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Etiology of vulvar cancer

There are two main causes of pre-stages and development of cancer of the vulva. The first is a degenerative skin disease called lichen sclerosus et atrophicus, and the second is the human papilloma virus (HPV). 

New types of HPV are continually detected. As per October 2014, there were 190 HPV genotypes characterized, of which 40 types can infect skin and genital mucosa by sexual contact. These genotypes are classified either as low-risk or high-risk types based on their degree of oncogenicity. Thirteen HPV types are now classified as high-risk, or oncogenic types, of which HPV 16, 18, 31, 33, and 45 are those most frequently detected in malignant tumors. Low-risk HPV type 6 and 11 cause genital warts.   

The HPV vaccine protects against 4 types of of the human papilloma virus. The next-generation HPV vaccine, still under clinical investigation, protects against 9 types. These are expected to also protect against development of cancer of the vulva.

Risk factors

  • Lichen sclerosus et atrophicus
  • HPV infection
  • Age
  • High number of sexual partners
  • Smoking
  • Reduced immune response including drug-induced immunosuppression
  • Chronic granulomatous disease
  • Diabetes

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