A retrospective study of clincal profile and treatment outcome of vulvar cancer patients attended at ORCI from January 2006 to December 2017

Abstract

ABSTRACT Background Vulva includes labia majora, mons pubis, labia minora, clitoris, vestibule of the vagina, bulb of the vestibule, greater and lesser vestibular glands, and vaginal orifice. Vulvar cancer is type of cancer that affects external genital organs that protect a woman's reproductive system. It commonly appears at labia majora. less frequently involve the labia minora, perineum, clitoris, and Mons. In 10% of cases, the lesion is too extensive to determine the actual site of origin. About 5% of cases have multifocal lesions i.e. all vulvar and perianal skin surfaces, as well as the cervix and vagina, should be evaluated. A synchronous second malignancy, most commonly cervical neoplasia, is found in up to 22% of patients with a vulvar malignancy.

An increase in incidence of vulva cancer has been seen worldwide for two decades now. Less than 20% of cases are women younger than 50 years, and more than 50% occur in women over the age of 70 years. The average age of diagnosis of invasive VC is 70 years where as non-invasive VC average age is about 20 years younger. In our region i.e., East Africa and Tanzania per se there is paucity of vulva cancer studies and currently the vulva cancer incidence is increasing where by more studies are needed to give out clear picture of the disease.

Objectives This study aimed to describe vulva cancer social demographic characteristics like age, clinical characteristics of the disease, stage of the disease at the time of diagnosis, histological type and grade, clinical signs and symptoms, associated factors for VC such as HIV status and pre-existing genital warts, treatment intent and modality and treatment outcome in terms of symptoms relief and disappearance and one year overall survival for all patients attended at ORCI from January 2006 to December 2017.

Methods Retrospective cohort study conducted at ORCI for all those patients with histological confirmed primary vulva cancer who fits inclusion criteria attended between January 2006 to December 2017. Data were collected by using Data extracting form extracting information from the patient’s files then processed by using SPSS version 24. Also measures of Descriptive statistics were used in analysing some of the clinical and demographic data like age, stage of the disease and grade. Survival rate was estimated by using the date of diagnosis and date of death or date of last visit. Cox proportional hazard model was used to examine various factors with time to death hazard ratios (HRs) and 95% confidence interval is presented. Two sided P-value < 0.05 is considered as statistically significant.

Results Total number of 61 cases attended during study period of 12 years were analysed.9 cases were = or > 60 years (14.80%) and 52 cases were < 60 years (85. 2%), 37 were HIV positive (60.70%),19 were HIV negative (31.10%). Main reasons for consultation was lesion at the vulva (100%).Other symptoms include pain (83.60%) pruritis (36.10%) watery discharge and foul smelling vagina discharge (26.20%). Common histology types were squamous cell carcinoma 90.20%, others were adeno carcinoma, basal cell carcinoma and verrucous carcinoma were 3.3%, 3.3% and 3.3% respectively. Grade I tumours were 47.5% followed by grade II 21.3%. Grade III and IV were 13.1%.18% of the cases tumor grades not known. Only 4 cases were staged (6.5%), all were stage III and IV. Only 2 cases (3.3%) received curative treatment, remaining 59 cases (96.7%) were given palliative treatment. The most common treatment modality used was CCRT (44.3%), others were RT alone 34.4%, medical palliation 16.4%, surgery and radiotherapy 1.6%, surgery alone 1.6% and chemotherapy alone was 1.6%. Symptoms relief was found in 68.9% of the cases, it was associated with treatment modality, RT technique, RT Dose and RT Field used. It was also observed that HIV negative cases survived more than HIV positive cases, the median 1-year overall survival for HIV negative patients was higher (4 months) than that of HIV positive cases (3 months).

Conclusion VC common occurs at younger below 60 years (85.2%). Was associated with HIV infection. Few cases which were staged had advanced disease. Majority were given palliative treatment with poor outcome in terms of symptom relief.1year Overall survival is still very poor. HIV infection and treatment modalities are the factors which affects survival. There was no relationship between age and survival status

Recommendation Since it occurs more common to younger age, awareness to the community should be increased so that people to avoid the risk factors which predispose them to the disease, also it will make them to do early consultation to the health facilities once they start to experience signs and symptoms of disease. Health care provider also will know early clinical signs and symptoms for early diagnosis or early referral for those facilities which they can’t diagnose, which might lead to early initiation of treatment with good outcome and increased survival.