What are other Names for this Condition? (Also known as/Synonyms)

• Invasive Squamous Cell Carcinoma of Vulva
• SCC of Vulva
• Vulvar Squamous Cell Carcinoma

What is Squamous Cell Carcinoma of Vulva? (Definition/Background Information)

• Squamous Cell Carcinoma (SCC) of Vulva is a rare, malignant condition affecting the skin and mucosal membranes of the vulva (area around the external vaginal opening), generally in middle-aged and older women. They develop from in situ Squamous Cell Carcinoma of Vulva
• The development of vulvar cancer occurs slowly and the process of pre-cancerous changes (dysplasia) leading onto invasive cancer, generally takes place over years. Cancers that originate in the vulva are called primary vulvar cancers. Even though such cancers are rare, a vast majority of cancers arising from the vulva are squamous cell carcinomas (around 80%)
• Also, in general, Primary Squamous Cell Carcinomas of Vulva are rare. In a majority of cases, SCC of Vulva occurs due to the progression of SCC of uterine cervix, which is then known as Secondary Invasive SCC of Vulva
• Almost all vulvar cancers are believed to originate from a premalignant lesion, known as high-grade squamous intraepithelial lesion (HSIL) or vulvar intraepithelial neoplasia (VIN) types 2 or 3. Its association with high-risk human papilloma virus (HPV) is responsible for a transformation to squamous cell carcinomas
  • Low-risk squamous intraepithelial lesion (LSIL) usually consists of squamous cells that are well-differentiated (such as keratinizing squamous cells)
  • High-risk squamous intraepithelial lesion (HSIL) or vulvar intraepithelial neoplasia (VIN) consists of moderately-to-poorly-differentiated squamous cells (non-keratinizing squamous cells)
• Squamous Cell Carcinoma of Vulva is not always associated with HPV infection. The cancer can also arise due to inflammatory conditions including lichen planus and lichen sclerosus affecting the vulva. In such circumstances, the cancer occurs from a HPV-negative SIL proliferation
• The signs and symptoms of Vulvar Squamous Cell Carcinoma include the presence of a nodule or an ulcer, abnormal vaginal bleeding or discharge, and pain during sex. The complications are dependent upon the stage of the cancer and may also include treatment complications
• Treatment for Squamous Cell Carcinoma of Vulva is mainly through surgery and other supplementary treatment measures. The prognosis depends on many factors including the cancer stage, overall health of the individual, and histological subtype

There are many histological variants of Squamous Cell Carcinoma (NOS) of Vulva and these include the following:

• Squamous Cell Carcinoma of Vulva , Keratinizing type
• Squamous Cell Carcinoma of Vulva , Non-Keratinizing type
• Squamous Cell Carcinoma of Vulva , Basaloid type
• Warty (Condylomatous) Squamous Cell Carcinoma of Vulva
• Verrucous Carcinoma of Vulva

The above-mentioned variants are classified based upon the microscopic findings, when examined by a pathologist under a microscope. This sub-classification of tumor may dictate the type of treatment to be provided and the prognosis of the cancer.

Who gets Squamous Cell Carcinoma of Vulva? (Age and Sex Distribution)

• Squamous Cell Carcinoma of Vulva usually affects women, who are between the ages of 30 and 60 years. Typically, the higher the age, the greater is the risk
• In general for vulvar cancers, over 80% of the cases are seen in women older than 50 years
• The condition is observed around the world; it has no geographical, racial, or ethnic preference

What are the Risk Factors for Squamous Cell Carcinoma of Vulva? (Predisposing Factors)

Squamous Cell Carcinoma of Vulva develops from SCC in situ that develops due to HPV-associated and high-grade SIL or vulvar intraepithelial neoplasia (VIN), or from non-HPV related VIN.

The risk factors that contribute to its formation include:

• Human papilloma virus (HPV) infection that is transmitted sexually. The subtypes responsible include 16 (in a majority of cases), 18, 31, 33, and 45. The low-risk HPV subtypes include 6 and 11
• Sexual promiscuity (multiple sexual partners) and high-risk sexual behavior including unprotected sex
• Weakened immune system due to many reasons, such as organ transplant, old age, HIV/AIDS infection, or due to administration of immune suppressing drugs
• Chronic and longstanding vulvar diseases that include lichen planus and lichen sclerosus: Around 1 in 16 women with lichen sclerosus of the vulva may develop cancer, particularly those with significant signs and symptoms and have a post-menopausal status. In such cases, if precancerous atypical squamous hyperplasia is present, then the disease advancement risk is also higher
• Smoking of tobacco
• Poor personal hygiene
• Cervical cancer, including precancers, can increase the risk for cancer of the vulva
• Use of oral contraceptives for long time duration
• Having the first child at a young age (before 17 years) and having had multiple pregnancies
• Presence of other sexually-transmitted infections (such as chlamydia)
• Chronic inflammation, in some cases
• A diet lacking fruits and vegetables
• Poverty or poor socioeconomic status

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Squamous Cell Carcinoma of Vulva? (Etiology)

Untreated (or delayed treatment of) squamous cell carcinoma in situ can result in Squamous Cell Carcinoma of Vulva.

• The exact cause of development of squamous cell carcinoma in situ of vulva is not completely known in a majority of cases
• In case HPV infection is associated with SCC in situ of vulva, it is caused by alteration in the DNA by the human papilloma virus that results in uncontrolled cell proliferation. HPV association is seen in most cases of Vulvar SCC
• Non-HPV related cause may include the presence of untreated well-keratinizing-type vulvar intraepithelial neoplasia (VIN)
• Other factors that may contribute to the condition include compromised immune system, sexual promiscuity, smoking, and even poor hygiene

What are the Signs and Symptoms of Squamous Cell Carcinoma of Vulva?

The signs and symptoms of Squamous Cell Carcinoma of Vulva may include:

• The presence of a poorly-defined single red lesion on the vulva; the solitary tumor may occur as a wart, nodule, macule, bag-like mass (pedunculated mass), or as an ulcer
• The lesion or tumor may grow and there may be itching sensation, pain, ulceration, and bleeding
• Ulceration may cause the lesion to have a raised form with well-defined and firm edges
• There may be pain and discomfort during sex
• Foul-smelling odor may emanate from the lesion
• Vaginal bleeding or discharge may be observed
• Urinary tract associated signs and symptoms such as frequent urination, painful urination, blood in urine (hematuria), etc.
• If the urinary bladder is involved, then it may obstruct the bladder and lead to retention of urine
• During the course of tumor development, the malignant lesion does not remain confined to the skin surface, but may invade the adjacent tissues and structures and/or even metastasize (commonly to the inguinal lymph nodes)

Usually, there are no symptoms, during the pre-cancer and early cancer stages (with small-sized tumors).

How is Squamous Cell Carcinoma of Vulva Diagnosed?

A diagnosis of Squamous Cell Carcinoma of Vulva may be made by using the following resources:

• Preliminary examination composed of:
  • Complete physical examination including pelvic exam
  • Evaluation  of medical (and family) history
• HPV DNA testing can be used as a tool to help screen for infections and administer vaccines
• Initial diagnosis that is made by:
  • Transvaginal ultrasound of the uterus can provide an image of the vagina and surrounding pelvic organs
  • MRI scans can be used to observe if a vulvar tumor has the characteristics of cancer, along with visualizing the cancer spread (if it has spread to other areas)
  • Plain radiographs of the chest can provide evidence if the tumor has spread to the lungs
  • CT scans are not commonly used in diagnosing vulvar cancer, but can be used to determine if metastasis has occurred

Blood tests to aid in the diagnostic process may include:

• Complete blood count (CBC) with differential of white blood cells
• Liver function test and kidney function test
• Blood tests called serum tumor markers that include:
  • CA-125 test
  • Human chorionic gonadotropin (hCG)
  • Alpha-fetoprotein (AFP)
  • Lactate dehydrogenase (LDH)
  • Inhibin (hormone)
  • Estrogen and testosterone levels

Some of the definitive tests that help in diagnosing the cancer include:

• Colposcopy:
  • The cervix (including the vagina and vulva) is examined with an instrument, called a colposcope. This helps the physician get a magnified view of the cervix
  • In order for this procedure to be performed, the individual has to lie on a table, as for a pelvic exam. An instrument, called the speculum, is placed in the vagina to keep the opening apart, in order to help the physician visualize the cervix. The colposcope is then used to get a magnified view of the inside

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Core biopsy of the tumor
• Open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

If a diagnosis of cancer is made on biopsy, further imaging (or other) studies may be conducted. These include:

• Ultrasound scan of the abdomen
• CT or CAT scan with contrast of the abdomen and pelvis may show a well-defined mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
• MRI scans of the abdomen and pelvis: Magnetic resonance imaging (MRI) uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
• X-ray of the abdomen and pelvic region
• Chest X-ray: Chest X-rays are used to detect if the cancer has spread to the lung
• Barium enema X-ray
• Vascular radiological studies of abdomen and pelvic region
• Positron emission tomography (PET scan): A PET scan is a nuclear medicine imaging technique that uses three-dimensional images to show how tissue and organs are functioning. A small amount of radioactive material is required with this test. The radioactive material may be injected into a vein, inhaled, or swallowed. It may be performed to see if the cancer has metastasized/spread to other regions
• Cystoscopy (to look at the inside of the bladder)
• Proctoscopy (to look at the inside of the rectum)
• Sometimes, an intravenous pyelogram (to find any abnormality/blockage in the urinary tract) may be conducted
• Whole body bone scan

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are possible Complications of Squamous Cell Carcinoma of Vulva?

The possible complications of Squamous Cell Carcinoma of the Vulva include:

• Ulceration of large tumor masses may get secondarily infected with bacteria or fungus
• The tumor may also adversely impact adjoining/surrounding structures, such as the nerves and joints, leading to discomfort or a loss of feeling
• The cancer can also spread to distant organs, such as to the lungs, peritoneum (abdominal cavity), liver, and GI tract
• Topical therapy for initial stage cancers can result in side effects such as severe vaginal and vulvar irritations
• Side effects of chemotherapy (such as toxicity) and radiation
• Sexual dysfunction can take place as a side effect of surgery, chemotherapy, or radiation therapy
• Recurrence of the cancer following incomplete surgical removal is known to occur

How is Squamous Cell Carcinoma of Vulva Treated?

Once a diagnosis of vulvar cancer has been made, the extent to which the tumor has spread is assessed, known as staging. The staging for vulvar cancer is based upon the FIGO (International Federation of Gynecology and Obstetrics) and the AJCC (American Joint Committee on Cancer) TNM staging systems.

The TNM classification for vulvar cancer is given below:

Tumor extent (T):

• Tis: The cancer is not growing into the underlying tissues. This stage, also known as carcinoma in situ, is not included in the FIGO system
• T1: The cancer is growing only in the vulva or perineum
  • T1a: The cancer has grown no more than 1 mm into underlying tissue (stroma) and is 2 cm or smaller in size (about 0.8 inches)
  • T1b: The cancer is either more than 2 cm or it has grown more than 1 mm into underlying tissue (stroma)
• T2: The tumor can be any size. The cancer is growing into the anus or the lower third of the vagina or urethra (the tube that drains urine from the bladder). This is called stage 2/3 in the FIGO system
• T3: The tumor can be any size. The cancer is growing into the upper urethra, bladder or rectum or into the pubic bone. This is called stage 4 in the FIGO system

Lymph node spread of cancer (N):

• N0: No lymph node spread
• N1: The cancer has spread to 1 or 2 lymph nodes in the groin with the following features:
  • N1a: The cancer has spread to 1 or 2 lymph nodes and the areas of cancer spread are both less than 5 mm (about 1/5th of an inch) in size
  • N1b: The cancer has spread to one lymph node and the area of cancer spread is 5 mm or greater
• N2: The cancer has spread to groin lymph nodes with the following features:
  • N2a: The cancer has spread to 3 or more lymph nodes, but each area of spread is less than 5 mm
  • N2b: The cancer has spread to 2 or more lymph nodes with each area of spread 5 mm or greater
  • N2c: The cancer has spread to lymph nodes and has started growing through the outer covering of at least one of the lymph nodes (called extracapsular spread)
• N3: The cancer has spread to the lymph nodes causing open sores (ulceration) or causing the lymph node to be stuck (fixed) to the tissue below it

Distant spread of cancer (M):

• M0: No distant spread
• M1: The cancer has spread to distant sites (includes spread to pelvic lymph nodes)

Stage grouping: Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage in a process called stage grouping. The stages identify tumors that have a similar outlook and are treated in a similar way.

