Multiple primary tumours in women with vulvar neoplasms: a case-control study

Abstract

Summary We sought to determine whether women with in situ or invasive squamous cell vulvar cancer were more likely than other women to have had a previous or concurrent tumour at other anogenital sites. One hundred and fifty-eight women with vulvar cancer were identified who were first diagnosed during 1980-1985, were ages 18-79 years at that time, and were residents of one of three counties in western Washington. Two control groups were selected: (1) from records of hospital pathology departments, a sample of 113 women with certain benign conditions of the vulva; (2) through random digit dialing, a sample of 212 women from the general population of these counties. Information on a history of other cancers, and on sexual, reproductive, medical, and demographic characteristics was collected from cases and controls in at-home interviews. Cases were more likely to report a history of other anogenital cancers than were controls, with relative risks of 3.5-29.8, depending on the type of case group and type of control. These associations were not explained by case-control differences in demographic characteristics or frequency of cervical screening. On the other hand, prior or concurrent non-anogenital cancers were equally common in cases and controls. These results support the hypothesis that the different anogenital cancers have at least one aetiology in common.Recent research suggests that cancers of the cervix, vulva, and anus may share one or more risk factors (Peters et al., 1984;Okagaki, 1984). If this is true, women with cancer at one anogenital site would be at increased risk of developing another anogenital tumour. One way to examine this possibility is to see if women with cancer at a specific anogenital site were more likely than other women to have had a previous or concurrent tumour at another anogenital site.There have been numerous reports of women with squamous cell cancer of the vulva who have had one or more second primary malignancies of the anogenital tract (Taussig, 1940;Cromer, 1963;Day, 1958;Caberra et al., 1966), especially the cervix (Franklin & Rutledge, 1974;Friedrich et al., 1980), that were detected before (McPherson et al., 1963), simultaneous with (Eichner, 1956), or after the vulvar tumour (Diehl et al., 1951). While these reports are intriguing, they were not derived from a defined population, nor were the cases compared to a control group. Using data on cancer incidence rates from the Connecticut Tumor Registry, Schoenberg (1977) showed that women who had cervical cancer were at greater risk for other anogenital malignancies compared with other women. In a hospitalbased, case-control study of vulvar cancer, Mabuchi et al. (1985) found that six of 149 women with vulvar cancer but none of 149 controls had a history of prior urogenital cancer.As part of a case-control study of women with in situ and invasive vulvar cancer, we had the opportunity to examine the hypothesis that multiple anogenital malignancies occur more commonly that would be predicted by chance. (2) a random sampl...

VIN 3: a clinicopathologic review

“…The most frequently affected sites were the labia majora (47), the labia minora (23), and the posterior fourchette (22). Other affected sites were the clitorus (5), mons pubis (1), perineal (14), and perianal (3) areas. Thirteen (76.5%) of the 17 patients with perineal and perianal disease had multifocal disease.…”

“…Husseinzadeh (11) reported an incidence of 35% when coexisting or preexisting condylomata was the objective criterion used, while in a more recent study polymerase chain amplification techniques confirmed HPV in 72% of cases (12) . The role of HPV in multifocal VIN 3, more often symptomatic, and in the multicentricity of other neoplastic lesions on the lower genital tract has been established (13) and emphasizes the need for concomitant cervical, vaginal, and anal examination, preferably by colposcopy, in the evaluation and follow-up of these women (14,15) . As the natural history of the disease has become more clearly defined, extensive and potentially mutilating surgery has little place in the contemporary management of VIN 3, except in extensive multifocal disease (5) .…”

Cervical Adenoid Cystic Carcinoma Coexisting with Multiple Human Papillomavirus-Associated Genital Lesions

“…In fact, about 20% of vulvar cancers are associated with other primary malignancies of the cervix or vagina [25,28]. These studies suggest that the coexistence of several pathologic entities may reflect a common etiology or 'field effect' in these lesions, which is likely to be a sexually transmitted disease, and in the majority of cases, HPV infection [25][26][27]. In several reported cases, basaloid or warty types of VIN were found adjacent to invasive vulvar carcinoma of similar types [20].…”

“…Indeed, several studies have indicated that patients with vulvar neoplasms are at increased risk of developing multiple genital malignancies, synchronously or metachronously, at some time during life [25][26][27]. In fact, about 20% of vulvar cancers are associated with other primary malignancies of the cervix or vagina [25,28].…”

“…Indeed, several studies have indicated that patients with vulvar neoplasms are at increased risk of developing multiple genital malignancies, synchronously or metachronously, at some time during life [25][26][27]. In fact, about 20% of vulvar cancers are associated with other primary malignancies of the cervix or vagina [25,28]. These studies suggest that the coexistence of several pathologic entities may reflect a common etiology or 'field effect' in these lesions, which is likely to be a sexually transmitted disease, and in the majority of cases, HPV infection [25][26][27].…”