Vulvar Cancer

Vulvar Cancer

Vulvar cancer is a type of cancer that occurs in the vulva, which is the external part of a woman’s genitalia. The vulva includes the labia minora and majora, clitoris, vaginal opening, and the perineum (area between the vagina and anus). Vulvar cancer is relatively rare, accounting for less than 5% of all gynecologic cancers.
Types of Vulvar Cancer
There are several types of vulvar cancer, including –

1. Squamous cell carcinoma: This is the most common type of vulvar cancer, accounting for about 90% of cases. It develops in the thin, flat cells that line the surface of the vulva.
2. Vulvar melanoma: This is a rare type of vulvar cancer that develops in the pigment-producing cells (melanocytes) in the skin.
3. Adenocarcinoma: This type of vulvar cancer develops in the glandular cells of the vulva, which produce mucus or other fluids.
4. Basal cell carcinoma: This is a rare type of vulvar cancer that develops in the basal cells, which are located in the deepest layer of the epidermis.
5. Verrucous carcinoma: This is a type of squamous cell carcinoma that usually grows slowly and is less likely to spread to other parts of the body.
6. Sarcoma: This is a rare type of vulvar cancer that develops in the connective tissue of the vulva.

Some types of vulvar cancer can have subtypes or variants, which may have different characteristics and treatment approaches. It’s also possible for vulvar cancer to be a combination of different types.

Vulvar Cancer

Causes and Risk Factors

The exact cause of vulvar cancer is not known, but several risk factors have been identified. Some of the known risk factors for vulvar cancer include –

1. Age: The risk of developing vulvar cancer increases as women age, with most cases occurring in women over the age of 60.
2. Human papillomavirus (HPV) infection: HPV is a common sexually transmitted infection that can cause changes to the cells in the vulva, increasing the risk of developing vulvar cancer.
3. Smoking: Smoking is a risk factor for many types of cancer, including vulvar cancer.
4. Chronic vulvar irritation or inflammation: Chronic irritation or inflammation of the vulva, such as that caused by long-term use of certain creams or a history of vulvar infections, may increase the risk of developing vulvar cancer.
5. History of genital warts or precancerous lesions: Women who have had genital warts or precancerous lesions in the past are at increased risk of developing vulvar cancer.
6. Weakened immune system: Women with weakened immune systems, such as those with HIV/AIDS or those who have undergone an organ transplant, are at increased risk of developing vulvar cancer.
7. Genetics: In rare cases, vulvar cancer may be caused by an inherited genetic mutation.

Having one or more of these risk factors does not necessarily mean that a woman will develop vulvar cancer. Many women with vulvar cancer have no known risk factors.

Symptoms

The symptoms of vulvar cancer can vary depending on the stage and type of cancer, but some common symptoms include –

1. Itching, burning, or tenderness in the vulva area
2. Pain or discomfort during urination or sex
3. Abnormal bleeding, such as bleeding after sex, between periods, or after menopause
4. A lump or mass in the vulva area
5. Changes in the color or thickness of the skin in the vulva area
6. Sores, ulcers, or warts on the vulva
7. Swollen lymph nodes in the groin area

These symptoms can be caused by a variety of conditions, not just vulvar cancer. However, if you experience any of these symptoms, it’s important to see a healthcare provider for a proper evaluation and diagnosis.

Diagnosis and Tests

The diagnosis of vulvar cancer usually involves a combination of medical history, physical examination, and diagnostic tests. Here are some common diagnostic tests and procedures used to diagnose vulvar cancer:

1. Physical examination: During a physical examination, your doctor will visually inspect your vulva for any abnormal growths or changes in color, texture, or size.
2. Biopsy: If your doctor suspects that you may have vulvar cancer, they will perform a biopsy to confirm the diagnosis. During a biopsy, your doctor will remove a small sample of tissue from the affected area and send it to a laboratory for analysis.
3. Colposcopy: A colposcopy is a procedure in which a special instrument called a colposcope is used to examine the vulva. The colposcope can help your doctor identify any abnormal areas that may require further testing or biopsy.
4. Imaging tests: Imaging tests, such as a CT scan, MRI, or PET scan, may be ordered to determine the extent of cancer and whether it has spread to other parts of the body.
5. Blood tests: Blood tests may be done to evaluate your overall health and to check for any signs of infection or abnormal blood cell counts.

If you are experiencing symptoms that may be related to vulvar cancer, such as itching, pain, or discharge, it is important to see your doctor right away. Early detection and treatment of vulvar cancer can improve your chances of successful treatment and recovery.

Stages 

There are different stages of vulvar cancer including –

Stage 0 – Cell changes on the surface of the skin.

Stage I – Cancer is limited to the vulva or perineum.

Stage II – Cancer has reached nearby structures but not yet reached the lymph nodes.

Stage III – Cancer has spread to nearby lymph nodes or to the upper part of the urethra, the bladder, the rectum, or the pelvic bone.

Stage IV – Cancer has started to reach organs from the original site.

Early detection and treatment can improve the outcome of vulvar cancer in women.

Treatments

Treatment for vulvar cancer depends on the stage of cancer, the location of the tumor, and the overall health of the patient. Treatment options may include:

1. Surgery: Surgery is the primary treatment for vulvar cancer. Depending on the stage of cancer, the surgeon may remove only the cancerous tissue or the entire vulva. In some cases, nearby lymph nodes may also be removed.

• Local excision: This surgery is used to remove a small tumor on the vulva. The surgeon removes the tumor and a margin of normal tissue around it. This procedure is usually done under local anesthesia.
• Radical vulvectomy: This surgery involves removing the entire vulva, including the clitoris, labia majora, labia minora, and the underlying tissue. The surgeon may also remove nearby lymph nodes. This procedure is typically used for larger tumors or tumors that have spread beyond the vulva.
• Modified radical vulvectomy: This surgery involves removing less tissue than a radical vulvectomy, but still removes the tumor and some surrounding tissue. The surgeon may also remove nearby lymph nodes.
• Lymph node dissection: If cancer has spread to nearby lymph nodes, the surgeon may perform a lymph node dissection to remove the lymph nodes. This procedure may be done at the same time as the vulvectomy.

2. Radiation therapy: Radiation therapy may be used before or after surgery to destroy cancer cells that may have spread beyond the vulva.

• External beam radiation therapy – is the most common type of radiation therapy used for vulvar cancer. During this procedure, a machine outside the body directs high-energy radiation beams at the tumor and surrounding tissues. The radiation may be delivered daily over several weeks.
• Internal beam radiation therapy – It is also called brachytherapy. During this procedure, a radioactive source is placed inside the vagina to deliver radiation directly to the tumor. This type of radiation therapy may be used alone for early-stage vulvar cancer or in combination with external beam radiation therapy for more advanced cases.

3. Chemotherapy: Chemotherapy may be used to shrink the tumor before surgery or to destroy cancer cells that may have spread to other parts of the body.

4. Immunotherapy: Immunotherapy is a type of treatment that helps the body’s immune system to fight cancer cells.

5. Palliative care: In cases where cancer has spread too far to be cured, palliative care may be recommended to manage symptoms and improve quality of life.

It’s important to consult with a healthcare professional to determine the best treatment plan for individual cases of vulvar cancer.

Outlook

The survival rate of vulvar cancer has increased to 5 yrs or longer due to advanced treatment in technologies. However, it all depends on the stage and type of vulvar cancer in a patient. There is also a 50% chance of recurrence and the outlook is less positive compared to other types of cancers in women.