Stage 0 (Tis, N0, M0):

• This is a very early cancer found on the surface of the skin of the vulva only. It is also known as carcinoma in situ and as Bowen disease
• This stage is not included in the FIGO system

Stage I (T1, N0, M0):

• The cancer is in the vulva or the perineum (the space between the rectum and the vagina) or both
• The tumor has not spread to lymph nodes or distant sites
• Stage IA (T1a, N0, M0):
  • These are stage I cancers with tumors that are 2 cm or less that have grown into the underlying tissue no deeper than 1 mm (about 1/25 inch)
• Stage IB (T1b, N0, M0):
  • These are stage I cancers that have invaded deeper than 1 mm and/or are larger than 2 cm

Stage II (T2, N0, M0):

• The cancer has grown outside the vulva or perineum to the anus or lower third of the vagina or urethra (T2)
• It has not spread to lymph nodes (N0) or distant sites (M0)
• In FIGO, this grouping is T2/T3, N0, M0, but it is still stage II

Stage III is subdivided into 3 stages that are termed as Stage IIIA, Stage IIIB, and Stage IIIC.

Stage IIIA (T1 or T2, N1a or N1b, M0):

• Cancer is in the vulva or perineum or both (T1) and may be growing into the anus, lower vagina, or lower urethra (T2)
• Either it has spread to a single nearby lymph node with the area of cancer spread 5 mm or greater in size (N1a);
• OR it has spread to 1 or 2 nearby lymph nodes with both areas of cancer spread less than 5 mm in size (N1b). It has not spread to distant sites (M0)

In FIGO, this stage is also IIIA, but it is split into IIIAi and IIIAii.

• Stage IIIAi (T1 or T2, N1a, M0):
  • The cancer is in the vulva or perineum and may be any size and growing into the anus, lower vagina, or lower urethra (T1 or T2)
  • It has spread to a single lymph node with the area of spread 5 mm or greater in size (N1a)
  • It has not spread to distant sites (M0)
• Stage IIIAii (T1 or T2, N1b, M0):
  • The cancer is in the vulva or perineum and may be any size and growing into the anus, lower vagina, or lower urethra (T1 or T2)
  • It has spread to 1 or 2 lymph nodes with the areas of cancer spread less than 5 mm in size (N1b)
  • It has not spread to distant sites (M0)

Stage IIIB (T1 or T2, N2a or N2b, M0):

• Cancer is in the vulva or perineum or both (T1) and may be growing into the anus, vagina, or lower urethra (T2)
• Either, the cancer has spread to 3 or more nearby lymph nodes, with all areas of cancer spread less than 5 mm in size (N2a)
• OR the cancer has spread to 2 or more lymph nodes with each area of spread 5 mm or greater in size (N2b)
• The cancer has not spread to distant sites (M0)

In FIGO, this stage is also IIIB, but it is split into IIIBi and IIIBii.

• Stage IIIBi (T1 or T2, N2a, M0):
  • The cancer is in the vulva or perineum and may be any size and growing into the anus, lower vagina, or lower urethra (T1 or T2)
  • The cancer has spread to 3 or more nearby lymph nodes, with all areas of cancer spread less than 5 mm in size (N2a)
  • It has not spread to distant sites (M0)
• Stage IIIBii (T1 or T2, N2b, M0):
  • The cancer is in the vulva or perineum and may be any size and growing into the anus, lower vagina, or lower urethra (T1 or T2)
  • The cancer has spread to 2 or more lymph nodes with each area of spread 5 mm or greater in size (N2b)
  • It has not spread to distant sites (M0)

Stage IIIC (T1 or T2, N2c, M0):

• Cancer is in the vulva or perineum or both (T1) and may be growing into the anus, lower vagina, or lower urethra (T2)
• The cancer has spread to nearby lymph nodes and has started growing through the outer covering of at least one of the lymph nodes (called extracapsular spread; N2c)
• The cancer has not spread to distant sites (M0)

In FIGO, this stage is also called IIIC.

Stage IV is subdivided into 2 stages that are termed as Stage IVA and Stage IVB.

• Stage IVA: Either of the following -
• T1 or T2, N3, M0:
  • Cancer is in the vulva or perineum or both (T1) and may be growing into the anus, vagina, or lower urethra (T2)
  • Cancer spread to nearby lymph nodes has caused them to be stuck (fixed) to the underlying tissue or caused open sores (ulceration) (N3)
  • It has not spread to distant sites

In FIGO, this stage is also called IVA.

