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Vulvar Cancer

Vulvar cancer happens when the cells lining the vulvar region start dividing abnormally and form a tumour. Women who smoke are at an increased risk of developing vulvar cancer.

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Overview

Vulvar cancer happens when the cells lining the vulvar region start dividing abnormally and form a tumour.

The vulva is the term given to female external genitalia. The vulva is the collective term for the labia majora and labia minora (inner and outer lips of the vagina), pudendal cleft, mons pubis, Bartholin glands, the clitoris and the vaginal and urethral openings.

Vulvar cancer is one of the rare cancers that can occur among women of any age group. However, it is found to be more common among older women.

One of the first symptoms of vulvar cancer is a lump or sore in the vulvar region.

Vulvar cancers are usually slow-growing and start as vulvar intraepithelial neoplasia, i.e., the precancerous condition of vulvar cancer, wherein the healthy cells in the lining of the vulva start showing asymmetrical changes.

Types

Based on the type that they originate from, vaginal cancers are classified into the following types:

  • 1. Squamous Cell Carcinoma: This is the most common type of vulvar cancer, and it forms on the surface of the vulva. The incidence of this vulvar cancer type is linked with HPV infection.
  • 2. Verrucous Carcinoma: This is a subtype of squamous cell carcinoma that is usually slow-growing.
  • 3. Adenocarcinoma: This cancer type usually starts in the vulvar sweat glands or Bartholin glands. It accounts for a small percentage of vulvar cancers.
  • 4. Melanoma: This cancer type forms in the melanocytes, which are the pigment-producing cells present in the vulvar region.
  • 5. Sarcoma: Sarcoma forms in the connective tissue present below the skin in the vulvar region.

Symptoms

In the initial stages, patients with vulvar cancer may not have any symptoms. However, as the disease progresses, the symptoms may start becoming apparent:

  • Presence of a lump in the vulvar or groin region
  • Changes in the texture and colour of the skin in the vulvar region
  • Itching, burning sensation, pain and soreness in the vulvar region
  • Pain during urination
  • Unusual bleeding
  • Persistent ulcers or open wounds that do not heal even after one month
  • Changes in the appearance of an existing mole (in the case of melanoma)
  • Occurrence of wart-like growths that have an appearance similar to that of genital warts

Causes

The exact cause of vulvar cancer remains unknown. However, researchers have identified a few risk factors that can increase one’s risk of developing vulvar cancer:

  • Age: Although vulvar cancer can happen at any age, it is found to be more common among women who are aged above 55.
  • HPV Infection: Those exposed to Human papillomavirus (HPV) have a higher risk of developing vulvar cancer, along with various other gynaecological cancers.
  • Smoking: Women who smoke are at an increased risk of developing vulvar cancer.
  • Compromised Immunity: Those with a weaker immune system, which could be caused due to immunosuppressants or health conditions, such as HIV infection, are also at an increased risk of developing vulvar cancer.
  • Vulvar Intraepithelial Neoplasia: Having a history of vulvar intraepithelial neoplasia, which is the precancerous condition of vulvar cancer, is also a risk factor for vulvar cancer. However, it is important to note that not everyone with this condition will develop vulvar cancer – this condition only increases the risk of the disease
  • Certain Skin Conditions: Skin conditions, such as lichen sclerosus, wherein the skin in the vulvar region become thin and itchy, can increase the risk of vulvar cancer.

Diagnosis

There are various tests recommended by the doctor for the detection and diagnosis of vulvar cancer.

a. Physical Examination and Medical History Assessment: If an individual is suspected to have vulvar cancer, the doctor recommends a physical exam, wherein the vulvar and the pelvic regions are examined for the signs of the disease. The doctor may also study the medical history of the patient in order to have a better understanding of the underlying medical conditions, previous medical treatments, allergies, etc.

b. Colposcopy: A colposcopy is a specialised tool used to examine the areas of the vulva, vagina and cervix. This lighted instrument magnifies and helps the doctor thoroughly examine these areas and find out if there are any abnormalities.

c. Biopsy: If vulvar cancer is suspected, the doctor may recommend a biopsy for a definitive diagnosis. During this procedure, a small portion of tissue from the suspicious area on the vulva is collected and examined under a microscope for the presence of cancer cells.

d. Imaging Tests: Further, the doctor may also recommend imaging tests, such as CT scan, MRI scan and other tests like cystoscopy and proctoscopy to check if cancer has spread to nearby organs. These imaging tests may be recommended throughout the cancer treatment as these also help in disease staging, treatment planning and therapy monitoring.

Treatment

Treatment planning for vulvar cancer is made based on multiple factors such as the stage of the disease, exact location of the tumour, the tumour size, the patient’s age, her overall health condition and preferences.

