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Vulvar carcinoma is a rare tumor of the female genital tract. In Nigeria, very few studies have looked at the management options for vulvar carcinoma. The objective of this study was therefore, to describe the management options available and the challenges in treating this malignancy in Nigeria.
A descriptive study of all vulvar cancer cases manag...
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Epidemiology
Vulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders.
Histology
Squamous cell carcinoma (SCC) is the most c...
The cornerstone of treatment in early-stage squamous cell carcinoma (SCC) of the vulva is surgery, predominantly consisting of wide local excision with elective uni- or bi-lateral inguinofemoral lymphadenectomy. This strategy is associated with a good prognosis, but also with impressive treatment-related morbidity. The aim of this study was to dete...
Objective:
To systematically review previous studies and to evaluate the feasibility and safety of video endoscopic inguinal lymphadenectomy (VEIL) in vulvar cancer.
Methods:
We conducted a comprehensive review of studies published through September 2014 to retrieve all relevant articles. The PubMed, EMBASE, Web of Science, Cochrane Library, Wan...
Citations
... 6 Vulvectomy for dysplasia of the vulva epithelium has its place but does not always prevent squamous cell carcinoma in that site. 7 Hysterectomy for all women showing cervical epithelial dysplasia or suffering from post menopausal bleeding or discharge or whose family is completed could well reduce the number of cancer if it is cervical cancer or cancer of the corpus uteri. 8 Such an approach, however, is likely to involve operative mordalities. ...
... 12,13 This is because those women who delay taking advice either die before treatment is instituted or they have cancers which are only slowly progressive . [5][6][7] This also explains why the clinical stage of cancer of the cervix is not necessarily proportional to the duration of symptoms. [14][15] Nevertheless, the earlier the patient reports, the better the overall 5year survival rate. ...
... She is then treated but only survives until 1995, and thus attributed to her late stage disease. [5][6][7] The above scenario is hypothetical. Evidence have shown that microscopically diagnosed cancer of the cervix at well women clinic who receive prompt treatment have better prognosis. ...
As more is learned about the factors associated with malignant diseases of the female genital tract comprising of cancers of the vulva, vagina, cervix,
endometrium, fallopian tubes and ovaries, there is hope of preventing certain types.
This involves elimination or control of what are believed to be causal agents, a typical example being the human papilloma virus (HPV) which is the prime aetiological factor of
cervical cancer.
Screening modalities in the developed world constituted a great step in the
prevention of cervical cancer by over 80%.
The advent of cervical cancer vaccination revolutionized the prevention of cancer of the cervix. However, there is scarcity of cervical cancer vaccines in the
developing countries of the world. Where these vaccines are available the cost is a challenge because majority of the masses cannot afford them.
Vulvectomy for dysplasia of the vulva epithelium has its place but does not always prevent squamous cell carcinoma in that site.
Hysterectomy for all women showing cervical epithelial dysplasia or
suffering from post menopausal bleeding or discharge or whose family is completed could well reduce the number of cancer if it is cervical cancer or cancer of
the corpus uteri. Such an approach, however, is likely to involve operative mordalities.
Reason and safety impose strict limit on the place of prophylactic surgery in the prevention of cancer of the vulva, cervix, corpus uteri, fallopian tubes and ovaries.
Early Diagnosis
It is generally accepted that an early cancer is
more amenable to cure than one which has been
present for sometimes.
11 It is important to pay heed to
the first suspicious symptoms or signs presented by
the patient, for example, irregular uterine bleeding or
discharge occurring after the age of forty years.
12
Although early diagnosis and treatment must offer the
patient a better chance of survival, they do not always
make much difference that might be expected.1,12
Stage 1 cases of cancer of the cervix can do badly
while more advanced ones sometimes respond well to
treatment.
13 This is because certain cancer cell growth
divide the vascular channel at a very early stage,
whereas others can come to terms with their cancer
cells,14 even to the extent of inactivating the malignant
cells liberated into the blood or lodged in the bone
marrow.
15 The first type is rarely cured no matter how
early the occurrence, whereas the second is nearly
always cured no matter how long treatment is
deferred. 14
The result of therapy according to the stage of
cancer of the cervix clearly shows that the less the
clinical extent of the disease the better the outlook.12-14
However, it is often assumed that the extent of a
cancer represents its age.13
... Vulvar and vaginal cancers are the rare tumours of the gynaecological cancers. For vulvar carcinoma, very few studies have looked at the management strategies [26]. For example, in Nigeria, a retrospective study found 344 were gynaecological cancers which of 4.36% were vaginal cancers with 66.67% occurred in adults while 33.33% were in children below the age of 20 years [27]. ...