OR

• T3, any N, M0:
  • The cancer has spread beyond nearby tissues to the bladder, rectum, pelvic bone, or upper part of the urethra (T3)
  • It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant sites (M0)

In FIGO, this stage is also IVA.

• Stage IVB (any T, any N, M1):
• Cancer has spread to distant organs or lymph nodes (M1)
• This is the most advanced stage of cancer

In FIGO, this stage is also IVB.

(Source: “The FIGO/AJCC system for staging vulvar cancer”; information provided by the American Cancer Society, February 2016)

Vulvar cancers are treated using several methods depending on the stage of the cancer:

In situ and initial stage cancers: Stage 0 and Stage I

• Vulvar intraepithelial neoplasia (VIN, or vulvar precancer) may be treated using topical applications, laser surgery, or local excisional surgery
• A lesser-invasive procedure, called ultrasound surgical aspiration, may be used to break the tumor into smaller segments and destroy them using ultrasound vibrations
• In some cases, a minor procedure known as skinning vulvectomy may be undertaken, which is followed through by surgical skin grafts to cover the surgery site
• Stage I cancers are removed either through wide local excisional surgery or radical local excisional surgery. In case lymph node involvement is noted, then the local lymph nodes are also removed
• Radiation therapy may be an option for individuals in whom surgical intervention is not possible

Higher stage cancers: Stage II to Stage IV

• Large-sized tumors may be removed through radical vulvectomy, modified radical vulvectomy, or by performing a radical local excisional surgery. In case the lymph nodes are involved, then they are also removed
• Radiation therapy may be an option for individuals in whom surgical intervention is not possible, or following surgery to destroy the remaining cancer cells
• Chemotherapy may be considered before or following surgery, either independently, or in combination with radiation therapy
• Advanced stage cancers (stage IV) are treated through a combination of radical vulvectomy, pelvic exenteration (if necessary), and radation therapy and/or chemotherapy
• Individuals who cannot withstand radical surgical procedures may be treated by a combination of radation therapy and chemotherapy. They may also be recommended for clinical trials

Recurrent cancers are treated on a case-by-case basis based on their stage and site of recurrence. They are treated through radical vulvectomy and/or pelvic exenteration invasive techniques. Often, a combination of treatment measures may be used by the healthcare providers (including recommendation for clinical trials, when recurrence is associated with higher stage cancers). Advanced stage tumors with metastasis may be treated on a case-by-case basis; often symptomatic treatment with radiation and/or chemotherapy is attempted.

The treatment of Squamous Cell Carcinoma of Vulva involves surgery, which is the most common treatment option considered.

Surgery:

• Laser ablation to remove solid tumors
• Vulvectomy: It is a surgical intervention technique to remove a part or the entire vulva. It may be of the following types:
  • If only the top layer of the skin over the vulva is removed, it is known as skinning vulvectomy. This procedure also involves the use of skin grafts (taken from other body sites) to cover surgical site
  • If only a portion of the vulva is removed, which may or may not be accompanied by removal of the affected lymph nodes; then, it is known as modified radical vulvectomy
  • If the entire vulva that is affected by cancer is removed, then it is called a radical vulvectomy. In such cases, the local lymph nodes are also removed. The entire vulva may include the clitoris and the inner and outer lips of the vagina
• Pelvic exenteration: It is an extensive surgical procedure wherein the entire vulva, the vagina, the surrounding tissues, and the pelvic lymph nodes are removed. In addition, depending on the extent of tumor spread, parts affected around the region (such as the cervix, urinary bladder, rectum, colon, etc.) may be removed. Recovery from this surgery usually takes a long period

Chemotherapy:

• Medications are used to kill the tumor cells, which may be given as oral pills or injected into veins
• A combination of chemotherapy medications may be used
• Chemotherapy may be used in addition to radiation and/or surgery, to treat cancers that have spread or recurred. When chemotherapy and radiation therapy are used together, it is called concurrent chemoradiation
• Side effects of chemotherapy may include nausea, vomiting, hair loss, loss of appetite, diarrhea, fatigue, increased risk of infection, mouth sores, and easy bruising, depending on the drugs used

Radiation therapy:

• This procedure uses high-energy beams to kill the cancer cells
• These beams may be delivered from outside the body (external beam radiation therapy) or the radioactive material maybe placed inside the vagina (internal radiation therapy or brachytherapy)
• Possible side effects may include:
  • Fatigue, nausea, vomiting, and diarrhea
  • Bladder irritation, leading to inflammation (cystitis)
  • Ovaries may be affected resulting in menstrual changes, or premature menopause
  • The vulva and vagina may be affected, causing soreness, or even scar tissue formation

Once treatment is complete, it is recommended that the individual schedule regular check-ups, based on the recommendation of the specialist treating them. 

