Muscle-skeletal metastatic pattern in vulvar cancer

Vulvar cancer is a rare malignancy of the genital tract, the fourth most common type in this category. The most common form of the clinical appearance is long-lasting pruritus, a lump or mass on the vulva. Despite its histological type, in most cases, invasive vulvar cancer metastasizes primarily through the lymphatic system. Bone metastases related to gynecological cancers are rare, often underdiagnosed, and have a very poor prognosis. The most common site of metastasis in vulvar cancer is the lung, which is affected in about 45%, followed closely by the liver and brain. Bone metastases are present in about 10% to a quarter of cases. The most common places are the spine, pelvic bone, ribs, skull, limb bones and sternum. The only characteristic of the bone microenvironment is its high sensitivity to endocrine status, as vulvar cancer affects postmenopausal women. Thus, the theory of the protective role of estrogen on bone density and bone metastases remains an open door for future protection and treatment strategies.