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| ORIGINAL ARTICLE |
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| Year : 2016 | Volume
: 13
| Issue : 1 | Page : 46-49 |
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The pattern of carcinoma of the vulva in Zaria, Northern Nigeria
Oguntayo O Adekunle1, Zayyan S Marliyya1, Adewuyi A Sunday2, Kolawole O Abimbola1, Tehemba Richard1, Ismail Habiba1, Koledade A Korede1
1 Department of Obstetric and Gynecology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
2 Department of Radio-oncology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| Date of Web Publication | 12-Feb-2016 |
Correspondence Address:
Oguntayo O Adekunle
Department of Obstetric and Gynecology, Ahmadu Bello University Teaching Hospital, Shika, Zaria
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0331-8540.176045
Background: Cancer of the vulva is a rare gynaecological condition and contributes to about 2.6% of gynaecological malignancies seen in our unit. The prevalence is on the increase and late presentation calls for concern. Objectives: To review the epidemiology of cancer of the vulva within the study period in view of the changing pattern. Methodology: This is a retrospective study of histologically diagnosed vulva cancers seen in our unit between March 2005 and February 2015. The records of the patients were retrieved from our Gynea-oncology register, the Health Management Information Department of the Hospital, cancer registry and the histopathology laboratory. Descriptive statistics were used under excel statistical package to analyse the findings using rates, ratio and proportion. Results: We had a total of 1089 gynaecological malignancies and carcinoma of the vulva accounting for 28 (2.6%) patients. Their ages ranged from 13 to 75 years with a mean of 47 years; parity was 0–14 deliveries with a median of 7 and a mean of 4. Most of the patients were of low socioeconomic class. Eight of the nine patients (88.9%) were managed surgically. Majority of the cases had radical/toilet vulvectomy with inguino-femoral lymphadenectomy and adjuvant radiotherapy because they all presented in the advance stage. The complications included one case of inguinal wound disruption and one case of wound sepsis. There were no deaths. The histological types of cancer of the vulva seen were mainly squamous cell cancer accounting for (22) 78.6%. Others include adenocarcinoma accounted for (3) 10.7%, (2) (7.1%) cases of malignant melanoma and embryonal rhabdomyosarcoma (1) 3.6%. Conclusion: What we see may only be the tip of the iceberg since these old women tend to hide their lesions. The treatment of this disease can be highly successful if only our patients present early and would be able to afford the cost of care. Keywords: Cancer, pattern, vulva
How to cite this article:
Adekunle OO, Marliyya ZS, Sunday AA, Abimbola KO, Richard T, Habiba I, Korede KA. The pattern of carcinoma of the vulva in Zaria, Northern Nigeria. Niger J Basic Clin Sci 2016;13:46-9 |
How to cite this URL:
Adekunle OO, Marliyya ZS, Sunday AA, Abimbola KO, Richard T, Habiba I, Korede KA. The pattern of carcinoma of the vulva in Zaria, Northern Nigeria. Niger J Basic Clin Sci [serial online] 2016 [cited 2023 Jun 8];13:46-9. Available from: https://www.njbcs.net/text.asp?2016/13/1/46/176045 |
| Introduction | |  |
Vulva cancers are relatively rare in our environment and even worldwide.[1],[2],[3],[4] It accounts for about 2.6% of all gynaecological malignancies in our unit whereas in the United States of America, it accounts for 0.6%.[4],[5] The incidence and prevalence is on the increase basically because human papilloma virus (HPV) which is one of the organisms implicated as a risk factor for vulva cancers, especially the squamous cell carcinoma.[6] The advent of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) which compromises the immunity of these patients make the HPV more virulent.[6] Other risk factors for carcinoma of the vulva include early age at onset of sexual intercourse, multiple sexual partners, inflammatory disease of the vulva, for example, granulomatous infection of the vulva, obesity, hypertension, diabetes, prior cervical or vaginal cancers, lichen sclerosis of the vulva, cigarette smoking and lack of Vitamin A.[7],[8],[9] It is a disease of the women in the fifth and sixth decade of life.[7],[8],[9] The mean age varies depending on the histological type.
The vulva consists of the external genital organs of the females that develop from a complex mesodermal tissue called genital eminence. The development of a malignant change can affect any of the following: Labia majora, labia minora, urethral meatus, mons pubis, fourchette, Skene's gland, Bartholin's gland, clitoris, bulb of the vestibule, hymen, vulva vestibule and vagina-introitus is termed vulva cancer.
Vulva intraepithelial neoplasia is the premalignant disease of the vulva with about 20–25% chances of malignant change. It has tendency for spontaneous regression. The earliest and the most common symptom of this disease entity was itching. After some time, bleeding, ulceration or growth on the vulva with offensive discharge are the key symptoms. One important sign to look out for is the enlargement of the inguinal lymph nodes, as this could mark onset of spread through the lymphatics. Other modes of spread are direct or haematogenous spread.
The treatment option depends on the age, stage of the disease and the histological type.
Available treatment options include radiotherapy, chemotherapy, surgery and combination therapy.
This study is very relevant in view of the increasing prevalence, changing pattern of presentation as well as late presentation, which is very peculiar to our situation.
| Methodology | | |
This is a retrospective study of histologically diagnosed vulva cancers seen in our unit between March 2005 and February 2015. The records of the patients were retrieved from our gynae-oncology register, the Health Management Information Department of the Hospital, cancer registry and the histopathology laboratory. A proforma was developed to extract the following information in patients' folder: Age at presentation, parity, ethnic group, religion, age at coitache, previous history of sexually transmitted diseases, symptoms at presentation, stage of the disease, histological type, treatment received and outcome. In this study, early stage was defined as Stages I and II whereas Stages III and IV as late stages.
