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Vaginal cancer is a rare neoplasm, accounting for only 3% of gynecologic cancers. Most cases of vaginal cancer are squamous cell carcinomas, with adenocarcinoma being the second most common histopathology. As the pathophysiology of vaginal squamous cell carcinoma is thought to be due to HPV infection, treatment strategies are largely based on the treatment of cervical cancer, with radiation therapy being the primary method of definitive treatment. The role of surgery also has been shown to improve survival outcomes but should be evaluated on an individualized basis. While there continues to be no existing randomized control trials on the treatment of vaginal cancer, recent studies have explored the benefits of combination chemoradiation for advanced stage disease. Five-year survival of vaginal cancer in Stage I or II has been shown to be as high as 80-90% with treatment, while advanced disease survival rates continue to be around 30%. This review contains 2 figures, 7 tables, and 53 references. Key words: vaginal cancer, squamous cell carcinoma, brachytherapy, external beam radiation, HPV

Vulvar cancer is one of the least common gynecologic cancers. In 2018, vulvar cancer accounted for approximately 6,190 (0.4%) of new cancer diagnoses and approximately 1,200 (0.2%) of cancer deaths in the United States.1 The median age at diagnosis is 68.1 At time of diagnosis, 59% of patients have local disease, 30% have regional disease, and 6% present with metastatic disease.1 The incidence of vulvar cancer per 100,000 women is 1.8 in white women, 1.3 in black women, and 1.3 in Hispanic women.2 Vulvar cancer typically presents as a pruritic lesion, noted by the patient or a provider on exam. Ninety percent of vulvar cancers are of squamous cell histopathology,3 and have risk factors similar to cervical squamous cell carcinoma. Vulvar cancer is staged surgically. The mainstay of vulvar cancer treatment is surgery, however later stages may be treated with chemotherapy and/or radiation. This review contains 2 figures, 2 tables, and 40 references. Keywords: vulvar cancer, chemoradiation, sentinel lymph nodes, inguinal lymphadenectomy, chemotherapy, lymphedema

Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively. This review contains 5 figures, 8 tables and 49 references Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole