[1] The most common route for treatment is combination therapy, consisting of a mix of both surgical and non-surgical interventions (radiotherapy, chemotherapy).
[19] Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with some gynecologic cancers, including those of the cervix, vagina, and vulva.
[20] A clear link between human papilloma virus and cervical cancer has long been established, with HPV associated with 70% to 90% of cases.
[21] Persistent human papilloma virus infections have been shown to be a driving factor for 70% to 75% of vaginal and vulvar cancers.
[30] The vast majority of cases are detected past point of metastasis beyond ovaries, implicating higher risk of morbidity and a need for aggressive combination therapy.
[31][34] The goal of this procedure is to leave no tumour larger than 1 cm by the removal of significant portions of affected reproductive organs.
[31][34] Multiple interventions may be used to achieve optimal debulking, including abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymph node sampling, and peritoneal biopsies.
[31][34] There is a lack of randomized controlled trials comparing outcomes between chemotherapy and optimal debulking, so the current standard of care typically involves the sequential administration of both, beginning with surgical interventions.
[31][35] A second look laparotomy may be used to assess tumour status in clinical trials, but is not a staple of standard care due to a lack of association with improved outcomes.
[40] Hormone therapy is most commonly used to treat systemic spread, as endometrial cancer patients tend to be older and have other illnesses that make them poor candidates to withstand harsh cytotoxic agents used in chemotherapy.
[31] Low incidence means that evidence-based therapy is relatively weak, but emphasis is placed on accurate assessment of cancerous tissue and reducing lymphatic spread.
[42] Surgery is preferred over radiotherapy due to the preservation of the ovaries and sexual function as well as the elimination of the risk of radiation.
[42] For more advanced stages of vaginal cancer, external-beam radiation therapy (EBRT) is the standard method for treatment.
[43][42] External-beam radiation therapy involves the delivery of a boost to the pelvic side of the patient at a 45 Gy dose.