... While in Nigeria, over a 12-year period, there were 867 gynaecological cancers and vulvar carcinoma presented 1.27%. Parity was with an average of 6.7 children [26]. In contrast, vaginal and vulvar cancers were respectively the 4 th and 5 th most common in Nigeria. ...
... Thus, incidence of cervical, ovarian and endometrial cancers remains high and presentations are at late stages [12]. In addition, vaginal cancers and uterine sarcomas are rare in Nigeria, but they contribute to high mortality among women [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Among gynaecological cancers worldwide, ovarian cancer has the highest fatality rate because lack of non-specific early warning symptoms and effective screening methods. ...
Objective: Gynaecological cancers are public health diseases and contribute to the global burden of diseases. In West Africa most have been carried out on all gynaecological and breast cases to describe the epidemiological features and management modalities. Methods: Our research covered a period from 1998 to 2018. The terms “gynaecological cancers” and “West Africa”; are used to find records in the research databases (PubMed, ScienceDirect, Scopus and Google Scholar). There are countries (Cape Verde, Guinea, Gambia, Liberia, Sierra Leone) in which we have not found any work in the research databases. The process for selecting studies followed selection steps based on PRISMA 2009. Result: Cervical cancer is the commonest, followed by breast cancer, ovarian cancer, uterine or endometrial cancers, vaginal cancer and vulvar cancer. The lowest common was tubal cancers. The two English-speaking countries, Nigeria and Ghana, recorded 60 (60.82%) and 16 (15.68%) articles published respectively. At the same time, these two countries reported the most cases of gynaecological cancers including 72,848 cases (68.97%), 12, 327 cases (11.67%) and 12, 021 cases (11.38%) for Nigeria, Cote d’Ivoire and Ghana respectively. West Africa countries are characterised by poor outcome due to ignorance, superstition, self-denial, late presentation and unavailability of treatment facilities. Conclusion: Our study suggests that comprehensive national health insurance schemes as well as preventive strategies, patient and health work force education may improve the current situation. Also, West African countries must necessarily have a policy of acquiring the technical platforms to carry out these diagnostic and prognostic examinations.Keywords: Gynaecological- Cancers- management- West Africa
... The fatality rate 6 months after surgery was 76% [35]. In Nnewi, over a 12 years period (1998-2009), 867 gyne-cological malignancies were detected and vulva carcinoma accounted for 1.27%, among them stage III represented the majority of the cases (45.4%) [36], while in Lagos, 86.5% of the ovarian cancer patients were diagnosed with stages III and IV [37]. All patients had surgery as 1st line treatment. ...
... All patients had surgery as 1st line treatment. It should be noticed that surgery and radiotherapy remain the main therapeutic approach in Nigeria and is usually highly successful when performed early [36]. Nigeria is characterized by patient-related delays in presentation, provider-related delays in referrals and poor compliance with recommended chemotherapy [37]. ...
Medicinal plants are a potential source of drug discovery and development of new pharmacological compounds for cancer chemoprevention. More than 80% of the West African population uses medicinal plants. It is estimated that over 60% of approved anti-cancer agents are derived from plants. The plant raw material used in African traditional medicine and particularly in West Africa can be an important source for the research of anti-tumor drugs against gynecological cancers. These tumors have a negative impact on women's general health status and causes enormous health costs as they affect all age groups. Gynecological cancers remain thus a major concern worldwide, especially in West Africa where these cancers are the leading cause of cancer deaths in women. This review reports on the contribution of West African flora to the discovery of potential antiproliferative and/or cytotoxic phytochemical compounds against gynecological cancer cells. Scientific databases such as PubMed, ScienceDirect, Scopus and GoogleScholar were used to extract publications reporting West African plants and/or isolated compounds used in cell models of gynecological cancers. Thresholds of cytotoxicity and modes of action of these phytochemicals have been summarized. This research can serve as a basis for taking medicinal plants into account in the management of these gynecological cancers in resource-limited countries such as those in West Africa.
... 6 Vulvectomy for dysplasia of the vulva epithelium has its place but does not always prevent squamous cell carcinoma in that site. 7 Hysterectomy for all women showing cervical epithelial dysplasia or suffering from post menopausal bleeding or discharge or whose family is completed could well reduce the number of cancer if it is cervical cancer or cancer of the corpus uteri. 8 Such an approach, however, is likely to involve operative mordalities. ...
