Clinical profile and treatment of patients with Vulvar Cancer: experience from a novice Gynecologic Oncology unit in Sub Saharan Africa

Clinical profile and treatment of patients with Vulvar Cancer: experience from a novice Gynecologic Oncology unit in Sub Saharan Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical profile and treatment of patients with Vulvar Cancer: experience from a novice Gynecologic Oncology unit in Sub Saharan Africa Malede Birara, Wondimu Gudu, Tadios Mekonen, Amani Abdu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4297271/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction Vulvar cancer is rare accounting approximately for 4% of gynecologic malignancies. The prevalence of vulvar cancer rising in sub-Saharan Africa primarily attributed to high incidence of HIV infections. This study aims to explore clinic-pathologic profile and treatment of patients at a novice gynecologic oncology unit in Ethiopia. Methodology A descriptive cross-sectional study was conducted, among vulvar cancer patients treated at Saint Paul’s Hospital millennium medical college in Ethiopia, gynecology oncologic unit from 2016 to 2020. Data was collected from patients’ medical records and hospital registries using a simple data extraction format. Data was analyzed using IBM SPSS 23.1 computer statistical software. Results The magnitude of vulvar cancer was 3.6%, with mean age of patients being 42 years. Commonest symptoms were vulvar swelling, itching, and ulceration. The average duration of symptoms was 12 months and 66 percent of patients were HIV positive. The mean lesion size was 5 cm, with squamous cell carcinoma being the most prevalent (82%). Disease was early stage in 56% percent of patients. Fifty seven Percent were given treatment. Surgery was done to 37% of patients, postoperative wound complications rate being 30 percent. 43 percent had Postoperative follow-up and among those who adhered to follow-up, 85 individuals were disease-free at the last assessment, with only one case of recurrent disease. Conclusions Vulvar cancer is not uncommon being more prevalent among HIV patients. Early diagnosis and staging are crucial for improved patient outcomes. Interventions to raise awareness, implementing screening programs, and ensuring early referrals are imperative. vulvar cancer Clinical presentation treatment pathology Ethiopia Figures Figure 1 Introduction Vulvar cancer is a relatively rare gynecologic malignancy, ranking as the fourth most common after uterine, ovarian, and cervical cancers. While it accounts for 4% of gynecological cancers globally, the incidence is expected to be high in Africa. Human papillomavirus (HPV) infection, particularly in association with human immunodeficiency virus (HIV), poses a significant risk for vulvar squamous cell carcinomas. The majority of cases are diagnosed in developed countries, but Africa, with its high prevalence of HPV, may see an increase in cases. [ 1 ] Squamous cell carcinomas make up over 80% of vulvar cancers, with melanomas being the next most common. However, there is no specific screening, and opportune treatment of predisposing lesions is the most effective strategy to reduce incidence. Women with vulvar cancer often present with symptoms such as pruritus, bleeding, discharge, dysuria, and pain. Timely biopsy of suspicious lesions is crucial for accurate diagnosis. [ 1 , 2 ] The mainstay of vulvar cancer treatment is surgery and, for advanced cases, concurrent chemo-radiation. Survival rates are favorable when therapy is promptly initiated. Despite its rarity, vulvar cancer has been on the rise globally, especially among younger women. Africa, with its high HPV prevalence, is expected to have a unique demographic pattern. However, studies in African countries, including Ghana and Nigeria, show varied incidence rates, and patients often face challenges such as late presentation and limited access to advanced treatment. [ 3 ] Vulvar cancer, though rare, poses a growing concern globally and there are literature data showing increasing incidence of vulvar cancer, particularly in younger women, attributed to HPV infection. Developing countries, including those in Africa, bear a significant burden of these cancers [ 3 ]. The study aims to review vulvar cancer cases over five years at SPHMMC and describe demographic and clinical patterns, and treatment of patients. Methods and Materials A retrospective review of vulvar cancer patients at Saint Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, was conducted from January 2016 to December 2020. This period coincided with the initiation of gynecologic oncology services at SPHMMC and the availability of a registry. As a referral center, SPHMMC provides oncology services, including surgical care and chemotherapy, but refers cases requiring radiotherapy to radiotherapy center. The study subjects were all vulvar cancer patients who presented to the Gynecologic oncology unit of SPHMMC during the study period. Data collection involved chart reviews for demographic, clinical, and pathological variables. Histologically proven vulvar cancer cases in the clinic's logbook were included, excluding benign and premalignant cases. Data analysis was made using IBM SPSS 23.1 computer statistical software, employing descriptive statistics. Due to low follow-up compliance and poor documentation, survival analysis and censoring were not feasible. Ethical clearance was obtained from SPHMMC IRB (Ref #: OM 23/172). As the data for this study was extracted retrospectively from patients’ medical records and hospital registries, no consent was directly obtained from patients. Results During the study period spanning from Jan 2016 to Dec 2020, the SPHMMc gynecologic oncology clinic observed nearly 1500 registered cases of gynecologic cancer. 