HPV-related vulvar cancer

How common is vulvar cancer?

Vulvar cancer is not particularly common. According to the American Cancer Society, 4850 vulvar cancer cases were reported in 2014 in the USA.

What percentage of vulvar cancers is attributed to oncogenic types of HPV?

It is believed that 40% of vulvar cancers are related to HPV. The statistical data from Europe and the USA show that there is a rise in HPV-related vulvar cancers, attributed to the epidemic of HPV infections.

What factors increase the chance of HPV-related vulvar cancer?

• A history of precancerous lesions (VIN) or other intraepithelial neoplasia or HPV-related cancer in the lower genital tract or the anal area
• A history of genital warts
• Age. The risk increases in a woman’s fourth decade and onwards.
• Smoking. In women with a history of infection from oncogenic types of HPV, smoking increases the risk for carcinogenesis in the vulva.

What are the symptoms, what does it look like?

In the beginning, vulvar cancer caused by HPV causes no symptoms. The lesion later looks like:

• an ulcer (wound) or
• protrusion or lump on the skin or
• like a harder area with “tension”.

The color of the lesion may be lighter or darker than the skin of the vulva or look pink or red.

What does diagnosis entail?

Diagnosis is made with a clinical examination and a biopsy.

What happens after the initial biopsy?

Staging follows the histological diagnosis. Staging requires, apart from the pelvic examination, a series of other examinations, like colposcopy, cystoscopy, anoscopy, chest X-ray, CT scan, etc.

How is vulvar cancer treated?

There are different treatments depending on the cancer stage.

The three main treatment methods are:

• surgical treatment
• radiation therapy
• chemotherapy

Vulvar cancer in the early stages is treated surgically, while, in more advanced stages, a combination of the above methods is used.

Why should VIN lesions be found and treated?

HPV-related squamous cell carcinoma of the vulva usually forms slowly over many years. Precancerous changes (VIN) often occur first and can last for several years.

Women with VIN lesions have an increased risk of developing invasive vulvar cancer.

The risk of progression to cancer seems to be highest with VIN 3 lesions. This risk can be altered with treatment. In one study, 88% of untreated VIN3 progressed to cancer, whereas only 4% of the women who were treated developed vulvar cancer.

Can HPV-related vulvar cancers be prevented?

The majority of these cancers are prevented if the following measures are taken:

• Preventive measures to reduce the risk of HPV infection (vaccination, use of a condom, limitation of sexual partners).
• Check-ups, especially in women with an HPV infection history, in order to detect in time any precancerous lesions (VIN).
• Quitting smoking.