**Vaginal Cancer** --- Vaginal cancer is one of the rarest gynecologic cancers, affecting fewer than 1 in 100,000 women annually and accounting for roughly 1–3% of all gynecologic cancer diagnoses. Because it is so uncommon, research moves slowly and some months the published literature is thin. May 2026 was one of those months. The papers with open-access licensing from May 2026 covered new comparative data on combination treatment for VaIN, useful population-level context on how vaginal cancer fits into the broader HPV cancer landscape, and real-world outcomes from one of the most intensive surgical interventions used for advanced or recurrent gynecologic cancers. *The papers highlighted here represent a selection of those published during the month. The papers were selected and summarized by AI. Accuracy of the summaries was confirmed by a scientist.* This digest incorporates only open-access research articles that are free to be read by the entire community and that are explicitly licensed to be shared and reused. --- **Combining two treatments for vaginal precancerous changes may improve long-term results** Vaginal intraepithelial neoplasia, or VaIN (abnormal cell changes in the vaginal lining that can, if untreated, progress to invasive cancer) is notoriously difficult to treat. There is no universally accepted standard approach, and recurrence rates are frustratingly high with any single treatment. - A multicenter retrospective study from two Chinese hospitals followed 146 people with VaIN over 12 months, comparing treatment with photodynamic therapy alone (a light-activated treatment in which a photosensitizing drug is infused and then activated by a specific wavelength of light to destroy abnormal cells) to treatment with a combination of photodynamic therapy plus CO₂ laser ablation (a technique that uses a precise laser beam to vaporize abnormal tissue). At three months, the two approaches performed similarly, with about 70–71% of participants showing complete remission in both groups. But at six and twelve months, the combination approach pulled ahead significantly: complete remission rates were 86% versus 63% at six months and 89% versus 66% at twelve months. HPV clearance was also substantially higher in the combination group at all time points. Recurrence by twelve months occurred in about 9% of the photodynamic therapy alone group and only 3% of the combination group, though the small number of recurrence events means this should be interpreted cautiously. The combination was generally well tolerated based on the available safety data. This is a retrospective study, which limits its conclusions, and larger prospective trials are needed before practice changes. Still, for a precancerous condition where recurrence is the rule rather than the exception, these numbers are meaningful. ([Read the full paper](https://doi.org/10.1186/s12905-026-04544-6)) --- **Understanding the broader HPV cancer burden matters for vaginal cancer advocacy** Most vaginal cancers are linked to infection with high-risk strains of HPV, the human papillomavirus. Putting vaginal cancer in its epidemiological context alongside other cancers that HPV also causes (cervical, vulvar, anal, and oropharyngeal) helps make the case for prevention investments and can strengthen advocacy for this community. - A population-based study using the Osaka Cancer Registry in Japan traced trends in HPV-related cancer incidence from 1977 to 2019 across more than 39,000 cases, capturing the period before the effects of HPV vaccination would be visible in cancer rates. Vaginal cancer showed no significant change over those four decades, which is a distinct pattern from the rise seen in vulvar, oropharyngeal, and anal cancers during this period. The authors note that future studies tracking generations with high vaccination rates as they reach cancer-susceptible ages will be essential to assess the vaccine's impact. For people affected by vaginal cancer, this study situates their disease within a constellation of HPV-related conditions where prevention tools now exist - tools that will take years to fully demonstrate their population-level benefit. ([Read the full paper](https://doi.org/10.1038/s41598-026-50914-3)) - A health economics study from New Zealand quantified the treatment cost of all six HPV-related cancers (oropharyngeal, cervical, vaginal, vulvar, anal canal, and penile) over a five-year period (2017–2022), using national hospital and pharmaceutical records. Vaginal cancer accounted for an estimated 56 HPV-attributable cases and NZ$2 million in treatment costs during this window, smaller in absolute terms than cervical or oropharyngeal cancer but part of a cumulative NZ$82.4 million burden that the authors argue is substantially underestimated. The study also found that New Zealand's HPV vaccination rates have been declining and called urgently for achieving 90% coverage. The central message for this community: the economic and human cost of HPV-related cancers is large, prevention is available, and vaccination rates are going the wrong direction in at least one high-income country. The paper also noted higher costs per patient in Māori communities, pointing to equity gaps that require targeted action. ([Read the full paper](https://doi.org/10.1136/bmjph-2025-003800)) --- **Pelvic exenteration for advanced or recurrent vaginal cancer: a realistic picture of outcomes** For some people whose vaginal or other gynecologic cancers recur after standard treatment, the only chance for long-term control may be with pelvic exenteration (a major operation that removes the pelvic organs affected by cancer, which can include the bladder, rectum, vagina, uterus, and nearby lymph nodes depending on the extent of disease). Understanding realistic outcomes from this procedure helps patients and their families make informed decisions. - A retrospective single-center study from the Royal London Hospital reviewed 47 people who underwent pelvic exenteration for gynecologic malignancies between 2004 and 2024. Vaginal cancer made up 15% of the cohort (7 cases), alongside endometrial, vulval, ovarian, and cervical cancers. The procedure was performed both as primary treatment and for recurrent disease and was divided into total (removing all pelvic organs), anterior (sparing the rectum), and posterior (sparing the bladder) approaches. Median blood loss was 1.5 liters; median hospital stay was 17 days; and major complications (those requiring reoperation, organ support, or intensive intervention) occurred in 32% of patients. One person died in the postoperative period. About 41% of patients remained free of recurrence after surgery, while 51% developed distant recurrence. For patients who had surgery with curative intent, mean overall survival was 94 months, with patients treated for recurrent disease faring similarly to those treated for primary disease in this center's experience. These are real-world numbers from a high-volume, specialized center; they reflect both the seriousness of the procedure and the meaningful survival achievable in carefully selected patients. ([Read the full paper](https://doi.org/10.3390/jcm15103957)) --- **What Does This Mean for Me?** **If you're managing VaIN (precancerous changes in the vaginal lining),** ask your gynecologic oncologist about the range of treatment options available at your center. This month's data suggest that combining photodynamic therapy with CO₂ laser ablation may achieve better long-term remission than either approach used alone, though this comes from a retrospective study in a specific clinical setting. Ask specifically: "What complete remission rates does this center achieve at 12 months, and how is recurrence managed?" **If you're facing recurrent or advanced vaginal cancer where standard treatments have stopped working,** pelvic exenteration may be one of the options your team discusses. The outcomes reported this month (about 40% remaining recurrence-free, with meaningful overall survival) come from a specialized center with decades of experience. If this surgery is being considered, ask whether your care is being planned at a high-volume gynecologic oncology center, and request a detailed conversation about the specific approach being proposed, its expected impact on bladder and bowel function, and what rehabilitation and quality-of-life support is available. **On prevention:** The studies this month reinforce how central HPV vaccination is to preventing vaginal cancer in the first place. If there are young people in your life who haven't been vaccinated against HPV, and if you have the opportunity to encourage it, this month's population data add another layer of evidence supporting that conversation. Because vaginal cancer is rare, research progress is helped by patient participation in clinical trials and registries. If you're interested in contributing, visit [ocrahope.org](http://ocrahope.org) to explore resources, and ask your care team about open studies in your area. *This digest is prepared by OCRA (Ovarian Cancer Research Alliance) for patients, caregivers, and advocates. It is intended to inform, not to guide individual treatment decisions. Please speak with your care team about what research findings may mean for your specific situation.* --- **Sources** **Directly Referenced in This Digest** 1. Hong H, et al. "Carbon dioxide laser combined with photodynamic therapy versus photodynamic therapy alone for vaginal intraepithelial neoplasia: a multicenter retrospective comparative cohort study." *BMC Women's Health.