The main treatment options available for vulvar cancer include surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy.

a. Surgery: Surgery is the main line of treatment for vulvar cancers. The primary goal of surgery is to remove the cancer cells whilst keeping the patient’s sexual function intact. There are multiple surgical options available for vulvar cancer; the doctor may recommend one of the following based on the stage of the disease:

  • Excision: An excision involves the removal of the tumour along with a small amount of healthy tissue that surrounds the tumour. Depending on the severity of the condition, the doctor may either recommend wide local excision (tumour with a small amount of healthy tissue) or radical excision (tumour with a large amount of healthy tissue) for the effective management of vulvar cancer.
  • Vulvectomy: Vulvectomy is a surgical procedure that involves the removal of either a portion or the entire vulva. Vulvectomy may be administered in combination with chemotherapy and radiation therapy in order to enhance the overall effectiveness of the treatment.
    • Simple Vulvectomy: During simple vulvectomy, the entire vulva, i.e., the labia majora and labia minora, along with tissue beneath the skin are removed.
    • Partial Vulvectomy: Partial vulvectomy involves the removal of the entire vulva along with the deep tissues.
    • Radical Vulvectomy: During radical vulvectomy, the entire vulva, the deep tissues and the clitoris are removed.
  • Removal of Lymph Nodes: If the cancer is suspected to have spread to the lymph nodes, the doctor may recommend the removal and examination of the lymph nodes for the presence of cancer cells. If the disease has spread to the lymph nodes, several lymph nodes may be removed in order to reduce the chances of cancer spreading to the nearby organs.
  • Pelvic Exenteration: Pelvic exenteration may be recommended for vulvar cancers that have spread to nearby organs. This surgical procedure involves the removal of key organs present in the pelvic region namely, the vulva, vagina, cervix, uterus, ovaries, fallopian tubes, lower large intestine and rectum along with the bladder. After this surgery, an artificial opening called a stoma, may be created and connected to a collection bag for the excretion of urine and stools.

b. Laser Surgery: Laser surgery involves the usage of focussed laser beams to destroy cancer cells. Laser surgery is largely used to treat vulvar intraepithelial neoplasia and pre-invasive vulvar cancer.

c. Radiation Therapy: For vulvar cancer, radiation therapy may be administered in combination with other treatment modalities, namely chemotherapy and surgery – this is important to enhance the overall effectiveness of the treatment. Radiation therapy uses high-energy radiation beams, which could be X-rays or proton beams, in order to destroy the cancer cells.

Usually, for vulvar cancers, radiation therapy is delivered externally.

d. Chemotherapy: Chemotherapy is a treatment method that uses strong anticancer drugs to kill cancer cells in the body. Chemotherapy may be administered orally or intravenously. It helps in preventing or slowing down the cancer cells from dividing and spreading to other organs. Chemotherapy may be administered along with radiation therapy before surgery in order to shrink the tumour. It is also one of the common treatments recommended for vulvar cancers that have spread to the nearby lymph nodes.

Frequently Asked Questions

1. Are vulvar cancers treatable?

Yes, if detected early, vulvar cancers can be treated successfully in most cases. There are multiple treatment options available today that can support the successful management of vulvar cancers.

For vulvar cancers to be detected in the early stages, it is important for women to be mindful of the changes happening in the vulvar region. No symptom should be ignored as this can lead to delayed diagnosis and poor clinical outcomes.

2. I have received treatment for cervical cancer in the past. Will I get vulvar cancer?

Studies have found that those who have received treatment for cervical cancer are at a higher risk of getting vulvar cancer, along with many other cancers. That said, it is important to note that not all patients with cervical cancer develop vulvar cancer.

If you have received cervical cancer treatment in the past, you can talk to your doctor to understand the best practices that you can follow in order to reduce your vulvar cancer risk.

3. Can vulvar cancers come back?

Yes, unfortunately, vulvar cancers can come back in a few cases. However, they can be treated successfully, if they are detected early.

After the treatments, patients must strictly keep up their follow-up appointments, which will help doctors in catching the recurrences in the early stages and treat them appropriately.

4. Can women have children after vulvar cancer treatment?

This depends on the severity or the stage of the disease. Those with early-stage vulvar cancers can still have children after the treatment in most cases.

In other cases, the doctor may recommend fertility preservation methods through which patients can have children after the treatment.

5. Can I prevent vulvar cancer?

One cannot prevent vulvar cancer entirely as there is no known cause for this condition. However, there are a few measures that you can follow in order to bring down your risk of developing vulvar cancers:

  • Avoid HPV Infection: HPV infection, which is sexually transmitted, increases vulvar cancer risk. Therefore, women must take necessary measures to reduce their HPV infection risk.
  • Quit Smoking: Smoking is also a risk factor for vulvar cancer, and therefore, by quitting smoking you can bring down your vulvar cancer risk.
  • Opt for Regular Screening: Regular screening can help you catch vulvar cancer in its early stage and receive timely treatment.

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