Descriptive statistics were analysed using excel statistical package to analyse the findings using rates, ratio and proportion.
| Results | | |
During the period under study, a total of 1089 cases of gynaecological cancers were managed. Vulva cancers constituted 2.6% (28). The most common cancer was cervical cancer accounting for 71% (775) whereas the least was fallopian tube cancer accounting for 0.09%.
The mean age for this study was 45.4 years with an age range of 13–85 years. Majority of the women were multiparous with a mean parity of four. Less than 20% of them were nulliparous. The Hausa/Fulani group constituted the majority of the ethnic group. More than 90% of them were married [Table 1].
The most common gynaecological cancer was cervical cancer (71%), whereas fallopian tube cancer (0.09%) was the least. Vulva cancers accounted for 2.6% [Table 2].
Squamous cell carcinoma was the most common histological variant, whereas embryonal rhabdomyosarcoma was the least [Table 3].
A large number of the patients (65%) attained coitache before the age of 18 years [Figure 1].
More than 50% of those who are currently married were in the second, third and fourth order of marriage.
Polygamous type of marriage was predominant among these patients, accounting for 53% type of marriage. Majority of the patients present late at advance stages in 96% (27) of ours and <4% (1) presented early in Stage I.
In view of the late presentation, 88.9% of them had either radical/toilet vulvectomy.
| Discussion | | |
Carcinoma of the vulva has been reported severally as rare,[1],[2] but how rare is this disease entity? In developing nations, we tend to have a relatively high or similar prevalence and incidence when compared to that of the developed nations. In Zaria, there is a prevalence of 2.6%, Lagos 3–5%, Ibadan 1.3% and in the USA 0.6%.[5],[7],[8] While another report has 4–5% in the USA [8] and in Europe, it accounts for <1% of all cancer cases and 7% of vulva and vagina cancers.[5],[9]
The pattern of gynaecological cancers seen in the study showed cancer of the cervix as the most common (71%), then ovarian and the least was fallopian tube cancer accounting for 0.09%, whereas in the USA, cancer of the uterine cervix was the most common, then ovarian whereas carcinoma of the vulva was the least (vulva and vagina accounts 4–6% of all gynaecological cancers).[5] In the United Kingdom, ovarian cancer was the leading gynaecological cancer with vagina and vulva as the least (7%). The worldwide range of vulva cancer was 0.3/100,000 women in Asia to 1.6/100,000 in North America and Europe.[5]
The risk factors are predominant in our settings; early age at coitache of <18 years, multiparity with an average parity of four is equally significant. Although history of cigarette smoking was not sort for, majority of our women in Northern Nigeria do smoke basically because of the closeness to the borders.[10] Knowing fully well that HIV is more prevalent in developing nations and even more evident among the women, with (60%) of them come down with the infection compared to their male counterpart. Poorly treated pelvic infection as well as chronic long-standing infections are all implicated in the risk faced by our women in this part of the world.[8]
The average age of presentation in this study was 45.4, a similar finding was reported from Ibadan (49.7) and Lagos.[5],[8] The age at presentation is relatively early compared to what is obtainable in developed countries and previous study were majority present in the fifth decade of life or post-menopausal period.[5],[8] This change is not unconnected with the HIV/AIDS infection which has a direct relationship with the HPV infection. The immune-compromised patients tend to have low CD4 count with antecedent-AIDS-defining illnesses, such as toxoplasmosis, Kaposi's sarcoma and carcinoma of the cervix. Studies have revealed that 40% of vulva cancers in the USA are HPVrelated.[5],[8] Most likely the percentages will be higher in developing countries because of the prevalence and incidence of HIV, which are relatively higher as we have seen in cases of carcinoma of the cervix.[11],[12] Our HPV prevalence generally varies from one region to another and the reports are not for the general population, most studies reported were either in relation to one disease entity or the other, for example, seroprevalence of HPV immunoglobulin G antibodies among women presenting at the reproductive health clinic of a University Teaching Hospital in Nigeria with a prevalence rate of 42.9%.[13]
The major challenge faced in the management of these patients is based on their late presentation. In our own study, over 96% present late and this was similar to findings in Lagos and Ibadan [Figure 2].[5],[8] In view of the aforementioned, they end up with high morbidity from surgery either because of challenges of primary wound closure from large surface or closure done under tension, sepsis, with high risk of thromboembolism. Majority (88.9%) of them end up with either radical/toilet vulvectomy with inguino-femoral lymphadenectomy and adjuvant radiotherapy because they all present in the advance stage. If picked up early, they can benefit local wide excision with 2 cm tumour-free margin confirmed by the histopathologist.
Squamous cell carcinoma was the most common histological type accounting for 78.6%. This is similar to other studies in the literature.[5],[14],[15] Embryonal rhabdomyosarcoma was the least accounting for only 3.6%.
Vulva cancers used to be very rare, but the prevalence of the disease is fast on the increase which is not unconnected with the prevalence of HIV which has over time influence the HPV prevalence, in view of the aforementioned, it is increasingly important to start creating awareness and even screen women for this supposedly rare cancer that is undergoing a change in pattern.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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