* May 28, 2026. PMID 42204715. 2. Yagi A, et al. "Trends in age-standardized incidence rates of cancers of HPV-related cancer sites in Osaka, Japan: 1977–2019." *Scientific Reports.* May 12, 2026. PMID 42120649. 3. Koh SP, et al. "Economic burden of human papillomavirus-related cancers in New Zealand." *BMJ Public Health.* May 10, 2026. PMID 42158553. 4. Zalawadia S, et al. "Morbidity, Recurrence and Survival Following Pelvic Exenteration for Gynaecological Malignancies: A Retrospective, Single-Centre Study." *Journal of Clinical Medicine.* May 20, 2026. PMID 42194919. **Additional Open-Access Papers Published in May 2026 on Related Topics** 5. Hawezy DJ, et al. "Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications." *BMC Surgery.* May 18, 2026. PMID 42151942. *(Prospective matched cohort evaluating protective ileostomy during colorectal surgery for deep endometriosis; includes vaginal and rectal repair; peripheral to vaginal cancer but relevant to gynecologic surgical morbidity.)* 6. Catena U, et al. "Surgical and Reproductive Outcomes of a Standardized Hysteroscopic Approach to Treat Septate Uterus and Associated Complex Anomalies." *Journal of Clinical Medicine.* May 14, 2026. PMID 42194748. *(Retrospective study of hysteroscopic correction of septate uterus including associated cervical and vaginal anomalies; peripheral to vaginal cancer, relevant to benign vaginal anatomy.)* 7. Anson N, et al. "An ultrasound-guided minimally invasive treatment for vaginal vault collections following major gynaecological surgery: a case series." *Frontiers in Surgery.* May 11, 2026. PMID 42199892. *(Case series of nine patients; describes an ultrasound-guided technique for draining infected post-hysterectomy vaginal vault haematomas, relevant to surgical morbidity management.)* 8. Vidac A, et al. "Metastatic Patterns and Adverse Histopathologic Features in Advanced Renal Cell Carcinoma: A Five-Year Single-Center Retrospective Pathology Study." *Medicina.* May 7, 2026. PMID 42195158. *(Retrospective pathology study of 32 metastatic RCC cases; vaginal metastasis identified in one case, illustrating the rare possibility of RCC spread to the vagina.)* 9. Andreasen EK, et al. "Women's preference for HPV self-sampling devices: a programme-embedded, large-scale paired comparative study within the cervical cancer screening programme in the Capital Region of Denmark." *BMJ Open.* May 19, 2026. PMID 42156147. *(Cross-sectional study of 1760 women comparing three vaginal self-sampling devices for HPV testing; relevant to cervical cancer prevention that protects against HPV-related vaginal cancer.)* 10. Li ZH, et al. "Radiotherapy in Cervical Myeloid Sarcoma: A Case Report and Literature Discussion." *International Journal of Women's Health.* May 1, 2026. PMID 42100502. *(Case report of a rare cervical myeloid sarcoma presenting with vaginal bleeding in a patient with AML; describes successful local control with pelvic IMRT and brachytherapy; peripheral but illustrates diagnostic challenges in cervical/vaginal bleeding.)* **Papers Excluded Due to Licensing Restrictions** This month, the licensing-excluded set contains several high-priority papers — including studies directly on vaginal cancer immunotherapy, VaIN brachytherapy, photodynamic therapy for cervical-vaginal precancerous lesions, and a novel photo-immunotherapy clinical trial. Their exclusion reflects the licensing rules of this digest, not their importance. Readers are strongly encouraged to access these papers through their healthcare provider or a medical library. 11. Abdeen CS, et al. "Beyond extrapolation: Immunotherapy outcomes in recurrent vulvovaginal carcinoma." *Gynecologic Oncology.* May 27, 2026. PMID 42202684. *(Excluded: All rights reserved, Elsevier. Topic: Retrospective cohort of 21 patients with recurrent vulvar and vaginal carcinomas treated with immune checkpoint inhibitors, primarily pembrolizumab; objective response rate 29%, median overall survival 4.6 months; meaningful durable responses in a subset. One of the most directly patient-relevant papers this month.)* 12. Lancellotta V, et al. "Image-guided interventional radiotherapy (modern brachytherapy) for treatment of vaginal intraepithelial neoplasia: single-institution experience and systematic literature review and meta-analysis." *Strahlentherapie und Onkologie.* May 26, 2026. PMID 42189190. *(Excluded: Unconfirmed license, Springer hybrid journal. Topic: Retrospective case series plus systematic review evaluating image-guided brachytherapy for high-grade VaIN3; 100% local control at one year in institutional series with acceptable toxicity.)