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HPV-associated vulvar cancer is the type of vulvar squamous cell cancer caused by persistent HPV infection, growing out of the precancer called usual-type VIN and marked by the p16 protein. It tends to affect younger women, responds better to radiotherapy and recurs less often than the HPV-independent type, and it is preventable by HPV vaccination.
The 2020 WHO classification splits vulvar squamous cell carcinoma into HPV-associated and HPV-independent disease because the two arise by different routes and behave differently. HPV-associated tumours follow persistent high-risk HPV infection, above all type 16, through the precursor high-grade squamous intraepithelial lesion (usual-type VIN), often in women who smoke or are immunosuppressed and often alongside cervical or anal HPV disease. They are basaloid or warty under the microscope, express p16 diffusely and keep wild-type p53. Large series and the AGO-CaRE-1 cohort have shown that p16-positive tumours have fewer local recurrences and better survival than p53-mutant tumours, and that they respond more completely to radiotherapy, which is why molecular subtype is now part of the pathology report even though it does not yet change first treatment.
Treatment follows stage rather than subtype. Usual-type VIN is excised or treated with imiquimod, with trials of topical agents such as artesunate under way; early cancers are removed by wide local excision with sentinel node biopsy for tumours under four centimetres with more than a millimetre of invasion (GROINSS-V I), and GROINSS-V II showed that groin radiotherapy can replace lymphadenectomy when the sentinel node metastasis is two millimetres or smaller. Locally advanced disease is treated with cisplatin chemoradiotherapy (GOG 205) to avoid exenterative surgery, and recurrent or metastatic disease with carboplatin and paclitaxel, with pembrolizumab available for PD-L1-positive tumours after chemotherapy on the strength of the KEYNOTE-158 vulvar cohort. Trials now test PD-1 antibodies with lenvatinib or with the PD-1 and CTLA-4 bispecific cadonilimab in recurrent disease, and the nonavalent HPV vaccine prevents the infections that start the disease.
Roughly a third to two fifths of vulvar squamous cell carcinomas; the commoner type in younger women and the share that HPV vaccination will eventually prevent.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Excision or laser ablation of visible lesions; imiquimod as a medical alternative; trials of artesunate ointment; HPV vaccination for prevention.
Wide local excision with sentinel node biopsy (GROINSS-V I); groin radiotherapy for sentinel node metastases of two millimetres or less and lymphadenectomy for larger ones (GROINSS-V II).
Cisplatin-based chemoradiotherapy (GOG 205); surgery for residual disease; p16-positive tumours respond well.
Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive or mismatch-repair-deficient tumours after chemotherapy; trials of pembrolizumab with lenvatinib and of cadonilimab.
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The size of the deposit in the sentinel node now decides treatment: radiotherapy for micrometastases, full groin dissection (with or without chemoradiotherapy) for macrometastases.
Women with small, unifocal vulvar cancers and clinically negative groins can be staged with a sentinel node procedure and spared full groin dissection when the node is clear.
Query for this cancer: (TITLE:"HPV-associated vulvar squamous cell carcinoma" OR ABSTRACT:"HPV-associated vulvar squamous cell carcinoma" OR TITLE:"HPV-positive vulvar cancer" OR ABSTRACT:"HPV-positive vulvar cancer" OR TITLE:"p16-positive vulvar squamous cell carcinoma" OR ABSTRACT:"p16-positive vulvar squamous cell carcinoma" OR TITLE:"Basaloid and warty vulvar carcinoma" OR ABSTRACT:"Basaloid and warty vulvar carcinoma" OR TITLE:"Vulvar cancer arising from usual-type VIN" OR ABSTRACT:"Vulvar cancer arising from usual-type VIN") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about HPV-associated vulvar squamous cell carcinoma, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose by Calvert formula using GFR (see the calculators).
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
See all on the product pages:BevacizumabCarboplatinCisplatinPaclitaxel / nab-paclitaxelPembrolizumab·Printable cards in the navigator
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