Burden, Management and Outcomes Ofpatients With Histologically Confirmed Vulvarcancer at the Kenyatta National Hospital (Retrospective Studyof the Period January 2014 –december 2018)

Abstract

Background: Each year, around 27,000 women are diagnosed with vulvar cancer (VC) globally,accountingfor approximately2-6% of malignancies of the female genital tract. While the causes of VC are unknown, a link with Human Papilloma Virus (HPV) and Human Immunodeficiency Virus (HIV) have been documented. However, there is limited information on vulva cancer in sub-Sahara Africa wherethere is a high prevalence of HPV and HIV infections. Most published reports are of small and heterogeneous groups of patients.In Kenya, data on vulvar cancer is limited. Objective: To determine the burden, presentation, and management andoutcomes of women with vulvar cancer at Kenyatta National Hospital between 2014 and 2018. Methodology:Data was collected using a data extraction tool, entered into an Excel sheet and analyzed using SPSS version 23 software. The incidence of cancer of the vulva was calculated, the descriptive statistics of patients presented as mean or proportions, and univariate analyses used to determine the association betweenindependent and dependent variables. Kaplan Meier statistics were used to determine the survival rate of patients by staging, treatment modality, and HIV status. Results:vulvar cancer constitute 3.5% of gynecological cancer during the study period with the mean age of 50.9 years. Majority of patients were married (40.3%), unemployed (62.3%) and had primary education (68.9%). Eighty four were HIV positive (60.4%) and were statistically significantly younger (41 years) than HIV negative vulvar cancer patients (60 years). Squamous cell carcinoma (SCC) was the commonest histology type (98.1%), while 57 patients had metastatic tumors (47.5%), seven to lymph nodes (12.2%) and five to the anus (8.8%). A vulvar mass (76.1%) and ulcers (25.2%) were the commonest clinical presentation. A majority of patients were in stage III vulvar cancer (57.8%) and received combination therapy (37.8%), mainly radiotherapy and combination therapy (48.9%). Deaths were 15/159 (9.4%) in a median time of 1.7 months with the 5-year survival rate found to be 64.8%. Stage IV and III vulvar cancer patients had a 5-year survival rate of 69.1% and 32.5%. HIV positive patients had a lower 5-year survival rate (55.2%) than HIV negative patients (88.5%), while the survival rate after single and combination therapy were 71.6% and 75.7%. Conclusion: Vulvar cancer was found to occur in younger patients who are HIV positive and most seek treatment late with advanced disease. Advocacy and sensitization programs that can improve the health seeking by at-risk of vulvar cancer needed.