How can Squamous Cell Carcinoma of Vulva be Prevented?

Squamous Cell Carcinoma of Vulva may be prevented through the timely and adequate treatment of Vulvar SCC in situ. Some steps for the prevention of SCC of Vulva may include:

• Use of measures to prevent sexually-transmitted infections, such as usage of condoms, avoiding multiple sexual partners, and circumcision in men
• Vaccination against human papilloma virus (HPV):
  • Two vaccines have been studied and approved for use in the United States - Gardasil (against HPV types 6, 11, 16, and 18) and Cervarix (against HPV types 16 and 18)
  • Cervarix has been approved for use in females aged 10-25 years, while Gardasil may be used in the 9-26 years age group
  • The American Cancer Society recommends routine vaccination of girls at 11-12 years of age
  • HPV vaccines are not successful against women who are already infected though
• Timely and adequate treatment of vulvar disease such as lichen planus and lichen sclerosus
• Avoidance of smoking

Due to its high metastasizing potential and recurrence rate, regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory for those who have already been treated for this cancer.

What is the Prognosis of Squamous Cell Carcinoma of Vulva? (Outcomes/Resolutions)

• According to the US National Cancer Institute (NCI) database, the 5-year survival rate for vulvar cancers range from 86% for local cancers that do not show nearby lymph node involvement, to 16% for cancers that have spread to other organs and body sites (say stage IV)
• FIGO stage IA prognosis of Squamous Cell Carcinoma of Vulva for 5 years is 100% (without recurrence); for 10 years, it is 95% (with no recurrence being noted)
• The involvement of lymph nodes (metastasis due to angiolymphatic vascular invasion) is a very big factor that adversely affects the prognosis. The factors favoring recurrence include:
  • Tumor size over an inch (over 2.5 cm)
  • Multifocal tumor: The tumor arises from discontinuous portions of the vulva. This often occurs, because the HPV affects large portions of the vulvar tissue potentially resulting in multifocal cancer development
  • Presence of high-grade squamous intraepithelial lesion (HSIL)
  • And positive margins on a surgically removed tissue
• The tumors that arise from well-differentiated keratinizing squamous intraepithelial lesion of vulva may also have a higher chance of recurrence
• In general, the prognosis for Squamous Cell Carcinoma of Vulva depends upon a set of several factors that include:
  • The size of the tumor and the extent of its invasion: Individuals with small-sized tumors fare better than those with large-sized tumors
  • Stage of cancer: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • Morphological subtype/variant of the cancer
  • Cell growth rate of the cancer
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Individuals with bulky disease have a poorer prognosis
  • Involvement of the regional lymph nodes, which can adversely affect the prognosis
  • Involvement of vital organs may complicate the condition
  • The surgical resectability of the tumor (meaning, if the tumor can be removed completely)
  • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur
  • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment
  • Progression of the condition makes the outcome worse
• An early diagnosis and prompt treatment of the tumor generally yields better outcomes than a late diagnosis and delayed treatment
• The combination chemotherapy drugs used, may have some severe side effects (like cardio-toxicity). This chiefly impacts the elderly adults, or those who are already affected by other medical conditions. Individuals, who tolerate chemotherapy sessions better, generally have better outcomes
• It is important to schedule and attend follow-up appointments with the healthcare provider. Many patients with metastatic or locally advanced tumors may be referred for clinical trials for experimental treatment options

Additional and Relevant Useful Information for Squamous Cell Carcinoma of Vulva:

• Cervical cancer is a malignancy of the cervix, which is the lower part of the uterus/womb. It is the 2nd or 3rd most common cancer in women worldwide. A vast majority of cancers arising from the cervix (almost 70 %) are squamous cell carcinomas

The following link can help you understand squamous cell carcinoma of uterine cervix:

http://www.dovemed.com/diseases-conditions/squamous-cell-carcinoma-of-cervix/