Female External Genital Cancers
Female external genital organ cancers are important in terms of early recognition and appropriate treatment. They are less common among female genital cancers, accounting for 3-5% of all female genital organ cancers.
Female external genital cancers are divided into two groups based on their etiological cause. One group consists of tumors that are more prevalent in older ages and are predominantly squamous cell carcinomas. The other group includes conditions that appear in younger women, typically before the ages of 45-50, and are often associated with factors that increase their incidence, such as human papillomavirus (HPV).
About 40% of female external genital cancers originate from the labia majora. They can also be found less frequently on the labia minora, clitoral region, and perianal area.
The risk of these cancers is increased in patients with a history of tumors in the lower genital tract, those receiving immunosuppressive therapy, and individuals with conditions such as hypertension, diabetes, older age, and a history of HPV infection. Additionally, the presence of pre-cancerous lesions is another factor that raises the risk of vulvar cancers, which are classified as external genital cancers.
One significant aspect of vulvar cancers is that, in cases where previous vulvar biopsies have been performed, or when suspicious areas have been tested using acetic acid staining or biopsy, lesions identified as High-Grade Squamous Intraepithelial Lesions (HGSIL) can sometimes indicate early stromal invasive cancer in adjacent areas or elsewhere in the vulva. This makes the early detection of invasive tumors crucial, as delays or missed diagnoses can lead to significant health concerns.
Another critical factor is the possibility of lymph node metastasis even at an early stage. The presence of lymph node metastasis can significantly affect the prognosis, highlighting the importance of external genital organ cancers. Among female genital cancers, these cancers require specific considerations during surgery, as they are anatomically distinct and can infiltrate the anus and urethra. Inguinofemoral lymph node dissection, and the use of sentinel lymph node procedures, is particularly relevant, as lymph node metastasis directly impacts prognosis. Other factors, such as tumor size, invasion of nearby organs, degree of invasion, the number and size of lymph node metastases, tumor location on the vulva, and pelvic lymph node involvement, directly influence surgical treatment choices and the need for radiotherapy and chemotherapy. Effective use of surgical treatment plays a vital role in the prognosis. For rarer tumors such as vulvar melanoma, staging and treatment choices differ significantly.
Despite their rarity, female external genital organ cancers are crucial due to the necessity of selecting the correct treatment and the effective and appropriate use of treatment modalities.