.4% of patients with vulvar cancer, respectively. In a univariate analysis tumor stage and tumor thrombocytosis were significantly associated with a shortened disease-free (log-rank test, p < 0.001 and p = 0.003, respectively) and overall survival (log-rank test, p < 0.001 and p < 0.001, respectively). Tumor anemia was not associated with a shortened disease-free, but with a shortened overall survival of patients with vulvar cancer (log-rank test, p = 0.1 and p = 0.002, respectively). A multivariate Cox regression model considering tumor stage, tumor anemia, and tumor thrombocytosis showed, however, that pretreatment Hb and platelet count did not confer additional prognostic information to that already obtained by the established prognosticator tumor stage on disease free (multivariate Cox regression model, p = 0.8, p = 0.2, and p = 0.003, respectively) and overall survival (multivariate Cox regression model, p = 0.4, p = 0.5, and p = 0.04, respectively). Pretreatment tumor anemia and tumor thrombocytosis were associated with a poor prognosis, but were not an independent predictor of outcome in patients with vulvar cancer.

Squamous Cell Carcinoma of the Vulva Stage IA: Long-Term Results

The authors present a retrospective review of their experience with 40 patients with a single T1 squamous cell vulvar cancer with invasion of 1 mm or less. Their aim was to evaluate the risk of lymph node metastases and the long-term results in these patients, who were treated with a variety of conservative or radical surgical therapies. Patients were identified from a review of all cases of primary squamous cell carcinoma of the vulva treated at the Mayo Clinic between 1976 and 1990. Pertinent data were abstracted from the records, and all slides were reviewed according to established guidelines. Patients were an average of 63 years old. Eight had previous cancers, and 27 had associated vulvar diseases. Most patients presented with pruritus (53 percent) or a vulvar lesion (40 percent). Four patients were treated with local excision; nine, with wide excision; three, with hemivulvectomy; and seven, with simple vulvectomy. Seventeen women underwent radical vulvectomy. Ten patients also had groin lymphadenectomy in association with their surgery. There were no positive nodes among these patients. Twenty patients (50 percent) had grade I (well differentiated) disease, 15 had grade II (moderately well differentiated) disease, and 5 had grade III (poorly differentiated) disease. Four of the 40 patients developed wound necrosis within 6 weeks of surgery, and one patient each had a wound hematoma and cellulitis. Seven patients developed long-term complications from surgery, including lymphedema (three patients). Three patients developed a cystocele, and three had a rectocele. There were two cases of vaginal prolapse and one case of stress urinary incontinence. During a mean follow-up period of 7.6 years, 2 of the 40 women had recurrences, both on the vulva. In one patient, who had undergone a wide local excision for a 1 × 1-cm lesion with 0.2 mm of invasion, a recurrence developed on the right labia majora 2.1 years after surgery. She underwent a second wide local excision and is alive and well at 6.1 years of follow-up. In the second patient, who had undergone a radical vulvectomy for a 2 × 1.5-cm, grade II lesion with 0.1 mm of invasion located to the left of the clitoris, a right paraurethral grade II lesion (2 × 1.1 cm, 3 mm of invasion) developed. She was treated with a wide local reexcision and did well for an additional 3.5 years, when metastases to the pelvic and aortic nodes occurred. She died of vulvar cancer 7.8 years after her initial treatment. This was the only death due to vulvar cancer noted. Seven women died of other causes. Gynecol Oncol 2000;76:24–27

Serum concentrations of squamous-cell carcinoma antigen and tissue polypeptide antigen in the follow-up of patients with vulvar cancer.

Our aim was to evaluate the clinical usefulness of serum concentrations of squamous-cell carcinoma antigen (SCC-Ag) and tissue polypeptide antigen (TPA) in the follow-up of patients with vulvar cancer. We measured SCC-Ag and TPA in 480 serum samples of 82 patients with squamous-cell vulvar cancer. Results were correlated with clinical data. SCC-Ag, TPA and the combination of SCC-Ag and TPA reached a sensitivity and specificity of 27%/97%, 28%/75% and 40%/73%, respectively. The sensitivity and specificity of the marker combination SCC-Ag and TPA was not significantly higher compared with SCC-Ag alone (McNemar's test, p = 0.6 and p = 0.09, respectively). Of the 35 patients with recurrent disease during follow-up, 19, 6 and 10 developed local, regional and distant recurrent disease, respectively. SCC-Ag showed lead-time effects in 26%, 75% and 50% and TPA in 25%, 0% and 33% of patients with local, regional and distant recurrent disease, respectively. The combination of SCC-Ag and TPA showed lead-time effects in 50%, 75% and 50% of patients with local, regional and distant recurrent disease, respectively. The difference between median lead-times of the combination of SCC-Ag and TPA and SCC-Ag alone was not statistically significant (Mann-Whitney U-test, p = 0.4). Our data show that serum SCC-Ag displays good sensitivity/specificity characteristics in the follow-up of vulvar cancer patients, with lead-time effects seen in 75% and 50% of patients with regional and distant recurrent disease, respectively. Furthermore, our data indicate that combining SCC-Ag with TPA is not a successful strategy to improve the sensitivity or the duration of lead-time effects in the follow-up of patients with vulvar cancer.

