Cancers of the vulva and birth canal represents about 8% of female genital tract malignancies. They typically present as precancerous lesions, which provides a window of opportunity to prevent the transition to cancer. Not all precancerous lesions develop into cancer, but their presence should prompt further evaluation and treatment due to the increased lifetime risk of genital tract cancers.
Symptoms of vulvar precancerous lesions (VIN) are similar to the symptoms of vulvar cancer. They include itching, burning, pain with urination, visible lesion, palpable nodularity or perineal pain. The symptoms of precancerous lesions of the birth canal (VAIN) are also similar to those for birth canal (BC) cancer. Some women do not have any symptoms at all and the lesion is found at the time of a routine gynecologic examination. Other symptoms include postcoital bleeding, abnormal bleeding, and an unusual discharge.
The presence of any of these symptoms such prompt immediate evaluation by a health care provider. The appearances of these precancerous lesions are variable. They can be raised or flat and the color can be white, red, pink, brown or grey. Any abnormal lesion should be biopsied. If there is any suggestion of a precancerous lesion then a complete evaluation of the genital tract is indicated include a pap smear. The presence of these lesions suggests that other lesions might be present either in the same area or in other places along the genital tract.
Not all precancerous lesions will progress to cancer. The availability of information on VAIN is limited but the evidence suggests that less than 1/3 will progress over time while more than 2/3 will regress. One study of VIN showed that about 46% resolved over time while only about 9% progressed and the rest persisted. Even if treatment occurs approximately 1/3 will recur over time and 4-8% of these will develop to invasive cancer. This cancer can occur in the site of treatment but could also be at a distinctly separate site.
Even though a diagnosis of a precancerous lesion doesn’t mean you will develop cancer, urgent attention is required and long-term care is needed to prevent this unwanted outcome. Risk factors for the development of cancer and for recurrence include immunosuppression, smoking, and persistent Human Papilloma virus (HPV) infection. Those who are at higher risk require more frequent surveillance. Effective treatment is available to prevent the development of cancer and now there is a vaccine, which can minimize the risk of HPV infection.
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