Curated Papers > Recent high-impact research on "mRNA vaccines" (IF≥30, last 5 years)

Comprehensive management of vulvovaginal cancers.

Literature Information

DOI	10.3322/caac.70014
PMID	40377134
Journal	CA: a cancer journal for clinicians
Impact Factor	232.4
JCR Quartile	Q1
Publication Year	2025
Times Cited	2
Keywords	vulvovaginal carcinoma, vulvovaginal melanoma, vulvovaginal sarcoma
Literature Type	Journal Article, Review
ISSN	0007-9235
Pages	410-435
Issue	75(5)
Authors	Angélica Nogueira-Rodrigues, Maaike H M Oonk, Domenica Lorusso, Brian Slomovitz, Mario M Leitão, Glauco Baiocchi

TL;DR

Vulvar and vaginal cancers are rare malignancies predominantly affecting older women, with a significant association to HPV infections, and while surgical intervention is the primary treatment, limited systemic options for recurrent cases lead to low survival rates. This review highlights the need for improved treatment strategies, increased clinical trial participation, and the psychosocial considerations of care, alongside advocating for HPV vaccination to potentially reduce future incidence.

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vulvovaginal carcinoma · vulvovaginal melanoma · vulvovaginal sarcoma

Abstract

Vulvar and vaginal cancers represent rare malignancies, with an incidence of 2.7 per 100,000 women for vulvar cancer, predominantly affecting women older than 60 years, although rising rates are observed in younger demographics. Approximately 90% of vulvar cancers are squamous cell carcinoma and frequently are associated with human papillomavirus (HPV) infection. Vaginal cancer, constituting less than 1% of all female cancers, similarly exhibit HPV-related trends. This review delineates the etiology, histopathology, and treatment strategies for carcinomas and vulvovaginal melanomas and sarcomas. Surgical intervention remains the primary treatment modality for vulvar cancer, involving tumor resection and inguinofemoral lymph node staging. For locally advanced vulvar carcinoma, chemoradiation is advised when exenterative surgery would be indicated. Recurrence rates within 2 years after diagnosis range from 12% to 37%. Unfortunately, systemic treatments for recurrent or metastatic disease are limited, with 5-year survival rates at approximately 20%. Current evidence primarily derives from retrospective studies or small phase 2 trials or otherwise is extrapolated from the treatment of cervical cancer. Enrollment in clinical trials is strongly advocated, along with prompt access to best supportive care to mitigate the effect of locoregional progression on quality of life. Moreover, the psychosocial implications of treatment on body image and sexuality necessitate careful consideration. Future HPV vaccination initiatives may reduce cancer incidence, although significant effects of such vaccination will manifest over decades, underscoring the urgent need to enhance treatment efficacy and minimize morbidity in vulvar and vaginal cancers.

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Primary Questions Addressed

1. What are the latest advancements in surgical techniques for vulvovaginal cancers?
2. How do HPV vaccination initiatives specifically target the prevention of vulvar and vaginal cancers?
3. What are the psychosocial support strategies that can help patients cope with the impact of vulvovaginal cancer treatment on body image?
4. How do recurrence rates for vulvar cancer compare to those of other gynecological cancers, and what factors contribute to these differences?
5. What role do clinical trials play in the development of new systemic treatments for recurrent vulvovaginal cancers?

Key Findings

Research Background and Objectives

Vulvar and vaginal cancers are rare malignancies, with vulvar cancer having an incidence of 2.7 per 100,000 women, predominantly affecting older women but increasingly seen in younger demographics. The majority of vulvar cancers (90%) are squamous cell carcinomas (SCCs), often linked to human papillomavirus (HPV) infection. This review aims to detail the etiology, histopathology, and treatment strategies for vulvovaginal carcinomas, including melanomas and sarcomas, while highlighting the need for improved management strategies and supportive care.

Main Methods/Materials/Experimental Design

The review employs a comprehensive analysis of existing literature on vulvovaginal cancers, focusing on:

• Diagnosis and Staging: Utilizing clinical examinations, imaging techniques (MRI, CT, and PET scans), and histopathological assessments.
• Treatment Modalities: Surgical interventions remain the cornerstone, supplemented by chemoradiation for advanced cases. The review emphasizes the importance of sentinel lymph node (SLN) biopsy in staging and managing early-stage vulvar cancer.

Key Results and Findings

• Incidence and Risk Factors: The rising incidence of vulvar cancer in younger women is attributed to HPV. Factors such as smoking and immunosuppression also increase risk.
• Treatment Outcomes: Surgical resection is the primary treatment for localized disease, with chemoradiation indicated for locally advanced cases. Recurrence rates post-treatment range from 12% to 37%, with a 5-year survival rate for advanced cases at approximately 20%.
• Psychosocial Impacts: The treatment of vulvovaginal cancers significantly affects patients' body image and sexuality, necessitating integrated psychosocial support.

Main Conclusions/Significance/Innovations

The review underscores the need for a comprehensive management approach for vulvovaginal cancers, emphasizing:

• The importance of clinical trials to improve treatment efficacy.
• The potential of HPV vaccination programs to reduce incidence rates in the long term.
• The necessity for supportive care to address the physical and psychological impacts of these cancers.

Research Limitations and Future Directions

• Limitations: The review primarily relies on retrospective studies and small phase II trials, highlighting a lack of large-scale clinical trials specifically targeting vulvovaginal cancers.
• Future Directions: There is an urgent need for enhanced treatment strategies, particularly for recurrent and metastatic cases. Further research into HPV vaccination's long-term effects and innovative treatment options, such as immunotherapy and targeted therapies, is essential to improve patient outcomes.

Summary Table of Treatment Modalities

Treatment Type	Description	Indications
Surgical Intervention	Tumor resection and lymphadenectomy	Localized vulvar cancer
Chemoradiation	Combination of chemotherapy and radiation	Locally advanced vulvar cancer
SLN Biopsy	Assessment of lymph node involvement	Early-stage vulvar cancer
Supportive Care	Psychological and physical rehabilitation	All stages, particularly post-treatment

This structured summary encapsulates the critical aspects of vulvovaginal cancer management as discussed in the review article, highlighting the need for comprehensive care and future research directions.

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Literatures Citing This Work

1. Comprehensive management of vulvovaginal cancers. - Angélica Nogueira-Rodrigues;Maaike H M Oonk;Domenica Lorusso;Brian Slomovitz;Mario M Leitão;Glauco Baiocchi - CA: a cancer journal for clinicians (2025)
2. Comparative Evaluation of Three Primary Antibody Clones for p16 Immunohistochemistry in Gynecologic Tumors. - Hiroshi Yoshida;Ayumi Sugitani;Mayumi Kobayashi-Kato;Masaya Uno;Mitsuya Ishikawa - Antibodies (Basel, Switzerland) (2025)

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