Clinico-pathological Characteristics, Management, and Survival of Patients Treated for Cancer of the Vulva at Kenyatta National Hospital, Kenya- 2012- 2017

Abstract

Introduction: Cancer of the vulva (CV) is the fourth most common gynecologic cancer in high economic countries and it causes about 5-6% of the all the female genital tract malignancies. Among the types of histologic vulvar cancer, squamous cell carcinoma is the most common representing almost 90% of all the cases. Clinical presentation includes vulvar itchiness, vulvar growth, ulceration and inguinal lymphadenopathy. Most women with vulvar cancer are diagnosed at an early stage. Traditional management includes radical vulvectomy with inguinal nodedissection, adjuvantradiotherapy and chemotherapy. The reported cumulative overall 5-year survival rate in the high resource countries is 72% while the 2-year survival rate in low resource countries is 51%, with a median survival of 33 months. Due to paucity of data in African region, this study aimed at describing the clinic-pathological characteristics, management and survival of patients suffering from cancer of the vulva at the Kenyatta National Hospital, Kenya. Objectives of the Study: To determine the clinico-pathological characteristics, management and 2- and 5-year survival of patients with cancer of the vulva at the Kenyatta National Hospital Gynecologic Oncology Unit between 2012- 2017. Methodology: Data was collected using the Data Abstraction tool, entered into excel sheet and analyzed using STATA ver.16 software. Descriptive statistics for the socio demographic characteristics and clinico-pathological presentation including management modalities were done and presented using means, variance and standard deviation. Kaplan Myer curve were used to present 2- and 5-year survival rates, taking a p value of less than 0.05 to be significant statistically. Results:Secondary data and phone calls on clinico-pathological characteristics, the management and Survival of 104 patients treated for cancer of the vulva at the KNH between 2012 to 2017 were reviewed. The median age for the participants was 47 years (IQR 38.0 – 58.5); 78.5% were diagnosed with stage III or Stage IV cancer; data on FIGO staging of half of the patients (53/104) were not available; (60.5%) were HIV positive and 96.2% of these were on ART; 93.3% patients had vulvar lesions/swelling; 23.1% had vulvar itch; 25.0% had inguinal lymph node on the left side and a similar percentage had on the right side; 89.2% had squamous cell carcinoma. A minority of the patients had LVSI (17.3%) and nodal invasion (17.2%); 85.6% (89/104) of pathologist reports had no grading done; more than two-thirds (68.0%) had involvement in the vagina, 38% in the anus and 18% in the clitoris. The most common type of tumor was the ulcerative type (71.2%), followed by fungating type (23.1%) and infiltrative type (8.7%). Almost all patients (98.0%) were examined under anesthesia and over half (52.0%) were determined to be at stage III (i.e. stages 3, 3A and 3B). The primary treatment was radiotherapy in 75.5%; 27%received chemotherapy. By the end of the study period, 29.8% of the patients had died, 26.0% were still alive while the 44.2%were lost to follow-up. Two- year survival rate was 71% while the five-year survival rate was 45%. Patients with FIGO stage 4 appear to have the worst survival experience (i.e. highest failure rate). The results from log-rank test revealed that there was no significant difference in the Survival of the patients by FIGO stage (P-value=0.200) Conclusion: In patients present in late stage with a diagnosis of cancer of the vulva, majority are treated using radiotherapy and though not significant statistically, tumor stage and size influenced survival with a 2- and 5-year survival rate of 71% and 45% respectively. Recommendations: Efforts be put in place to enhance early diagnosis of vulva cancer, early initiation of effective treatment and follow up.