61 cases of biopsy-proven vulvar cancer were identified from the patient logbook, constituting 3.8% of the total cancer cases. Ten medical records of patients were lost, leaving 51 cases for inclusion in the analysis. The mean age of the patients was 42 years, ranging from 18 to 80 years. Of these cases, 34 (67%) were HIV-positive, with a mean age of 36.7 years for HIV-positive patients, compared to 54 years for HIV-negative ones. The average parity was 2.7, and nearly half of the patients hailed from rural areas (Table 1 ). Table 1 Sociodemographic and Clinical profile of vulvar cancer patients at SPHMMC (January 2016 to Dec 2020) Variable Number (%) Age (average) 42.5 years Place of residence Addis Ababa Outside AA 28 (54.9) 23 (41.1 ) Religion Christian Muslim 43 ( 84.3) 8 (15.7%) Parity (average) 2.5 HIV status Negative Positive 17 (33.3) 34 (66.7) Presenting symptoms Swelling Itching Ulceration 37 (72.5%) 31 (60.5%) 19 (37.3%) Duration of symptoms (average) 12 months Lesion size (average) 5.2 cm Time to get treatment (average) 3.7 months Stage of Disease I II III IV 18 (35.3) 11 (21.6) 15 (29.4) 7 (13.4) The mean duration of complaints was 12 months, with some patients presenting as late as 3 years. Commonly reported symptoms included vulvar swelling (72.5%), itching (60.5%), and ulceration (37.3%). The mean size of the lesions was 5 cm. The most common histological type was squamous cell carcinoma (82.4%). Other rare histologic types included Verrucous (3) followed by, Basaloid (2), of the SCC Warty type were (2), (see Fig. 1 ). Among SCC histology,57% were of keratinized subtype. Staging, based on the hybrid method using clinical and surgical information following the FIGO 2008 staging system, revealed that 58% of patients presented with an early stage disease. The average duration of time to get treatment was 4 months. 39% underwent surgical treatment, 19% received palliative chemotherapy, while 29.4% referred for radiotherapy (Table 2 ). Seven patients disappeared and did not receive any treatment. Among those treated by surgery, six patients took neoadjuvant chemotherapy for 3 cycles followed by surgery. The administered chemotherapy included Cisplatin and Taxol. One patient had complete histological remission after surgery. Table 2 Treatment provided and immediate complications among patients with vulvar Ca at SPHMMC from January 2016 to Dec 2020 Variable N (%) Treatment (N = 51) Surgery Chemotherapy Radiotherapy referral No treatment 19 (37.3) 9 (19.6) 15 (29.4) 7 (13.7) Surgery type (N = 20) Radical Vulvectomy IFLD 20 (%) 16 (%) Complication (N = 20) Yes No 7 13 Postoperatively, the mean hospital stay was 15 days, with 35% experiencing complications, including six wound infections and one case of lymphocyte. Pathologic results indicated two patients with lymph node positivity, referred for adjuvant chemo radiotherapy. Five patients had margin-positive results and managed by re excision and one referred for radiotherapy. Only 22 (45%) of patients had postoperative follow-up, with an average duration of 7.6 months. One patient experienced local recurrence after 1 year, prompting referral for radiotherapy. Assessing overall disease-free and overall survival was challenging due to incomplete data. HIV-positive patients were significantly younger than HIV-negative patients (p < 0.05) and presented at earlier stages. Although the duration of symptoms was shorter for HIV-positive vulvar cancer cases, and the lesions were larger, these differences were not statistically significant Discussion The prevalence of vulvar cancer in our study was determined to be 3.6%, consistent with numerous global reports that cite a prevalence range of 2 to 5%. Despite the common belief that vulvar cancer is infrequent in sub-Saharan Africa, our findings reveal an equivalent disease burden comparable to developed nations, largely attributed to the high rate of HPV infection in Africa [ 1 ]. A South African study reported a remarkably high HPV positivity rate of 62% [11]. In our study, the mean age of vulvar cancer patients was 42 years, significantly younger (20 to 30 years) than the average age reported in the US SEER data, which indicates a mean age of 68 years for vulvar cancer. This age difference aligns with findings from a similar Ethiopian study conducted at Black Lion Hospital, which reported a mean age of 36 years [ 4 ]. The notable increase in the incidence of vulvar cancer at a younger age is strongly associated with high rates of HPV and HIV infections. HIV-positive patients, constituting 67% of our study population, have contributed to the overall lower average age. It is imperative to underscore the importance of reinforcing HPV screening and awareness programs, particularly for individuals living with HIV. Additionally, given the psychosexual challenges associated with younger patients, there is a need to prioritize these aspects during treatment planning [ 1 , 4 , 10 ]. In our study, a common occurrence was a bulky tumor size, aligning with a report from Black Lion Hospital. This observation is attributed to a high prevalence of HPV infection, leading to bulkier and multifocal lesions. The size of the lesion, akin to disease stage and lymph node status, serves as a crucial prognostic factor influencing survival.one contributing factor to the larger lesion size is delayed presentation. Many women seek medical attention