Premalignant and malignant disease of the vulva and vagina

Vaginal intraepithelial neoplasia is a rare, premalignant condition of the vagina, which is caused by persistent infection with oncogenic strains of the human papillomavirus (HPV). It occurs either concurrently with intraepithelial neoplasia of other parts of the anogenital tract, or can develop after treatment of cervical lesions or pelvic irradiation. It can be difficult to diagnose and treat, due to the proximity of surrounding structures such as the bladder and rectum, and the need to preserve sexual function. Squamous carcinoma of the vulva is the most common vulval malignancy. It may arise from two distinct types of vulval intraepithelial neoplasia (VIN). Vulval extramammary Paget’s disease is a rare intraepithelial adenocarcinoma which accounts for less than 2% of primary vulval tumours. VIN and Paget’s disease are treated in order to relieve symptoms, such as severe pruritus, to exclude invasive disease, and to decrease the risk of developing cancer. Specialist follow-up in multidisciplinary clinics, with access to conservative surgery and reconstruction, as well as psychosexual support, are important in the management of women with vulval premalignant disease. Vulvar and vaginal cancer are rare gynaecological malignancies that occur predominantly in elderly women. Where the cornerstone of vulvar cancer treatment is surgery, radiotherapy is the most common treatment given in vaginal cancer. Vulvar cancer treatment has undergone significant modifications during the last decades, all with the aim to reduce treatment-related morbidity without compromising survival rates. The introduction of the sentinel node procedure has been a major advantage in the treatment of this disease.