... 12,13 This is because those women who delay taking advice either die before treatment is instituted or they have cancers which are only slowly progressive . [5][6][7] This also explains why the clinical stage of cancer of the cervix is not necessarily proportional to the duration of symptoms. [14][15] Nevertheless, the earlier the patient reports, the better the overall 5year survival rate. ...
... She is then treated but only survives until 1995, and thus attributed to her late stage disease. [5][6][7] The above scenario is hypothetical. Evidence have shown that microscopically diagnosed cancer of the cervix at well women clinic who receive prompt treatment have better prognosis. ...
... All studies were conducted between 2001 and 2019 and three studies [22][23][24] were reported in non-English language publications (Refer to Table 2). While the majority of studies were conducted in Brazil (n = 12) and Turkey (n = 9), most other regions with LMIC were represented, including: South America (n = 12) [5,20,24,[32][33][34][35][36][37][38][39]49], Europe (n = 11) [21, 23, 25-31, 50, 51], Southern Asia (n = 6) [41][42][43][44][45]52], West Africa (n = 3) [22,40,53], Middle East (n = 3) [47,48,54] and East Asia and Pacific (n = 1) [46]. ...
... This study was the only study to use bioelectric impedance to diagnose lymphedema [35]. Other methods used for measuring and defining lymphedema included: tape measurement (n = 16) [21, 25, 27-30, 32, 37, 38, 41-43, 45, 47, 48, 54]; patient self-report (n = 8) [22,33,39,44,46,50,52,53]; water volumeter (n = 2) [31,36]; palpation and clinical diagnosis (n = 2) [40,49]; and perometer (n = 1) [34]. ...
... All five studies that reported leg lymphedema used either patient self-report (n = 3) or palpation or clinical diagnosis (n = 2). Studies which used the self-report method of lymphedema diagnosis only used either palpation or observation methods of identifying lymphedema in the affected limbs of the patients [22,50,53]. These were based on patients' reports of swelling in the legs alone. ...
Background:
Little is known about the prevalence and incidence in low and middle-income countries (LMICs) of secondary lymphedema due to cancer. The purpose of the study is to estimate the prevalence and incidence in LMICs of secondary lymphedema related to cancer and/or its treatment(s) and identify risk factors.
Method:
A systematic review and meta-analysis was conducted. Medline, EMBASE and CINAHL were searched in June 2019 for peer-reviewed articles that assessed prevalence and/or incidence of cancer-related lymphedema in LMICs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Estimates of pooled prevalence and incidence estimates were calculated with 95% confidence intervals (CI), with sub-group analyses grouping studies according to: country of origin, study design, risk of bias, setting, treatment, and lymphedema site and measurement. Heterogeneity was measured using X2 and I2, with interpretation guided by the Cochrane Handbook for Systematic Reviews.
Results:
Of 8766 articles, 36 were included. Most reported on arm lymphedema secondary to breast cancer treatment (n = 31), with the remainder reporting on leg lymphedema following gynecological cancer treatment (n = 5). Arm lymphedema was mostly measured by arm circumference (n = 16/31 studies), and leg lymphedema through self-report (n = 3/5 studies). Eight studies used more than one lymphedema measurement. Only two studies that measured prevalence of leg lymphedema could be included in a meta-analysis (pooled prevalence =10.0, 95% CI 7.0-13.0, I2 = 0%). The pooled prevalence of arm lymphedema was 27%, with considerable heterogeneity (95% CI 20.0-34.0, I2 = 94.69%, n = 13 studies). The pooled incidence for arm lymphedema was 21%, also with considerable heterogeneity (95% CI 15.0-26.0, I2 = 95.29%, n = 11 studies). There was evidence that higher body mass index (> 25) was associated with increased risk of arm lymphedema (OR: 1.98, 95% CI 1.45-2.70, I2 = 84.0%, P < 0.0001, n = 4 studies).
Conclusion:
Better understanding the factors that contribute to variability in cancer-related arm lymphedema in LMICs is an important first step to developing targeted interventions to improve quality of life. Standardising measurement of lymphedema globally and better reporting would enable comparison within the context of information about cancer treatments and lymphedema care.
... While the majority of studies were conducted in Brazil (n=12) and Turkey (n=9), most other regions with LMIC were represented, including: South America (n=12) (5,20,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33), Europe (n=11) (21,23,(34)(35)(36)(37)(38)(39)(40)(41)(42), Southern Asia (n=6) (43)(44)(45)(46)(47)(48), West Africa (n=3) (22,49,50), Middle East (n=3) (51)(52)(53) and East Asia and Paci c (n=1) (54). ...