belatedly due to feelings of embarrassment and a lack of awareness. Additionally, some may not have consulted the appropriate healthcare professionals, particularly outside Addis Ababa, resulting in delayed referrals. The impact of large lesions extends beyond medical implications; it also affects the psychological well-being of patients due to postoperative disfigurement of the external genitalia and potential wound failure. [ 4 , 5 , 6 ]. Although the reported duration of symptoms by the patient was 12 months, the majority of patients (58%) presented at an early stage, specifically stage I and II. This is in contrast to findings from other African countries, where as much as 75% of cases are diagnosed in advanced stages [ 7 , 8 , 10 ]. There was significant time lapse (3.8 Months) between initial patient appearance to service delivery or referral. This time would be even much higher for those referred to radiotherapy. This is much higher than the report from Ghana of 58 days (9). These systemic bottlenecks could contribute for disappearance 7 cases from follow up. Surgical intervention, specifically Modified Radical Vulvectomy and inguino-femoral lymph node dissection, stands as the optimal treatment for early-stage patients, offering the most favorable survival outcomes. In our hospital, 20 patients (39%) underwent surgical procedures. However, it's noteworthy that among early-stage patients eligible for surgery, eight were directed towards chemo-radiation. As per NCCN guidelines, palliative chemotherapy is advocated for stage IV patients and those deemed unfit for surgery. Localized advanced or stage III cases present multiple viable options, including surgery, neoadjuvant chemotherapy, and chemo-radiation. Notably, there is a paucity of evidence supporting the survival advantage of neoadjuvant chemotherapy preceding surgery in managing vulvar cancer. Within our hospital, six patients underwent surgery post-Neoadjuvant Chemotherapy (NACT). Post-operative pathology results revealed three cases with positive margins, and one patient experienced recurrence after one year. This prompts the necessity for further studies to ascertain the efficacy of this treatment modality. Groin dissection was performed on 15 patients, while cases classified as stage 1A, being at an early stage, do not derive benefits from groin dissection [ 7, 8,10]. The post-operative complication rate of 35% aligns with findings in other African studies. Only one case involving lymphocytes has been observed. Margin positivity was noted in six patients, with half undergoing re excision as supplementation. Enhancing tumor-free margin incisions during the initial surgery is recommended. The suggested follow-up duration of 3 to 5 years needs reinforcement, especially for patients referred for radiotherapy at Black Lion Hospital. Unfortunately, many of them do not attend follow-up appointments, making it challenging to monitor their outcomes. However, all surgically managed patients received follow-up, revealing only one case of recurrent disease after a year. Apart from that, the remaining 19 cases remained disease-free at the last follow-up. Survival analysis was hindered by the absence of robust follow-up mechanisms, and utilizing telephones proved ineffective for most cases. Strengths of this study include the ability to trace a good number of cases despite the rarity of the disease. The charts were evaluated rigorously, and strict criteria were applied for staging. All cases in the study originated from a single center, ensuring uniformity in management protocols and registration. This contributes valuable insights to the existing pool of knowledge on VC studies, particularly from developing countries. However, the study has some limitations. Its retrospective design poses a constraint, and the relatively small number of cases hinders the possibility of conducting advanced analyses. Unfortunately, the study couldn't perform survival analysis, and obtaining information on patients referred for radiotherapy to Black Lion Hospital proved unattainable. Conclusions and recommendations Vulvar cancer in Ethiopia is as common as developed countries, and particularly prominent among young women. There is a critical need for heightened awareness among women regarding early symptoms and prompt recognition. Timely diagnosis and proper staging upon hospital presentation are pivotal for effective management and reducing mortality rates. The significant incidence of vulvar cancer among HIV patients underscores the importance of integrating screening services and HPV testing within HIV clinics. Surgical intervention proves to be advantageous for survival in early-stage cases and should be reinforced. To address advanced forms of vulvar cancer, the accessibility of radiotherapy services must be expanded. The follow-up care for post-treatment patients is currently inadequate and requires improvement. Moreover, it is imperative to incorporate the consideration of psychosexual problems in the treatment of these patients, especially given that a majority of them are young. Declarations Ethics approval and consent to participate Ethical clearance was obtained from SPHMMC Institutional review board (Ref #: OM 23/172). As the data for this study was extracted retrospectively from patients’ medical records and hospital registries, no consent was directly obtained from patients Availability of data and materials The data and materials are available on reasonable request to the primary or co-authors: email [email protected] or at https://repo.spirhr.org/xmlui/ Competing interests The authors have no conflicts of interest Funding None Authors' contributions MB: inception, planning, conduct, data analysis, and manuscript writing; WG: analysis and revision of manuscript; TM: inception, data collection tools AA: data collection & supervision Conflicts of interest The authors have no conflicts of interest. References Nishio S, Matsuo K, Shibata T, Yamaguchi S, Kanao H, Takehara K, et al. Changes in the Clinico pathological Demographics of Vulvar Cancer in Japan: Increasing Oldest-Old, Stage Shifting, and Decreasing Cohort-Level Survival. Journal of clinical medicine. 