Background:The role of human papillomavirus(HPV)in the development of vulvar cancer(VC)has been widely studied,but findings have been inconsistent.Despite numerous meta-analyses exploring the potential link between HP...Background:The role of human papillomavirus(HPV)in the development of vulvar cancer(VC)has been widely studied,but findings have been inconsistent.Despite numerous meta-analyses exploring the potential link between HPV and VC,the association remains controversial due to inherent limitations in meta-analytic methods.Objectives:To address this controversy,the study aims to investigate the potential link between HPV and VC using the Bradford Hill criteria,which offer a more comprehensive framework for establishing causation.Methodology:The study began by extracting all relevant studies on the association between HPV and VC from the PubMed database.The potential links were then assessed by examining the data using the major postulates of the Bradford Hill criteria.To ensure the reliability of the findings,the methodologies of the identified studies were critically evaluated to account for possible false-negative and false-positive results.Results:The assessment of previous studies against the Bradford Hill criteria revealed that the major postulates were not fulfilled.Conclusion:Based on the findings,it can concluded that there is no causal association between HPV and VC.展开更多
Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks...Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.展开更多
Background:Large cancer registries help analyze the prognosis of rare malignancies,such as advanced vulvar cancer.This study aimed to compare the overall survival(OS)rates of patients with metastatic vulvar cancer who...Background:Large cancer registries help analyze the prognosis of rare malignancies,such as advanced vulvar cancer.This study aimed to compare the overall survival(OS)rates of patients with metastatic vulvar cancer who had undergone chemoradiotherapy and radiotherapy alone and identify prognostic factors using data from the Surveillance,Epidemiology,and End Results(SEER)registry.Methods:In this retrospective cohort study,we used the SEER database to identify patients with metastatic vulvar cancer diagnosed between 2000 and 2019.Propensity score matching was performed to balance the covariates.Kaplan–Meier curves and Cox models were used to analyze OS.Results:A total of 685 patients were included and divided into chemoradiotherapy and radiotherapy groups,and 400 patients were included after propensity score matching.The chemoradiotherapy group had higher OS in the matched cohort(hazard ratio[HR]=0.7367;95%confidence interval[CI]:0.5906–0.9190;P=0.0049)than the radiotherapy group,which was similar to that in the pre-matched cohort(P<0.0001).Patients who had undergone surgery+radiotherapy with or without chemotherapy showed higher OS rates than those who had received radiotherapy with or without chemotherapy for patients aged<75 years and local tumor excision/destruction or surgical removal of the primary site was the recommended surgical choice(P<0.05).Chemoradiotherapy is sufficient for patients 75 years of age.Conclusions:Patients with metastatic vulvar cancer should undergo surgery if they can tolerate it.Adjuvant chemoradiotherapy should be encouraged because this treatment modality was associated with higher OS than radiotherapy alone.展开更多
Sentinel lymph node （SLN） biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic mal...Sentinel lymph node （SLN） biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors （≤ 2 cm diameter or stage ≤ IB2） where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refnement of appropriate patient selection and long-term follow-up are necessary.展开更多
Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with loc...Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical exploration.Our case supports the principles of adjuvant therapy for breast cancer to be applied to ectopic breast cancer arising in the vulva. A literature review highlights common key points in similar cases to guide management.展开更多
The study of Gynaecology over the years has been influenced by the culture and social attitudes of society to the body as a whole and to the genital organs in particular. Variations in these attitudes between differen...The study of Gynaecology over the years has been influenced by the culture and social attitudes of society to the body as a whole and to the genital organs in particular. Variations in these attitudes between different cultures and at different times have influenced the subsequent rate of progress in the study of the vulva and its diseases.展开更多
AIM： To analyze the major complications after exenteration of gynecological and rectal malignancies.METHODS： Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenterati...AIM： To analyze the major complications after exenteration of gynecological and rectal malignancies.METHODS： Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration （PE） between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases （vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin＇s gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases （cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively）. Posterior PE, total PE and anterior PE were most often performed.RESULTS： Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients （42.9%）. Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome （ARDS）, thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies.CONCLUSION： PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.展开更多
文摘Background:The role of human papillomavirus(HPV)in the development of vulvar cancer(VC)has been widely studied,but findings have been inconsistent.Despite numerous meta-analyses exploring the potential link between HPV and VC,the association remains controversial due to inherent limitations in meta-analytic methods.Objectives:To address this controversy,the study aims to investigate the potential link between HPV and VC using the Bradford Hill criteria,which offer a more comprehensive framework for establishing causation.Methodology:The study began by extracting all relevant studies on the association between HPV and VC from the PubMed database.The potential links were then assessed by examining the data using the major postulates of the Bradford Hill criteria.To ensure the reliability of the findings,the methodologies of the identified studies were critically evaluated to account for possible false-negative and false-positive results.Results:The assessment of previous studies against the Bradford Hill criteria revealed that the major postulates were not fulfilled.Conclusion:Based on the findings,it can concluded that there is no causal association between HPV and VC.
文摘Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.
文摘Background:Large cancer registries help analyze the prognosis of rare malignancies,such as advanced vulvar cancer.This study aimed to compare the overall survival(OS)rates of patients with metastatic vulvar cancer who had undergone chemoradiotherapy and radiotherapy alone and identify prognostic factors using data from the Surveillance,Epidemiology,and End Results(SEER)registry.Methods:In this retrospective cohort study,we used the SEER database to identify patients with metastatic vulvar cancer diagnosed between 2000 and 2019.Propensity score matching was performed to balance the covariates.Kaplan–Meier curves and Cox models were used to analyze OS.Results:A total of 685 patients were included and divided into chemoradiotherapy and radiotherapy groups,and 400 patients were included after propensity score matching.The chemoradiotherapy group had higher OS in the matched cohort(hazard ratio[HR]=0.7367;95%confidence interval[CI]:0.5906–0.9190;P=0.0049)than the radiotherapy group,which was similar to that in the pre-matched cohort(P<0.0001).Patients who had undergone surgery+radiotherapy with or without chemotherapy showed higher OS rates than those who had received radiotherapy with or without chemotherapy for patients aged<75 years and local tumor excision/destruction or surgical removal of the primary site was the recommended surgical choice(P<0.05).Chemoradiotherapy is sufficient for patients 75 years of age.Conclusions:Patients with metastatic vulvar cancer should undergo surgery if they can tolerate it.Adjuvant chemoradiotherapy should be encouraged because this treatment modality was associated with higher OS than radiotherapy alone.
文摘Sentinel lymph node （SLN） biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors （≤ 2 cm diameter or stage ≤ IB2） where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refnement of appropriate patient selection and long-term follow-up are necessary.
文摘Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical exploration.Our case supports the principles of adjuvant therapy for breast cancer to be applied to ectopic breast cancer arising in the vulva. A literature review highlights common key points in similar cases to guide management.
文摘The study of Gynaecology over the years has been influenced by the culture and social attitudes of society to the body as a whole and to the genital organs in particular. Variations in these attitudes between different cultures and at different times have influenced the subsequent rate of progress in the study of the vulva and its diseases.
文摘AIM： To analyze the major complications after exenteration of gynecological and rectal malignancies.METHODS： Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration （PE） between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases （vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin＇s gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases （cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively）. Posterior PE, total PE and anterior PE were most often performed.RESULTS： Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients （42.9%）. Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome （ARDS）, thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies.CONCLUSION： PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.