... This study was the only study to use bioelectric impedance to diagnose lymphedema (28). Other methods used for measuring and de ning lymphedema included: tape measurement (n=16) (21, 25, 32-34, 38, 39, 41-45, 48, 51-53); patient self-report (n= 8) (22,26,30,40,46,47,49,54); water volumeter (n=2) (27,35); palpation and clinical diagnosis (n=2) (29,50); and perometer (n=1) (31). ...
... [Insert Table 3] Leg lymphedema following gynecological cancer treatment All ve studies that reported leg lymphedema used either patient self-report (n=3) or palpation or clinical diagnosis (n=2). Studies which used the self-report method of lymphedema diagnosis only used either palpation or observation methods of identifying lymphedema in the affected limbs of the patients (22,40,49). These were based on patients' reports of swelling in the legs alone. ...
Background Little is known about the prevalence and incidence in low and middle-income countries (LMICs) of secondary lymphedema due to cancer. This study aims to estimate the prevalence and incidence in LMICs of secondary lymphedema related to cancer and/or its treatment(s) and identify risk factors.
Method A systematic review and meta-analysis was conducted. Medline, EMBASE and CINAHL were searched in June 2019 for peer-reviewed articles that assessed prevalence and/or incidence of cancer-related lymphedema in LMICs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Estimates of pooled prevalence and incidence estimates were calculated with 95% confidence intervals (CI), with sub-group analyses grouping studies according to: country of origin, study design, risk of bias, setting, treatment, and lymphedema site and measurement. Heterogeneity was measured using X ² and I 2 , with interpretation guided by the Cochrane Handbook for Systematic Reviews.
Results Of 8766 articles, 36 were included. Most reported on arm lymphedema secondary to breast cancer treatment (n=31), with the remainder reporting on leg lymphedema following gynecological cancer treatment (n=5). Arm lymphedema was mostly measured by arm circumference (n=16/31 studies), and leg lymphedema through self-report (n=3/5 studies). Eight studies used more than one lymphedema measurement. Only two studies that measured prevalence of leg lymphedema could be included in a meta-analysis (pooled prevalence =10.0%, 95%CI 7.0 – 13.0, I 2 =0%). The pooled prevalence of arm lymphedema was 27%, with considerable heterogeneity (95%CI 20.0 – 34.0, I 2 =94.69%, n =13 studies). The pooled incidence for arm lymphedema was 21%, also with considerable heterogeneity (95%CI 15.0 – 26.0, I 2 =95.29%, n =11 studies). There was evidence that higher BMI (>25) was associated with increased risk of arm lymphedema (OR: 1.98, 95%CI 1.45 – 2.70, I 2 =84.0%, P< 0.0001, n =4 studies).
Conclusion Better understanding the factors that contribute to variability in cancer-related arm lymphedema in LMICs is an important first step to developing targeted interventions to improve quality of life. Standardising measurement of lymphedema globally and better reporting would enable comparison within the context of information about cancer treatments and lymphedema care.
... Several reports from African authors reflect the rarity of vulva cancer. Its proportion in relation to other gynecological cancers is highly variable, ranging between 1.3 and 5% (Eke et al., 2010). In our study, cancer of the vulva was the fourth most common diagnosed gynecological cancer. ...
... The mean age for vulva carcinoma from this study 56.3 years (Table 1) with a range of 24 to79 years agreeing with average age ranging between 46 and 61 which has been reported by other African studies (Eke et al., 2010;Tanko et al., 2012). In Western Europe, the average ages are over 70 years (Buttmann-Schweiger et al., 2015).The difference in average ages between Europe and the less developed countries could be explained by the difference in life expectancy at birth. ...
Highlights
• Seventy- 5% of vulvar cancer cases present with advance disease.
• Definitive radiotherapy/chemoradiation is the main stay of treatment.
• One third of patients default treatment.
• Five year survival following radiotherapy was 36.7%.
... Squamous cell carcinoma is the main histological type [12]. The diagnostic stages are different between Europe and Africa with 47.6 % for stage IB in the Netherlands [13] and 45.4 % for stage III in Nigeria [14]. In Burkina Faso, no specific study on vulvar cancers has been conducted at the moment. ...