2019;8(12):2081. Oguntayo O. Adekunle ZSM, Adewuyi A. Sunday, Kolawole O. Abimbola TR, Ismail Habiba, Koledade A. Korede. The pattern of carcinoma of the vulva in Zaria, Northern Nigeria. Nigerian Journal of Basic and Clinical Sciences. 2016. Alkatout I, Schubert M, Garbrecht N, Weigel MT, Jonat W, Mundhenke C, et al. Vulvar cancer: epidemiology, clinical presentation, and management options. International journal of women's health. 2015; 7:305. Rogers LJ, Cuello MA. Cancer of the vulva. International Journal of Gynecology & Obstetrics. 2018; 143:4-13. Kroeber ES, Mathewos A, Wondemagegnehu T, Aynalem A, Gemechu T, Piszczan S, et al. Vulvar cancer in Ethiopia: A cohort study on the characteristics and survival of 86 patients. Medicine. 2018;97(9). Wu X, Matanuska G, Chen VW, et al. Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States. Cancer Supplement. 2008;113(S10):2873-2882. Zongo S, Gang-Ny, Orange, Zida, Ouédraogo, Bambara, Bambara1, Si Simon Traore, Niamba TaD. Cancer of the vulva in Burkina Faso. Infectious Agents and Cancer. 216. Butt JL, Botha MH, Vulvar cancer is not a disease of the elderly: Treatment and outcome at a tertiary referral center in South Africa, SAMJ, 2017:107(11) MaryJ, Charles A, Verna V: Vulvar cancer in Ghana: Gynecol Onco Rep J. 2017 Azamosadat Mousavi AY, Mitra Modarres‑Gilani, Setareh Akhavan SSH. Vulvar cancer in Iran: Retrospective study over 20 years (1998‑2018). Journal of Family Medicine and Primary Care. April 2019; Volume 8 (Issue 4 ). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 May, 2025 Reviews received at journal 11 Feb, 2025 Reviewers agreed at journal 10 Feb, 2025 Reviews received at journal 24 Jul, 2024 Reviewers agreed at journal 15 Jul, 2024 Reviewers invited by journal 25 Apr, 2024 Editor assigned by journal 24 Apr, 2024 Submission checks completed at journal 24 Apr, 2024 First submitted to journal 20 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4297271","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":296261280,"identity":"fbe3f401-fcd9-40d3-80ec-d4e24739ff3c","order_by":0,"name":"Malede Birara","email":"","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Malede","middleName":"","lastName":"Birara","suffix":""},{"id":296261281,"identity":"46e0373d-1cbe-447a-8efc-184e1c47e38f","order_by":1,"name":"Wondimu Gudu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYJACCQYGGzBJkpY00rUcJkGLwfHegze/tp1P7J/dfPABQ41NNGEtZ84lW8u23U6ccedYsgHDsbTcBkJazG7kmElLArU0ABkSjA2HidZyLnE+SVokP7YdSNxAtBb7M2eMrRnOJRtvvJGWbJBAjF8k23sMb/4os5OddyP54IMPNTaEtYAAMw8DgyNYZQIxykGA8QfQgcQqHgWjYBSMghEIAJZiQx9n7FFpAAAAAElFTkSuQmCC","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":true,"prefix":"","firstName":"Wondimu","middleName":"","lastName":"Gudu","suffix":""},{"id":296261282,"identity":"294f1e4c-7f6c-4c73-96f1-9cb8439cb597","order_by":2,"name":"Tadios Mekonen","email":"","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Tadios","middleName":"","lastName":"Mekonen","suffix":""},{"id":296261283,"identity":"e1db794d-11eb-4898-98b3-7de5c42c0ded","order_by":3,"name":"Amani Abdu","email":"","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Amani","middleName":"","lastName":"Abdu","suffix":""}],"badges":[],"createdAt":"2024-04-20 11:24:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4297271/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4297271/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55633832,"identity":"4c4e8aef-2f44-4a2a-8ee4-53ec0958f215","added_by":"auto","created_at":"2024-04-30 20:06:17","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139071,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of histopathologic types among vulvar ca patients at SPHMMC (from January 2016 to Dec 2020)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4297271/v1/bcf02496a37718c81de86548.jpeg"},{"id":55693144,"identity":"fa00a2e6-9364-45a4-be70-a3b96f694b23","added_by":"auto","created_at":"2024-05-02 00:24:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":339506,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4297271/v1/f5b57941-6327-4209-ae0b-2facff44d127.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical profile and treatment of patients with Vulvar Cancer: experience from a novice Gynecologic Oncology unit in Sub Saharan Africa","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVulvar cancer is a relatively rare gynecologic malignancy, ranking as the fourth most common after uterine, ovarian, and cervical cancers. While it accounts for 4% of gynecological cancers globally, the incidence is expected to be high in Africa. Human papillomavirus (HPV) infection, particularly in association with human immunodeficiency virus (HIV), poses a significant risk for vulvar squamous cell carcinomas. The majority of cases are diagnosed in developed countries, but Africa, with its high prevalence of HPV, may see an increase in cases. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSquamous cell carcinomas make up over 80% of vulvar cancers, with melanomas being the next most common. However, there is no specific screening, and opportune treatment of predisposing lesions is the most effective strategy to reduce incidence. Women with vulvar cancer often present with symptoms such as pruritus, bleeding, discharge, dysuria, and pain. Timely biopsy of suspicious lesions is crucial for accurate diagnosis. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe mainstay of vulvar cancer treatment is surgery and, for advanced cases, concurrent chemo-radiation. Survival rates are favorable when therapy is promptly initiated. Despite its rarity, vulvar cancer has been on the rise globally, especially among younger women. Africa, with its high HPV prevalence, is expected to have a unique demographic pattern. However, studies in African countries, including Ghana and Nigeria, show varied incidence rates, and patients often face challenges such as late presentation and limited access to advanced treatment. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eVulvar cancer, though rare, poses a growing concern globally and there are literature data showing increasing incidence of vulvar cancer, particularly in younger women, attributed to HPV infection. Developing countries, including those in Africa, bear a significant burden of these cancers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The study aims to review vulvar cancer cases over five years at SPHMMC and describe demographic and clinical patterns, and treatment of patients.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003e A retrospective review of vulvar cancer patients at Saint Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, was conducted from January 2016 to December 2020. This period coincided with the initiation of gynecologic oncology services at SPHMMC and the availability of a registry. As a referral center, SPHMMC provides oncology services, including surgical care and chemotherapy, but refers cases requiring radiotherapy to radiotherapy center. The study subjects were all vulvar cancer patients who presented to the Gynecologic oncology unit of SPHMMC during the study period. Data collection involved chart reviews for demographic, clinical, and pathological variables. Histologically proven vulvar cancer cases in the clinic's logbook were included, excluding benign and premalignant cases. Data analysis was made using IBM SPSS 23.1 computer statistical software, employing descriptive statistics. Due to low follow-up compliance and poor documentation, survival analysis and censoring were not feasible. Ethical clearance was obtained from SPHMMC IRB (Ref #: OM 23/172). As the data for this study was extracted retrospectively from patients\u0026rsquo; medical records and hospital registries, no consent was directly obtained from patients.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period spanning from Jan 2016 to Dec 2020, the SPHMMc gynecologic oncology clinic observed nearly 1500 registered cases of gynecologic cancer. 61 cases of biopsy-proven vulvar cancer were identified from the patient logbook, constituting 3.8% of the total cancer cases. Ten medical records of patients were lost, leaving 51 cases for inclusion in the analysis. The mean age of the patients was 42 years, ranging from 18 to 80 years. Of these cases, 34 (67%) were HIV-positive, with a mean age of 36.7 years for HIV-positive patients, compared to 54 years for HIV-negative ones. The average parity was 2.7, and nearly half of the patients hailed from rural areas (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic and Clinical profile of vulvar cancer patients at SPHMMC (January 2016 to Dec 2020)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (average)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePlace of residence\u003c/p\u003e\n\u003cp\u003eAddis Ababa\u003c/p\u003e\n\u003cp\u003eOutside AA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e28 (54.9)\u003c/p\u003e\n\u003cp\u003e23 (41.1 )\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReligion\u003c/p\u003e\n\u003cp\u003eChristian\u003c/p\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e43 ( 84.3)\u003c/p\u003e\n\u003cp\u003e8 (15.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eParity (average)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHIV status\u003c/p\u003e\n\u003cp\u003eNegative\u003c/p\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e17 (33.3)\u003c/p\u003e\n\u003cp\u003e34 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePresenting symptoms\u003c/p\u003e\n\u003cp\u003eSwelling\u003c/p\u003e\n\u003cp\u003eItching\u003c/p\u003e\n\u003cp\u003eUlceration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e37 (72.5%)\u003c/p\u003e\n\u003cp\u003e31 (60.5%)\u003c/p\u003e\n\u003cp\u003e19 (37.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDuration of symptoms (average)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 months\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLesion size (average)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.2 cm\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTime to get treatment (average)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.7 months\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStage of Disease\u003c/p\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e18 (35.3)\u003c/p\u003e\n\u003cp\u003e11 (21.6)\u003c/p\u003e\n\u003cp\u003e15 (29.4)\u003c/p\u003e\n\u003cp\u003e7 (13.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean duration of complaints was 12 months, with some patients presenting as late as 3 years. Commonly reported symptoms included vulvar swelling (72.5%), itching (60.5%), and ulceration (37.3%). The mean size of the lesions was 5 cm.