Vulvar Cancer -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1269 involves human papillomavirus (HPV) infection, which leads to VIN and predisposes the patient to vulvar cancer. The second type involves vulvar non-neoplastic epithelial disorders (VNED) and advanced age, leading to cellular atypia and cancer (Table 1). Vulvar cancer most frequently occurs in women 65 to 75 years of age. It can develop in younger patients, and a recent review noted that approximately 15 percent of all vulvar cancers occur in women younger than 40 years of age. One study noted that in women younger than 50 years of age, the incidence of vulvar cancer has increased from 2 to 21 percent over the past 20 years. Most of the vulvar cancers appearing in young women arise in a field of warty or basaloid VIN. An estimated 80 percent of untreated women with warty VIN develop invasive disease. Thirty percent of patients with vulvar cancer present at 70 years or older, and the rate increases with age, reaching a peak of 20 per 100,000 women by 75 years of age. This rate equals lifetime risks of acquiring vulvar carcinoma and dying as a result of it of 0.3 and 0.1, respectively. No specific medical factors have been clearly identified as causative. Hypertension, diabetes mellitus, and obesity have been found I n 1998, approximately 3,200 women in the United States developed cancer of the vulva, and 800 women died of the disease. Over the past decade, an increase in vulvar intraepithelial neoplasia (VIN) and VIN-related invasive vulvar cancer has been noted in women younger than 50 years. Overall, vulvar cancer is relatively uncommon, accounting for 3 to 5 percent of female genital-tract malignancies. Approximately 90 percent of vulvar tumors are squamous cell carcinomas. When such tumors are found early, the prognosis is quite good. Despite its infrequency, vulvar cancer remains an important female disease, because of its significant impact on sexuality. Over the past decade, numerous advances have been made in the management of vulvar cancer, with a trend toward more conservative surgery and improved psychosexual outcomes. Early detection and biopsy of any abnormal vulvar lesions by primary care physicians are imperative to achieve diagnosis of vulvar cancer in the early stages and improve subsequent morbidity and mortality.