* 13. Liu Y, et al. "Systematic photodynamic therapy for concurrent cervical-vaginal high-grade squamous intraepithelial lesion: a series of eight cases." *Lasers in Medical Science.* May 27, 2026. PMID 42192023. *(Excluded: License type unconfirmed (Springer hybrid journal; available in PMC but CC type not verifiable from available data). Topic: Case series of eight patients treated with Hiporfin-photodynamic therapy for concurrent cervical and vaginal HSIL; 75% complete response rate at 3–6 months, with all partial responders achieving complete response after additional treatment.)* 14. Asano H, et al. "Hokkaido phase II study of photo-immunotherapy combination with ASP-1929 for recurrent or persistent EGFR-positive vulvar, vaginal, and cervical cancers not amenable to further radiotherapy (HICARi study)." *Journal of Gynecologic Oncology.* May 18, 2026. PMID 42172495. *(Excluded: Unconfirmed license, Journal of Gynecologic Oncology (hybrid OA). Topic: Protocol paper for a phase II Japanese clinical trial of photo-immunotherapy using ASP-1929 — an anti-EGFR antibody conjugated to a light-activated dye — for recurrent or persistent vulvar, vaginal, and cervical cancers refractory to radiotherapy; 16 patients enrolled, primary outcome tumor shrinkage.)* 15. Ryan HM, Brennan DJ. "Genitourinary syndrome of menopause in women with cancer — a narrative review." *Maturitas.* May 28, 2026. PMID 42224847. *(Excluded: All rights reserved, Elsevier. Topic: Narrative review of local vaginal estrogen therapy for genitourinary syndrome of menopause in breast and gynecological cancer survivors, including shared decision-making around hormone-sensitive cancers.)* 16. Ramseyer TG, et al. "Pap testing and high-risk HPV testing for women aged 65 years and older with surgical pathology follow-up." *Cancer Cytopathology.* May 2026. PMID 42080588. *(Excluded: Unconfirmed license, Wiley hybrid journal. Topic: Institutional analysis of 1536 Pap tests in women ≥65 years; high rates of abnormal cytology and significant histologic findings including HPV-negative squamous lesions; questions current guidelines on stopping cervical screening at 65.)* 17. Kuroki LM, et al. "Molecular classification and association with survival outcomes in high-intermediate and high-risk early-stage endometrial cancers: Ancillary analysis of GOG-0249." *Gynecologic Oncology.* May 26, 2026. PMID 42190623. *(Excluded: All rights reserved, Elsevier. Topic: Ancillary analysis of the GOG-0249 trial evaluating molecular subgroups in endometrial cancer patients treated with vaginal cuff brachytherapy plus chemotherapy versus pelvic radiation; p53abn tumors had worst survival outcomes.)* 18. Su X, et al. "Sexual health among patients with breast cancer undergoing endocrine therapy: an integrative review." *Supportive Care in Cancer.* May 4, 2026. PMID 42081187. *(Excluded: Exclusive license to Springer-Verlag. Topic: Integrative review of 43 studies on sexual dysfunction and genitourinary symptoms including vaginal dryness in breast cancer patients on endocrine therapy; high prevalence of sexual dysfunction (51–93%).)* 19. Wakana K, et al. "Long-Term Disease-Free Survival After Systemic-First Sequential Multimodal Therapy for Advanced and Recurrent Large-Cell Neuroendocrine Carcinoma of the Uterine Cervix: A Case Report." *Journal of Obstetrics and Gynaecology Research.* May 2026. PMID 42152606. *(Excluded: Unconfirmed license, Wiley journal. Topic: Case report of stage IIIC2 cervical large-cell neuroendocrine carcinoma achieving 9-year disease-free survival with systemic-first sequential multimodal therapy.)* 20. Peydayesh M, et al. "Diagnostic performance of pap smear for cervical intraepithelial neoplasia in women with treatment-resistant vaginal infections: A colposcopy-guided biopsy correlated study." *Cancer Treatment and Research Communications.* May 5, 2026. PMID 42150393. *(Excluded: All rights reserved, Elsevier. Topic: Retrospective accuracy study examining Pap smear performance for CIN detection in 975 women with treatment-resistant vaginal infections; low sensitivity and specificity noted.)* 21. Westendorp J, et al. "A cross-sectional study of caesarean deliveries performed by medical doctors and associate clinicians in nine district and regional hospitals in Sierra Leone using the Robson Ten Group Classification System." *International Journal of Gynaecology and Obstetrics.* May 30, 2026. PMID 42216876. *(Excluded: Unconfirmed license, Wiley hybrid. Topic: Cross-sectional study of obstetric care delivery in Sierra Leone focusing on caesarean delivery rates and task-sharing; vaginal delivery data reported but paper is not related to vaginal cancer.)