A Comparative Study on Presentation of Vulval Cancer in Patients Below 50 Years and at 50 Years and Above at Kenyatta National Hospital

Abstract

Vulval cancer is uncommon and is known to predominantly affect elderly women. However, the emerging trend of affection of younger women is worrying, therefore, needs to be investigated. Recent years have shown an increase in the trend of vulval cancer in women below the age of 50 years. This phenomenon has not yet been elucidated in our set up. This study, therefore, seeks to compare sociodemographic, clinicopathologic features and management strategies in the two groups with an aim to explain the change in age patterns over time. Objective: To determine the difference in the sociodemographic, clinicopathologic features and management strategies in the presentation of vulval cancer at diagnosis below 50 and 50 years of age and above over a time period of 10 years in a tertiary care hospital. Methodology: A comparative cross sectional study design was used. The hospital records of 115 patients with histologically proven vulvar cancer who presented to Kenyatta National Hospital in the last ten years from 2008 to 2018 were reviewed at the records department at Kenyatta National Hospital and the following information was recorded on a prestructured questionnaire. Information based on age, clinicopathologic presentation, staging, management strategy and complications, antecedent lesions and concurrent conditions was studied. The data collected was recorded in a data entry sheet then coded, processed and cleaned off any inconsistencies and outliers and further analysed using SPSS version 21.0. Characteristics of the two groups were compared using appropriate statistical tests. All reported P values was two-tailed with the statistical significance set at P < 0.05. Data was compared with published literature. Results: The mean presenting age of these patients had a downward trend from 64 to 38 years. There was a strong history of HIV co- infection in the women below 50 years (P <0.001). They were also found to have a significantly higher level of education (P 0.008) and had more complaints of per vaginal bleeding (P 0.002) than their counterparts. In terms of duration of symptoms before presentation, smoking history or tumor size there was no statistical difference. Both groups presented with advanced stage disease. Management strategy was largely similar with age and complications arising from treatment were also similar across the two groups.

Conclusion: There seems to be a trend in our patient population where younger women are increasingly presenting with symptoms characteristic of vulval cancer. Human immunodeficiency virus appears to be important as an aetiologic factor and is more common in this age group . Vulval bleeding is a common presenting symptom in patients below 50 years. Education encouraging the early detection and prevention of HIV might alter the rising incidence of this disease in younger women.