How can we treat vulvar carcinoma in pregnancy? A systematic review of the literature

Andrea Palicelli, Lucia Giaccherini, Magda Zanelli, Maria Paola Bonasoni, Maria Carolina Gelli, Alessandra Bisagni, Eleonora Zanetti, Loredana De Marco, Federica Torricelli, Gloria Manzotti, Mila Gugnoni, Giovanni D’ippolito, Angela Immacolata Falbo, Filomena Giulia Sileo, Lorenzo Aguzzoli, Valentina Mastrofilippo, Martina Bonacini, Federica De Giorgi, Stefano Ricci, Giuditta BernardelliLaura Ardighieri, Maurizio Zizzo, Antonio De Leo, Giacomo Santandrea, Dario de Biase, Moira Ragazzi, Giulia Dalla Dea, Claudia Veggiani, Laura Carpenito, Francesca Sanguedolce, Aleksandra Asaturova, Renzo Boldorini, Maria Giulia Disanto, Margherita Goia, Richard Wing Cheuk Wong, Naveena Singh, Vincenzo Dario Mandato

Research output: Contribution to journalReview articlepeer-review

Abstract

According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17–41 years). The tumor size range was 0.3–15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before‐and‐after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV‐related features (condylomas/warts; HPV infection; high‐grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time‐to‐recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5–48 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease‐free at the end of follow‐up. Pregnant patients must be followed‐up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory.

Original languageEnglish
Article number836
JournalCancers
Volume13
Issue number4
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Cancer
  • Carcinoma
  • Cesarean
  • Condyloma
  • Fetal
  • HPV
  • Lichen sclerosus
  • Pregnancy
  • Treatment
  • Vulva

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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