The first 60 days: HPV-associated vulvar squamous cell carcinoma
HPV-associated vulvar cancer is the type of vulvar squamous cell cancer caused by persistent HPV infection, growing out of the precancer called usual-type VIN and marked by the p16 protein. It tends to affect younger women, responds better to radiotherapy and recurs less often than the HPV-independent type, and it is preventable by HPV vaccination. Below, week by week, is what OnCo's record of HPV-associated vulvar squamous cell carcinoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Early stage (tumour under four centimetres, clinically negative groins).
- SurgeonNamed in the standard of care for: Precursor (usual-type VIN), Early stage (tumour under four centimetres, clinically negative groins), Locally advanced disease.
- Medical oncologistNamed in the standard of care for: Precursor (usual-type VIN), Early stage (tumour under four centimetres, clinically negative groins), Locally advanced disease, Recurrent or metastatic disease.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Early stage (tumour under four centimetres, clinically negative groins), Locally advanced disease.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.Early stage (tumour under four centimetres, clinically negative groins)NCCN Guidelines: Vulvar Cancer
Wide local excision with sentinel node biopsy (GROINSS-V I); groin radiotherapy for sentinel node metastases of two millimetres or less and lymphadenectomy for larger ones (GROINSS-V II).
Cisplatin-based chemoradiotherapy (GOG 205); surgery for residual disease; p16-positive tumours respond well.
Excision or laser ablation of visible lesions; imiquimod as a medical alternative; trials of artesunate ointment; HPV vaccination for prevention.
Thermal ablation and cryotherapy for cervical precancerHPV & HBV vaccinationNonavalent HPV vaccinePhase II Study of Artesunate Ointment for the Treatment of Vulvar High Grade Squamous Intraepithelial Lesions (Vulvar HSIL, VIN2/3)Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy FemalesCarboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive or mismatch-repair-deficient tumours after chemotherapy; trials of pembrolizumab with lenvatinib and of cadonilimab.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example p16 immunohistochemistryand HPV DNA, p53 immunohistochemistry, Depth of invasion, Sentinel node status and metastasis size, PD-L1 combined positive score), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Usual-type vulvar intraepithelial neoplasia, Basaloid HPV-associated vulvar squamous cell carcinoma, Warty HPV-associated vulvar squamous cell carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Precursor (usual-type VIN)
- For my situation (precursor (usual-type vin)), which of the standard options do you recommend and why?Guideline options include: Excision or laser ablation of visible lesions; imiquimod as a medical alternative; trials of artesunate ointment; HPV vaccination for prevention.
- Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Phase II Study of Artesunate Ointment for the Treatment of Vulvar High Grade Squamous Intraepithelial Lesions (Vulvar HSIL, VIN2/3) and Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy Females apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Early stage (tumour under four centimetres, clinically negative groins)
- For my situation (early stage (tumour under four centimetres, clinically negative groins)), which of the standard options do you recommend and why?Guideline options include: Wide local excision with sentinel node biopsy (GROINSS-V I); groin radiotherapy for sentinel node metastases of two millimetres or less and lymphadenectomy for larger ones (GROINSS-V II).
Locally advanced disease
- For my situation (locally advanced disease), which of the standard options do you recommend and why?Guideline options include: Cisplatin-based chemoradiotherapy (GOG 205); surgery for residual disease; p16-positive tumours respond well.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic disease
- For my situation (recurrent or metastatic disease), which of the standard options do you recommend and why?Guideline options include: Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive or mismatch-repair-deficient tumours after chemotherapy; trials of pembrolizumab with lenvatinib and of cadonilimab.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Pembrolizumab Combination With Lenvatinib in Pts With Recurrent,Persistent,Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative Surge and AK104 for Recurrent or Metastatic Vulvar Cancer apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, Pembrolizumab Combination With Lenvatinib in Pts With Recurrent,Persistent,Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative Surge, AK104 for Recurrent or Metastatic Vulvar Cancer, Phase II Study of Artesunate Ointment for the Treatment of Vulvar High Grade Squamous Intraepithelial Lesions (Vulvar HSIL, VIN2/3)?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No treatment yet differs by HPV status despite the difference in behaviour”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Recurrence of usual-type VIN after treatment is common”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy FemalesPhase 3 · recruiting · NCT04422366A Multicenter,Randomized,Blind and Positive-Controlled Phase Ⅲ Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent Human Papillomavirus (Types 6, 11, 16, 18,31,33,45,52 and 58) Recombinant Vaccine (Hansenula Polymorpha) in Chinese Female Subjects Aged 20-45 Years
- AK104 for Recurrent or Metastatic Vulvar CancerPhase 2 · recruiting · NCT05932212A Multicenter, Open-label, Phase II Study of AK104 in the Treatment of Recurrent or Metastatic Vulvar Cancer
- Pembrolizumab Combination With Lenvatinib in Pts With Recurrent,Persistent,Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative SurgePhase 2 · recruiting · NCT05903833Pembrolizumab in Combination With Lenvatinib in Pts With Recurrent, Persistent, Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative Surgery or Radiotherapy
- Phase II Study of Artesunate Ointment for the Treatment of Vulvar High Grade Squamous Intraepithelial Lesions (Vulvar HSIL, VIN2/3)Phase 2 · recruiting · NCT06075264A Phase II Double-blind, Placebo-controlled, Randomized Trial of Topical Artesunate Ointment for the Treatment of Patients With Vulvar High-grade Squamous Intraepithelial Lesions (Vulvar HSIL)
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- HPV-associated vulvar squamous cell carcinoma: the full pageHPV-associated vulvar cancer is the type of vulvar squamous cell cancer caused by persistent HPV infection, growing out of the precancer called usual-type VIN and marked by the p16 protein. It tends to affect younger women, responds better to radiotherapy and recurs less often than the HPV-independent type, and it is preventable by HPV vaccination.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Combined positive score (CPS): A PD-L1 score that counts stained tumour cells and immune cells together.
- HPV-positive (p16) head and neck cancer: Throat cancers caused by the human papillomavirus, identified by a p16 stain.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.