* 22. Andreasen EK et al. — listed in Additional Papers above (42156147). 23. Etrusco A, et al. "Reproductive outcomes after rescue luteal phase support for women with low serum progesterone in artificial cycles around frozen embryo transfer day: Systematic review and network meta-analysis of over 7500 patients." *International Journal of Gynaecology and Obstetrics.* May 5, 2026. PMID 42087457. *(Excluded: Unconfirmed license, Wiley hybrid. Topic: Network meta-analysis on progesterone supplementation before embryo transfer; includes vaginal progesterone administration as one route; not related to vaginal cancer.)* 24. Ibrahimov A, Novruzova F. "Clinical Significance of Atypical Squamous Cells of Undetermined Significance (ASC-US) and Atypical Squamous Cells-Cannot Exclude High-Grade Squamous Intraepithelial Lesion (ASC-H) in a Low-Income Clinical Setting: A Retrospective Analysis." *Asian Pacific Journal of Cancer Prevention.* May 1, 2026. PMID 42169587. *(Excluded: License not available (source: not_available per PubMed metadata). Topic: Retrospective analysis of ASC-US/ASC-H cervical cytology predictive value for CIN2+ in low-resource settings; high loss to follow-up observed.)* 25. Hasan A, et al. "Transabdominal retrieval of oocytes when transvaginal access is not an option: mastering an egg-cellent technique." *Fertility and Sterility.* May 9, 2026. PMID 42107484. *(Excluded: All rights reserved, Elsevier. Topic: Video article demonstrating transabdominal oocyte retrieval; one patient presented with locally advanced neovaginal cancer preventing transvaginal access; peripheral to vaginal cancer.)* 26. Salameh A, et al. "Behind the bleeding: rare and relentless uterine lymphoma ending in chemotherapy toxicity." *BMJ Case Reports.* May 4, 2026. PMID 42082264. *(Excluded: BMJ proprietary open access license (no commercial re-use), not a permitted CC license. Topic: Case report of primary endometrial diffuse large B-cell lymphoma presenting with vaginal bleeding; diagnostic re-evaluation highlighted.)* 27. Hoang J, et al. "Factors Associated With Menopause Symptoms: A Systematic Review and Meta-Analysis." *BJOG.* May 6, 2026. PMID 42087841. *(Excluded: Unconfirmed license, Wiley hybrid. Topic: Meta-analysis of factors associated with vasomotor symptoms and vaginal dryness in menopause; relevant to survivorship context but not to vaginal cancer directly.* **Vulvar Cancer** --- Vulvar cancer is one of the rarer gynecologic cancers, accounting for roughly 4-5% of diagnoses in this category, and May 2026 reflected both the promise and the limits of research in a low-incidence disease. The month's most substantive contribution was a comprehensive review on sentinel lymph node biopsy, the single most active debate in vulvar cancer surgery, including a striking finding about what patients themselves prioritize when weighing less-invasive surgery against survival risk. Two case reports rounded out the licensed literature: one describing an exceptionally rare adenocarcinoma arising from anogenital mammary-like glands, and one illustrating how a vulvar lesion in a patient with a prior colorectal cancer history can represent metastatic spread rather than a new primary tumor. A separate epidemiologic study from Japan documented rising rates of vulvar cancer as one of several HPV-related cancers. *The papers highlighted here represent a selection of those published during the month. The papers were selected and summarized by AI. Accuracy of the summaries was confirmed by a scientist.* This digest incorporates only open-access research articles that are free to be read by the entire community and that are explicitly licensed to be shared and reused. --- **Sentinel lymph node biopsy: what the evidence says, and what patients actually want** Sentinel lymph node biopsy (a procedure that identifies and tests the first one or two lymph nodes most likely to receive cancer cells from the tumor, allowing many patients to avoid more extensive groin surgery) is the most debated and most studied topic in vulvar cancer management. A comprehensive review published in the *Journal of Gynecologic Oncology* this month surveys 20 years of evidence on this procedure and arrives at conclusions that may surprise some patients and clinicians alike. - The review, authored by an international team including researchers from Milan and Australia, confirms that sentinel node biopsy is safe and significantly reduces treatment-related morbidity, particularly lymphedema (the long-term swelling of the leg or groin caused by damage to the lymphatic system during surgery) in appropriately selected patients. At the same time, it takes seriously the risk of false-negative results: cases where the sentinel node