Serum concentrations of squamous cell carcinoma antigen in patients with vulvar intraepithelial neoplasia and vulvar cancer.

Our aim was to evaluate whether serum concentrations of squamous cell carcinoma antigen (SCC-Ag) are an independent prognostic factor in patients with vulvar cancer. We measured SCC-Ag in pretreatment serum samples of 55 patients with squamous cell vulvar cancer, 30 patients with vulvar intraepithelial neoplasia (VIN) grade III and 50 healthy female controls. The results were compared with clinical data. Median serum concentrations of SCC-Ag in healthy female controls, patients with VIN III, and patients with invasive vulvar cancer were 0.5 (range 0.1 to 3.8) ng/mL, 0.5 (range 0 to 4.1) ng/mL and 1.6 (range 0.3 to 65) ng/mL, respectively (Mann-Whitney U test, p < 0.001). The 75% quantile of serum concentrations of SCC-Ag in patients with vulvar cancer was defined as cut-off level. Elevated pretreatment serum concentrations of SCC-Ag were significantly correlated with a shorter disease-free and overall survival (log-rank test, p=0.002; and p<0.001, respectively). A multivariate Cox regression model showed that serum concentrations of SCC-Ag are a prognostic factor of disease-free and overall survival independent of tumour stage (multivariate Cox regression model, p=0.03; and p=0.048, respectively). Pre-treatment serum concentrations of SCC-Ag were not correlated with tumour stage, histological grade and patients' age. In summary, our data indicate that serum concentrations of SCC-Ag may be an additional independent prognostic factor of disease-free and overall survival in patients with vulvar cancer.

-Therapy of vulvar carcinoma in the early stages-.

In the past, and still in some centres, patients with clinical stage I and II squamous cell vulvar cancer were treated by radical vulvectomy and bilateral inguinal-femoral lymphadenectomy. Modern management of vulvar cancer during the last 20 years has developed towards more conservative procedures in the therapy of early stage disease. At the Royal Hospital for Women, Sydney, women with invasive tumours < 20 mm (T1), are treated by a radical local excision. The lesion should be unifocal and the rest of the vulva healthy. A surgical margin of at least 10 mm should be obtained. If no focus with greater than 1 mm of stromal invasion is present, lymph node dissection may be omitted. Lateral lesions with a depth of invasion > 1 mm may undergo unilateral inguinal-femoral lymphadenectomy. Midline lesions and those involving the labia minora require bilateral groin dissection. In selected cases radical local excision of the primary lesion may also be performed in T2 lesions > 20 mm but should always be combined with a bilateral inguino-femoral lymphadenectomy. Adjuvant pelvic and groin irradiation should be given if at least one large node has undergone a tumorous change of if there are multiple nodes containing micrometastases. Careful patient selection is necessary to successfully achieve high cure rates, acceptable cosmetic results and psychosexual wellbeing.

Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva Stage III and IVA FIGO

Lymph node positivity in invasive squamous cell vulvar cancer implies a severe decrease in survival rates. Pathological lymph node positivity covers a wide range of metastatization patterns. In the present investigation the nodal positivity of 53 patients affected by Stage III and IVA invasive vulvar squamous cell carcinoma has been carefully evaluated and correlated with survival. Number, size of the metastasis inside the node, intracapsular or extracapsular site of the metastasis, and immune response of the positive nodes were considered. Cancer-related survival has been obtained for the whole study group (53 cases), for the patients with monolateral node positivity (36 cases), and for the patients showing only one positive node (19 cases). The diameter and the site of the metastasis were significantly correlated with survival in all three groups studied. Patients showing an intracapsular positivity or a size of metastasis less than 5 mm had a 5-year cancer-related survival of almost 90%, while patients showing a metastasis larger than 15 mm or an extracapsular site had a 20% survival. The results demonstrate that patients affected by invasive squamous cell vulvar cancer with positive nodes can be divided into two groups with a significantly different survival according to the histopathological pattern of lymph node invasion.

In situ and invasive vulvar cancer incidence trends (1973 to 1987)

The objective of this study was to examine recent trends in the incidence of vulvar cancer. Cases of in situ and invasive squamous cell vulvar cancer were identified from nine Surveillance, Epidemiology, and End Results cancer registries. The incidence rate of in situ vulvar cancer nearly doubled between 1973 to 1976 and 1985 to 1987, whereas the rate of invasive squamous cell carcinoma remained relatively stable. Possible reasons for this discordance include the following: (1) Women affected by the "sexual revolution" are not yet old enough to have invasive vulvar carcinoma; (2) early diagnosis and treatment of in situ carcinoma have mitigated anticipated increases in invasive vulvar carcinoma incidence; (3) in situ and invasive carcinomas of the vulva have different etiologies, with the sexually transmitted human papillomavirus involved in the etiology of in situ carcinoma and other factors involved with most invasive squamous cell carcinoma.