\u003c/p\u003e\n\u003cp\u003eThe most common histological type was squamous cell carcinoma (82.4%). Other rare histologic types included Verrucous (3) followed by, Basaloid (2), of the SCC Warty type were (2), (see Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Among SCC histology,57% were of keratinized subtype. Staging, based on the hybrid method using clinical and surgical information following the FIGO 2008 staging system, revealed that 58% of patients presented with an early stage disease.\u003c/p\u003e\n\u003cp\u003eThe average duration of time to get treatment was 4 months. 39% underwent surgical treatment, 19% received palliative chemotherapy, while 29.4% referred for radiotherapy (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Seven patients disappeared and did not receive any treatment. Among those treated by surgery, six patients took neoadjuvant chemotherapy for 3 cycles followed by surgery. The administered chemotherapy included Cisplatin and Taxol. One patient had complete histological remission after surgery.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eTreatment provided and immediate complications among patients with vulvar Ca at SPHMMC from January 2016 to Dec 2020\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTreatment (N\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\n\u003cp\u003eSurgery\u003c/p\u003e\n\u003cp\u003eChemotherapy\u003c/p\u003e\n\u003cp\u003eRadiotherapy referral\u003c/p\u003e\n\u003cp\u003eNo treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e19 (37.3)\u003c/p\u003e\n\u003cp\u003e9 (19.6)\u003c/p\u003e\n\u003cp\u003e15 (29.4)\u003c/p\u003e\n\u003cp\u003e7 (13.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgery type (N\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\n\u003cp\u003eRadical Vulvectomy\u003c/p\u003e\n\u003cp\u003eIFLD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e20 (%)\u003c/p\u003e\n\u003cp\u003e16 (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComplication (N\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePostoperatively, the mean hospital stay was 15 days, with 35% experiencing complications, including six wound infections and one case of lymphocyte. Pathologic results indicated two patients with lymph node positivity, referred for adjuvant chemo radiotherapy. Five patients had margin-positive results and managed by re excision and one referred for radiotherapy.\u003c/p\u003e\n\u003cp\u003eOnly 22 (45%) of patients had postoperative follow-up, with an average duration of 7.6 months. One patient experienced local recurrence after 1 year, prompting referral for radiotherapy. Assessing overall disease-free and overall survival was challenging due to incomplete data.\u003c/p\u003e\n\u003cp\u003eHIV-positive patients were significantly younger than HIV-negative patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and presented at earlier stages. Although the duration of symptoms was shorter for HIV-positive vulvar cancer cases, and the lesions were larger, these differences were not statistically significant\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of vulvar cancer in our study was determined to be 3.6%, consistent with numerous global reports that cite a prevalence range of 2 to 5%. Despite the common belief that vulvar cancer is infrequent in sub-Saharan Africa, our findings reveal an equivalent disease burden comparable to developed nations, largely attributed to the high rate of HPV infection in Africa [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A South African study reported a remarkably high HPV positivity rate of 62% [11]. In our study, the mean age of vulvar cancer patients was 42 years, significantly younger (20 to 30 years) than the average age reported in the US SEER data, which indicates a mean age of 68 years for vulvar cancer. This age difference aligns with findings from a similar Ethiopian study conducted at Black Lion Hospital, which reported a mean age of 36 years [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The notable increase in the incidence of vulvar cancer at a younger age is strongly associated with high rates of HPV and HIV infections. HIV-positive patients, constituting 67% of our study population, have contributed to the overall lower average age. It is imperative to underscore the importance of reinforcing HPV screening and awareness programs, particularly for individuals living with HIV. Additionally, given the psychosexual challenges associated with younger patients, there is a need to prioritize these aspects during treatment planning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, a common occurrence was a bulky tumor size, aligning with a report from Black Lion Hospital. This observation is attributed to a high prevalence of HPV infection, leading to bulkier and multifocal lesions. The size of the lesion, akin to disease stage and lymph node status, serves as a crucial prognostic factor influencing survival.one contributing factor to the larger lesion size is delayed presentation. Many women seek medical attention belatedly due to feelings of embarrassment and a lack of awareness. Additionally, some may not have consulted the appropriate healthcare professionals, particularly outside Addis Ababa, resulting in delayed referrals. The impact of large lesions extends beyond medical implications; it also affects the psychological well-being of patients due to postoperative disfigurement of the external genitalia and potential wound failure. