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OCCASIONAL REVIEW: Vulvar Cancer: The Cinderella of Gynaecological Oncology
Author(s) -
Giles Graham G.,
Kneale Barry L.G.
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb01835.x
Subject(s) - vulvar cancer , incidence (geometry) , vulvar intraepithelial neoplasia , medicine , intraepithelial neoplasia , cancer , epidemiology , malignancy , dermatology , vulva , carcinoma in situ , genital warts , papilloma , gynecology , oncology , cervical cancer , pathology , prostate cancer , physics , optics
EDITORIAL COMMENT; We have accepted this paper for publication because it gives a good overview of the current situation in Victoria regarding the epidemiology and management of vulvar cancer. There are some problems that still need to be resolved especially the need to divide the cases into those that are associated with intraepithelial carcinoma of the vulva and those that present in the traditional manner of the older woman with a macroscopically apparent lesion, at least if you look carefully, which is not always as easy as it sounds! It may be that it is confusing to consider the 2 groups together.Summary: Cancer of the vulva is a rare malignancy that increases progressively with age. The age‐standardized incidence averages between 1 and 2 per 100,000 women in Western countries. The majority (80–90%) are squamous cell carcinomas, melanoma and adenocarcinoma each accounting for about 5% of cases. Internationally, the incidence of vulvar cancer varies more than 30‐fold, the highest rates being seen in populations of Portuguese South America. In many populations the incidence appears to be stable but there is some evidence that the incidence of in situ carcinoma is increasing in the United States of America. Epidemiological studies have identified sexual factors, particularly human papilloma virus (HPV) infection, as increasing risk. Smoking also increases risk by interacting synergistically with HPV infection and genital warts. The aetiologies of vulvar intraepithelial neoplasia (VIN)3/in situ disease and invasive cancer appear to differ. VIN does not automatically progress to invasive cancer and is strongly associated with HPV infection. Many older women with invasive vulvar cancer do not have evidence of HPV and do not smoke. More research is needed on the cause of vulvar carcinoma in this group. Treatment has become more conservative over the years and this has reduced morbidity and probably mortality. Although FIGO data do not show much by way of improvement in survival, data from population‐based cancer registries have shown definite increases in survival (5‐year survival proportions in excess of 80%, when age and Stage have been taken into account). Improvement is particularly related to the preponderance of early stage disease.