Vulval cancer: Squamous cell carcinoma of the vulva

• What is Vulval Cancer (Squamous Cell Carcinoma of the Vulva)
• Statistics on Vulval Cancer (Squamous Cell Carcinoma of the Vulva)
• Risk Factors for Vulval Cancer (Squamous Cell Carcinoma of the Vulva)
• Progression of Vulval Cancer (Squamous Cell Carcinoma of the Vulva)
• Symptoms of Vulval Cancer (Squamous Cell Carcinoma of the Vulva)
• Clinical Examination of Vulval Cancer (Squamous Cell Carcinoma of the Vulva)

What is Vulval Cancer (Squamous Cell Carcinoma of the Vulva)

The main type of vulvae cancer is Squamous Cell Carcinoma of the Vulva. The vulvae are the female external genitalia, consisting of the mons pubis, the labia majora and minora and the clitoris. The proximal two-thirds of the labia minora and all tissues internal to them are of endodermal origin. All tissue external to this point is ectodermal in origin and histology resembles that of skin. Between the labia minora is the vestibule – containing the external urethral meatus, the hymen and the clitoris.

Statistics on Vulval Cancer (Squamous Cell Carcinoma of the Vulva)

It is uncommon, accounting for 3% of genital tract cancers. It occurs with increasing age. Vulvar carcinoma is most common in the postmenopausal, with sex incidence being obviously female. Geographically, the tumour is found worldwide but is more common in patients of northern European ancestory.

Risk Factors for Vulval Cancer (Squamous Cell Carcinoma of the Vulva)

Increasing age, human papilloma virus infection (HPV 16 and 18), immunodeficiency syndromes (more common in renal transplant patients) and a prior history of cervical cancer. There appear to be two distinct subtypes of vulvar squamous cell carcinoma:

• HPV-associated vulvar carcinoma- occurs in slightly younger women and has additional risk factors associated with earlier age at first sexual intercourse, higher numbers of sexual partners and HIV infection; and
• Non-HPV vulvar carcinoma- is more common and occurs in older women. Both forms have been associated with mutations in the p53 tumour suppressor gene.

Progression of Vulval Cancer (Squamous Cell Carcinoma of the Vulva)

This type of tumour spreads by local invasion initially, and then via the lymphatics – with inguinal, pelvic, para-aortic and iliac nodes being the most common sites of early spread. Systemic dissemination occurs late in the course of the disease through lymphatic and haematogenous spread and tends to involve the lungs and liver.