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the reported duration of symptoms by the patient was 12 months, the majority of patients (58%) presented at an early stage, specifically stage I and II. This is in contrast to findings from other African countries, where as much as 75% of cases are diagnosed in advanced stages [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere was significant time lapse (3.8 Months) between initial patient appearance to service delivery or referral. This time would be even much higher for those referred to radiotherapy. This is much higher than the report from Ghana of 58 days (9). These systemic bottlenecks could contribute for disappearance 7 cases from follow up.\u003c/p\u003e \u003cp\u003eSurgical intervention, specifically Modified Radical Vulvectomy and inguino-femoral lymph node dissection, stands as the optimal treatment for early-stage patients, offering the most favorable survival outcomes. In our hospital, 20 patients (39%) underwent surgical procedures. However, it's noteworthy that among early-stage patients eligible for surgery, eight were directed towards chemo-radiation. As per NCCN guidelines, palliative chemotherapy is advocated for stage IV patients and those deemed unfit for surgery. Localized advanced or stage III cases present multiple viable options, including surgery, neoadjuvant chemotherapy, and chemo-radiation. Notably, there is a paucity of evidence supporting the survival advantage of neoadjuvant chemotherapy preceding surgery in managing vulvar cancer. Within our hospital, six patients underwent surgery post-Neoadjuvant Chemotherapy (NACT). Post-operative pathology results revealed three cases with positive margins, and one patient experienced recurrence after one year. This prompts the necessity for further studies to ascertain the efficacy of this treatment modality. Groin dissection was performed on 15 patients, while cases classified as stage 1A, being at an early stage, do not derive benefits from groin dissection [ 7, 8,10].\u003c/p\u003e \u003cp\u003eThe post-operative complication rate of 35% aligns with findings in other African studies. Only one case involving lymphocytes has been observed. Margin positivity was noted in six patients, with half undergoing re excision as supplementation. Enhancing tumor-free margin incisions during the initial surgery is recommended.\u003c/p\u003e \u003cp\u003eThe suggested follow-up duration of 3 to 5 years needs reinforcement, especially for patients referred for radiotherapy at Black Lion Hospital. Unfortunately, many of them do not attend follow-up appointments, making it challenging to monitor their outcomes. However, all surgically managed patients received follow-up, revealing only one case of recurrent disease after a year. Apart from that, the remaining 19 cases remained disease-free at the last follow-up. Survival analysis was hindered by the absence of robust follow-up mechanisms, and utilizing telephones proved ineffective for most cases.\u003c/p\u003e \u003cp\u003eStrengths of this study include the ability to trace a good number of cases despite the rarity of the disease. The charts were evaluated rigorously, and strict criteria were applied for staging. All cases in the study originated from a single center, ensuring uniformity in management protocols and registration. This contributes valuable insights to the existing pool of knowledge on VC studies, particularly from developing countries. However, the study has some limitations. Its retrospective design poses a constraint, and the relatively small number of cases hinders the possibility of conducting advanced analyses. Unfortunately, the study couldn't perform survival analysis, and obtaining information on patients referred for radiotherapy to Black Lion Hospital proved unattainable.\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eVulvar cancer in Ethiopia is as common as developed countries, and particularly prominent among young women. There is a critical need for heightened awareness among women regarding early symptoms and prompt recognition. Timely diagnosis and proper staging upon hospital presentation are pivotal for effective management and reducing mortality rates. The significant incidence of vulvar cancer among HIV patients underscores the importance of integrating screening services and HPV testing within HIV clinics. Surgical intervention proves to be advantageous for survival in early-stage cases and should be reinforced. To address advanced forms of vulvar cancer, the accessibility of radiotherapy services must be expanded. The follow-up care for post-treatment patients is currently inadequate and requires improvement. Moreover, it is imperative to incorporate the consideration of psychosexual problems in the treatment of these patients, especially given that a majority of them are young.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from SPHMMC Institutional review board (Ref #: OM 23/172). As the data for this study was extracted retrospectively from patients\u0026rsquo; medical records and hospital registries, no consent was directly obtained from patients\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials are available on reasonable request to the primary or co-authors: email [email protected] or at https://repo.spirhr.org/xmlui/\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMB: inception, planning, conduct, data analysis, and manuscript writing; WG: analysis and revision of manuscript; TM: inception, data collection tools AA: data collection \u0026amp; supervision\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflicts of interest\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNishio S, Matsuo K, Shibata T, Yamaguchi S, Kanao H, Takehara K, et al. Changes in the Clinico pathological Demographics of Vulvar Cancer in Japan: Increasing Oldest-Old, Stage Shifting, and Decreasing Cohort-Level Survival. Journal of clinical medicine. 