appears cancer-free but other nodes are not. Pooled data from multiple studies puts the false-negative rate at roughly 6-10%, and the review notes that most patients who experience an isolated groin recurrence after a negative sentinel node ultimately die of the disease. But perhaps the most striking finding in this review is not surgical - it's about patient priorities. Multiple surveys cited in the paper found that the majority of patients with vulvar cancer, when told about the false-negative risk, said they would not accept any increase in mortality risk in exchange for reduced morbidity. In one study, 53% of patients said they would take no risk at all with their life, and only 15% were willing to accept the approximately 1-in-100 risk of dying that a 5% false-negative rate would imply. This directly challenges the assumption common among clinicians that patients would readily trade some survival chance for lower rates of lymphedema. The review also highlights an exciting ongoing randomized trial (the ANVU trial) testing whether serial ultrasound surveillance of the groin every two months could eventually replace any form of groin surgery in appropriately selected patients. If the trial is positive, the authors estimate roughly 70% of patients would be spared groin dissection entirely. ([Read the full paper](https://doi.org/10.3802/jgo.2026.37.e110)) --- **Rare vulvar tumor types: two case reports that expand our understanding of diagnosis** Because vulvar cancer is uncommon, case reports (detailed accounts of individual patient experiences) play an important role in building knowledge about unusual subtypes and presentations. Two such reports were published under open-access licenses this month. - A case report from Portugal describes one of the rarest subtypes of vulvar cancer: an adenocarcinoma (a glandular tumor) arising from anogenital mammary-like glands, specialized tissue found in the vulvar region that shares characteristics with breast tissue. The patient, a woman in her 90s, presented with septic shock and was found incidentally to have a 5-centimeter vulvar mass. Careful tissue analysis ruled out a breast primary or distant spread, confirming this as a primary vulvar tumor of this rare type. The patient declined surgery and was managed conservatively. The case underscores the diagnostic complexity of rare vulvar subtypes: the resemblance of these glands to breast tissue means tumors arising here can be confused with spread from a breast cancer, and careful pathological evaluation is essential to distinguish between them. This report is illustrative rather than generalizable since this type of tumor is exceptionally uncommon, but it is valuable for the pathologists and clinicians who may encounter it. ([Read the full paper](https://doi.org/10.1136/bcr-2026-272510)) - A case report from Morocco describes a patient with prior rectal cancer who developed a new vulvar lesion a year after surgery. The clinical picture was initially ambiguous, but biopsy and immunohistochemistry (laboratory staining techniques that identify the origin of tumor cells) confirmed that the lesion was metastatic colorectal adenocarcinoma spread to the vulva, not a new primary vulvar cancer. The distinction matters enormously: primary vulvar cancers are generally treated locally with surgery and radiation, while a metastatic deposit from colorectal cancer requires systemic chemotherapy. The patient was treated with a combination chemotherapy regimen (irinotecan, leucovorin, 5-fluorouracil, and bevacizumab - agents that target cancer cell division and block tumor blood vessel growth) and remained clinically stable. For anyone with a history of a prior cancer who develops a new vulvar lesion, this case is a reminder that thorough diagnostic workup, including tissue biopsy, is essential before assuming the origin of the lesion. ([Read the full paper](https://doi.org/10.7759/cureus.108140)) --- **Rising rates of HPV-related cancers in Japan, vulvar cancer among them** A population-based study from Japan's Osaka Cancer Registry analyzed 43 years of cancer incidence data (1977-2019) for cancers caused by human papillomavirus (HPV), a sexually transmitted virus linked to cervical, vulvar, vaginal, anal, oropharyngeal, and penile cancers. The study found that vulvar cancer incidence has increased over this period, joining oropharyngeal and anal cancers as HPV-related sites with rising rates. This trend predates the widespread uptake of HPV vaccination in Japan, which was suspended for a period due to safety concerns and only recently resumed. The authors note that future studies will observe how the trend changes as vaccinated cohorts reach cancer-susceptible ages, a finding with hopeful implications for prevention. While this study focuses on Japan, the pattern is consistent with what has been observed in other high-income countries, where HPV-related vulvar cancers (particularly in younger women) have been rising even as lichen sclerosus–related vulvar cancers follow different trends. The paper is a reminder that HPV vaccination, which is recommended for adolescents and young adults, and available to adults up to age 45 in many countries, is one of the clearest prevention strategies available for HPV-associated vulvar cancer. ([Read the full paper](https://doi.org/10.1038/s41598-026-50914-3)) --- **What Does This Mean for Me?** **If you are discussing groin surgery with your care team,** ask directly about what sentinel lymph node biopsy means for your specific situation, and don't hesitate to share what matters most to you. Research summarized this month shows that patients with vulvar cancer, when fully informed, tend to prioritize survival over the side-effect reduction that sentinel node biopsy offers. Your care team may assume you would welcome the less-invasive option; this review suggests that assumption is often wrong. The tradeoffs are real and worth an honest conversation. Ask: "What is the estimated false-negative rate at this center, and what would happen if a recurrence occurred?" **If you have a history of any other cancer and develop a new vulvar lesion,** make sure your care team knows your full cancer history before any treatment decisions are made. The case reported this month is a reminder that vulvar lesions are not always primary vulvar cancers; they can occasionally represent spread from cancers elsewhere in the body, and the treatment approach is entirely different. Biopsy with immunohistochemical analysis is the definitive way to determine origin. **On HPV vaccination and prevention:** if you have children or younger family members who haven't been vaccinated, the data from Japan add to an already strong case for vaccination. HPV-related vulvar cancers are preventable, and vaccination before first sexual exposure offers the greatest protection, though it is also recommended up to age 45 in many guidelines. Ask a pediatrician or primary care provider about timing. Because vulvar cancer is rare, patient participation in clinical trials and registries can help progress research. Visit [ocrahope.org](http://ocrahope.org) or speak with your care team about studies that may be open in your area. *This digest is prepared by OCRA (Ovarian Cancer Research Alliance) for patients, caregivers, and advocates. It is intended to inform, not to guide individual treatment decisions. Please speak with your care team about what research findings may mean for your specific situation.* --- **Sources** **Directly Referenced in This Digest** 1. Bogani G, et al. "Sentinel lymph node biopsy in vulvar cancer: current evidence, limitations, and future perspectives." *Journal of Gynecologic Oncology.* May 6, 2026. PMID 42172493. 2. Aguiar RS, et al. "Adenocarcinoma of anogenital mammary-like glands: a rare primary vulvar tumour." *BMJ Case Reports.* May 22, 2026. PMID 42173533. 3. Khater K, et al. "Vulvar Metastasis From Colorectal Adenocarcinoma: A Report of a Rare Case and Review of Diagnostic and Therapeutic Approaches." *Cureus.* May 2, 2026. PMID 42231999. 4. Yagi A, et al. "Trends in age-standardized incidence rates of cancers of HPV-related cancer sites in Osaka, Japan: 1977–2019." *Scientific Reports.* May 12, 2026. PMID 42120649. **Additional Open-Access Papers Published in May 2026 on Related Topics** All open-access papers published in May 2026 on vulvar cancer and related topics with permitted licenses are referenced in the digest above. **Papers Excluded Due to Licensing Restrictions** 5. Ishibashi M, et al. "Treatment patterns and prognosis of vulvar cancer: a nationwide retrospective analysis from the JSOG tumor registry (2016-2020)." *Journal of Gynecologic Oncology.* May 19, 2026. PMID 42210771. *(Excluded: License not confirmed — no PMC record; JGO subscription article not confirmed open access. Topic: Nationwide Japanese registry study of 1,147 patients showing 5-year survival by FIGO stage (Stage I: 70.5%, Stage IV: 20.9%) and finding that non-surgical management carries significantly worse overall survival compared to primary surgery.)* 6. Asano H, et al. "Hokkaido phase II study of photo-immunotherapy combination with ASP-1929 for recurrent or persistent EGFR-positive vulvar, vaginal, and cervical cancers not amenable to further radiotherapy (HICARi study)." *Journal of Gynecologic Oncology.