... They represented 5.3 % of all the gynaecological cancers diagnosed in the same period (396 cases). In Africa, all the authors agree that this cancer is rare but its proportion in relation to gynaecological cancers is highly variable, oscillating between 1.3 and 5 % [14,17,18]. In our study, cancer of the vulva was the 4th most common diagnosed gynaecological cancer in order of importance after cancer of the cervix, the uterus, and the ovary. ...
... In our study, only two patients (2/21) were at stage I or II contrasting with a small proportion of metastatic cases (3/21). These results are similar to the data in the African literature in which the time to first medical consultation was superior to 6 months in 60 % of the cases and 80 % of the patients were at stages III and IV of FIGO [14,19,37]. This contrasts with stage at diagnosis in the developed countries. ...
Background
Vulvar cancer is a rare gynaecological cancer. In Burkina Faso, the diagnosis of vulvar cancers is delayed and the prognosis is poor. However, no specific study on vulvar cancers has been conducted at the moment. This work aimed to study the characteristics of these cancers.
Methods
This is a prospective study on histologically confirmed primary cancers of the vulva diagnosed between 1st January 2013 and 30th June 2015. The demographic and clinical aspects were studied at the Yalgado Ouedraogo University Hospital of Ouagadougou (CHU-YO).
Results
We noticed 21 cases of vulvar cancers within 30 months, ranking it as the 4th most common gynaecological cancer. The average age of the patients was 55 years (standard deviation +/− 6.3) and the median age was 57 years. Scars resulting from female circumcision, menopause (n = 20) and HIV infection were noticed in 19 cases and 6 cases respectively. The average time from first symptoms to first consultation was 29 months. Pain and ulceration were the main reasons for consultation. The clinical picture was chiefly an ulcero-granulating tumour. There was squamous cell carcinoma in 20 cases and basal carcinoma in 1 case. Fifteen patients were at stage III or IV, where of three patients had metastatic disease. We noticed vitiligo in 9 vulvar cancer cases.
Conclusion
The cancer of the vulva is rare. Women are of menopausal age, are mostly circumcised and HIV-infection is common. A majority of patients sought consultation at advanced stage of disease, and diagnosis was belatedly made. Pain and ulceration were the main reasons for consultation. The sensitization of the population, education for self- examination would allow earlier diagnosis.
... When symptoms are present, the most common include pruritus vulvae, vulvar bleeding or pain, swelling, or vaginal discharge. 16,17 Often, the patient does not complain due to cultural reasons, the so-called "culture of silence", due to embarrassment, or for economic reasons. Vulvar SCC may be confused with condyloma 14 and therefore may be inadequately treated by various modalities. ...
Shyam B Verma,1 Uwe Wollina21Nirvana Clinic, Vadodara, Gujarat, India; 2Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, GermanyAbstract: Vulvar cancer is uncommon and may be confused with genital condylomata. We report two cases of middle-aged women presenting with exophytic vulvar tumors of the midline for which diagnosis of a vulvar squamous cell carcinoma was confirmed by histopathology. Risk factors, staging, and treatment options are discussed.Keywords: condyloma, human papillomavirus (HPV), squamous cell carcinoma, surgery, vulva
Introduction: Gynaecological malignancies cause most death in women. The estimation of gynaecological epidemiology is invaluable in setting priorities for its control. No study has elucidated the epidemiological burden on Nigerian women until this point. Methods: Our work covered published articles on gynaecological malignancies in Nigeria. The terms of search are "Gynaecological malignancies" and "Nigeria". We searched databases (PubMed, AJOL, Research4Life, Science Direct, Scopus, and Google Scholar), journal homepages (BMC, Sahel Medical Journal), and free web searches of related papers. Downloaded papers were assessed for eligibility following PRISMA 2009. Results: The charted data indicated that cervical, ovarian, and uterine were the commonest forms. The rarest was fallopian tube cancers. Developed cities in Nigeria, such as Lagos, Zaria, Anambra, and Enugu had the highest number of publications. In contrast, less developed states such as Imo, Lokoja, Oyo, Akwa Ibom, Bauchi, Benin, Delta, Kebbi and Ogun states had the least publications. The histological screening was the primary means of diagnosis. Risk factors for some reported cases include active sexual history, age, parity, and family history. Systematic Review Article Ani et al.; IRJO, 6(4): 55-73, 2022; Article no.IRJO.94101 56 Conclusions: The distribution pattern of gynaecological cancers is consistent with what is obtainable worldwide, where cervical, ovarian, and uterine cancers were identified as the most prevalent. National screening protocol, national health insurance schemes, and workforce education are key to early detection, mitigating diseases, and improving survival outcomes.