2019;8(12):2081.\u003c/li\u003e\n\u003cli\u003eOguntayo O. Adekunle ZSM, Adewuyi A. Sunday, Kolawole O. Abimbola TR, Ismail Habiba, Koledade A. Korede. The pattern of carcinoma of the vulva in Zaria, Northern Nigeria. Nigerian Journal of Basic and Clinical Sciences. 2016.\u003c/li\u003e\n\u003cli\u003eAlkatout I, Schubert M, Garbrecht N, Weigel MT, Jonat W, Mundhenke C, et al. Vulvar cancer: epidemiology, clinical presentation, and management options. International journal of women\u0026apos;s health. 2015; 7:305.\u003c/li\u003e\n\u003cli\u003eRogers LJ, Cuello MA. Cancer of the vulva. International Journal of Gynecology \u0026amp; Obstetrics. 2018; 143:4-13.\u003c/li\u003e\n\u003cli\u003eKroeber ES, Mathewos A, Wondemagegnehu T, Aynalem A, Gemechu T, Piszczan S, et al. Vulvar cancer in Ethiopia: A cohort study on the characteristics and survival of 86 patients. Medicine. 2018;97(9).\u003c/li\u003e\n\u003cli\u003eWu X, Matanuska G, Chen VW, et al. Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States. Cancer Supplement. 2008;113(S10):2873-2882. \u003c/li\u003e\n\u003cli\u003eZongo S, Gang-Ny, Orange, Zida, Ou\u0026eacute;draogo, Bambara, Bambara1, Si Simon Traore, Niamba TaD. Cancer of the vulva in Burkina Faso. Infectious Agents and Cancer. 216. \u003c/li\u003e\n\u003cli\u003eButt JL, Botha MH, Vulvar cancer is not a disease of the elderly: Treatment and outcome at a tertiary referral center in South Africa, SAMJ, 2017:107(11) \u003c/li\u003e\n\u003cli\u003eMaryJ, Charles A, Verna V: Vulvar cancer in Ghana: Gynecol Onco Rep J. 2017\u003c/li\u003e\n\u003cli\u003eAzamosadat Mousavi AY, Mitra Modarres‑Gilani, Setareh Akhavan SSH. Vulvar cancer in Iran: Retrospective study over 20 years (1998‑2018). Journal of Family Medicine and Primary Care. April 2019; Volume 8 (Issue 4 ).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"vulvar cancer, Clinical presentation, treatment, pathology, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4297271/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4297271/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVulvar cancer is rare accounting approximately for 4% of gynecologic malignancies. The prevalence of vulvar cancer rising in sub-Saharan Africa primarily attributed to high incidence of HIV infections. This study aims to explore clinic-pathologic profile and treatment of patients at a novice gynecologic oncology unit in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive cross-sectional study was conducted, among vulvar cancer patients treated at Saint Paul’s Hospital millennium medical college in Ethiopia, gynecology oncologic unit from 2016 to 2020. Data was collected from patients’ medical records and hospital registries using a simple data extraction format. Data was analyzed using IBM SPSS 23.1 computer statistical software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe magnitude of vulvar cancer was 3.6%, with mean age of patients being 42 years. Commonest symptoms were vulvar swelling, itching, and ulceration. The average duration of symptoms was 12 months and 66 percent of patients were HIV positive. The mean lesion size was 5 cm, with squamous cell carcinoma being the most prevalent (82%). Disease was early stage in 56% percent of patients. Fifty seven Percent were given treatment. Surgery was done to 37% of patients, postoperative wound complications rate being 30 percent. 43 percent had Postoperative follow-up and among those who adhered to follow-up, 85 individuals were disease-free at the last assessment, with only one case of recurrent disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVulvar cancer is not uncommon being more prevalent among HIV patients. Early diagnosis and staging are crucial for improved patient outcomes. Interventions to raise awareness, implementing screening programs, and ensuring early referrals are imperative.\u003c/p\u003e","manuscriptTitle":"Clinical profile and treatment of patients with Vulvar Cancer: experience from a novice Gynecologic Oncology unit in Sub Saharan Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-30 20:06:12","doi":"10.21203/rs.3.rs-4297271/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-08T11:27:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-12T00:39:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70398092612584829857872146269097215837","date":"2025-02-10T20:50:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-24T10:23:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234928765049253656077577585892859441841","date":"2024-07-15T10:16:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-26T03:47:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-24T23:52:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-24T23:52:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-04-20T11:20:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2eb83c8d-2362-44a3-afb7-17e3454b9ec9","owner":[],"postedDate":"April 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-10T09:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-30 20:06:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4297271","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4297271","identity":"rs-4297271","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}