* May 18, 2026. PMID 42172495. *(Excluded: License not confirmed — no PMC record; JGO subscription article not confirmed open access. Topic: Phase II trial protocol for photo-immunotherapy using ASP-1929, an anti-EGFR antibody conjugated to a light-activated dye, for recurrent vulvar, vaginal, and cervical cancers that cannot receive further radiation — a novel approach first approved in Japan for head and neck cancer.)* 7. Day T, et al. "2026 International Society for the Study of Vulvovaginal Disease (ISSVD) terminology for vulvar intraepithelial neoplasia and squamous intraepithelial lesions." *American Journal of Obstetrics and Gynecology.* May 28, 2026. PMID 42214713. *(Excluded: All rights reserved (Elsevier/AJOG). Topic: Updated ISSVD international consensus terminology for precancerous vulvar conditions, establishing HPV-associated and HPV-independent VIN as two distinct entities requiring different classification, surveillance, and treatment, and introducing the new category "vulvar aberrant maturation" for HPV-independent lesions of uncertain neoplastic potential arising in lichen sclerosus.)* 8. Trozzi R, et al. "A review of reviews of the prevalence of molecular biomarkers in vulvar cancer and their implications for prognosis refinement and treatment strategies." *Gynecologic Oncology.* May 19, 2026. PMID 42155564. *(Excluded: License not confirmed — proprietary Elsevier journal, no open-access record. Topic: Umbrella review synthesizing molecular biomarker data across vulvar cancer subtypes, finding high TP53 mutation rates in HPV-independent tumors linked to poorer survival, strong p16 overexpression in HPV-associated tumors linked to better outcomes, and identifying PIK3CA, HRAS, and FGFR3 as potential therapeutic targets.)* 9. Tran HTT, et al. "Racial Disparities in Survival Among Patients with Vulvar Melanoma: A National Cancer Database Analysis." *Journal of the American Academy of Dermatology.* May 19, 2026. PMID 42162673. *(Excluded: License not confirmed — JAAD is a subscription journal with no open-access record for this article. Topic: National Cancer Database analysis examining racial disparities in survival outcomes among patients with vulvar melanoma.)* 10. Liang CJ, Hsiao SM. "Crizotinib for refractory vulvar malignant melanoma with equivocal MET amplification: a case report." *Taiwanese Journal of Obstetrics & Gynecology.* May 2026. PMID 42036199. *(Excluded: CC BY-NC-ND (TJOG, Elsevier). Topic: Case report of a woman with refractory vulvar melanoma and MET amplification who achieved a partial response to crizotinib — a targeted therapy that inhibits MET, ALK, and ROS1 kinases — before eventual disease progression.)* 11. Chen WA, et al. "Epithelial-myoepithelial carcinoma with high-grade transformation of bartholin gland — A case report and literature review." *Taiwanese Journal of Obstetrics & Gynecology.* May 2026. PMID 42036191. *(Excluded: CC BY-NC-ND (TJOG, Elsevier). Topic: Case report and literature review of an extremely rare aggressive Bartholin gland carcinoma with high-grade transformation, emphasizing the need for multidisciplinary treatment and thorough immunohistochemical analysis.)* 12. Pathak P, et al. "Carcinoma of the Vulva." *Radiographics.* May 2026. PMID 42024545. *(Excluded: License not confirmed — Radiographics/RSNA is a subscription journal; no open-access record confirmed. Topic: Comprehensive imaging review covering vulvar anatomy, pathogenesis, routes of spread, and the roles of MRI, PET/CT, PET/MRI, and lymphoscintigraphy in staging and treatment planning.)* 13. Yasaka M, et al. "Clinical utility of the Geriatric-8 in the functional assessment of patients with gynecological cancer aged 75 and older: a retrospective study." *Japanese Journal of Clinical Oncology.* May 7, 2026. PMID 41636630. *(Excluded: All rights reserved (OUP). Topic: Retrospective study of 180 women aged 75+ with gynecologic malignancies finding that the Geriatric-8 frailty screening tool (median score lowest in vulvar cancer at 10) was associated with treatment selection and ability to tolerate treatment — relevant for older patients with vulvar cancer being evaluated for surgery or chemoradiation.)* 14. Leite SJ, et al. "Concurrent Vulvar and Cutaneous Melanoma in a 40-Year-Old Woman: A Rare Case of Multiple Primary Melanomas." *Gynecologic Oncology Reports.* May 9, 2026. PMID 42180414. *(Excluded: CC BY-NC-ND (Gynecologic Oncology Reports, Elsevier). Topic: Case report of synchronous vulvar and cutaneous melanomas in a 40-year-old woman, emphasizing multidisciplinary management, selective use of Mohs micrographic surgery for margin control in anatomically sensitive areas, and the need for integrated gynecologic and dermatologic surveillance.)*

This Month in Vaginal & Vulvar Cancer Research

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