VULVAR CANCER

Vulvar cancer is a type of cancer that occurs when abnormal cells grow uncontrollably on or inside the vulva, which is the outer part of a woman’s genitals. It’s distinct from vaginal cancer, which starts inside the vagina.

The vulva comprises several parts:

The opening of the vagina, which is the passage leading out from the uterus.
The labia consists of two sets of skin folds resembling lips. The outer folds are called the labia majora, while the inner folds are known as the labia minora.
The clitoris, a sensitive tissue knob situated beneath a protective skin hood where the labia minora meet.
The mons pubis, a soft mound of tissue in front of the pubic bones that becomes covered in hair during puberty.
The perineum, the skin area between the vulva and anus.

Early Signs You Shouldn’t Ignore:

While there might not be noticeable symptoms at first, be on the lookout for changes in your vulva, such as:

Unusual growths, bumps, or sores
Discoloration of the vulva
Changes in the appearance of moles
Thickened skin
Persistent itching or burning
Unusual vaginal bleeding or discharge
Pain during urination or sex

These can also indicate other conditions, so it’s crucial to see your doctor if you experience any of them.

Types of Vulvar Cancer:

There are several forms of vulvar cancer, each with its characteristics:

Squamous Cell Carcinoma: The most common type, it often starts in the skin cells and may be linked to HPV infection, especially in younger women.
Adenocarcinoma: This type usually develops in glands near the vaginal opening and can look like a cyst.
Melanoma: Less common, this type arises from pigment-producing cells and can form anywhere on the body, including the vulva.
Sarcoma: This cancer starts in bone, muscle, or connective tissue and can occur at any age.
Basal Cell Carcinoma: The most frequent type of skin cancer, it rarely affects the vulva.

Risk Factors:

The exact causes of vulvar cancer are unknown, but certain factors can increase your chances of developing it:

Age (more than half of cases occur in women over 70)
Abnormal Pap test history
Weakened immune system (HIV/AIDS)
HPV infection
History of melanoma or unusual moles
Family history of melanoma
Precancerous vulvar conditions
Past vaginal or cervical cancer
Lichen sclerosus (a vulvar skin condition)
Smoking, especially if combined with HPV

Diagnosis and Staging:

During your appointment, your doctor will likely:

Take your medical history, asking about your overall health, habits, and any past illnesses.
Perform a pelvic exam to check for signs of cancer by visually inspecting the vulva and palpating the uterus, vagina, ovaries, bladder, and rectum.
Conduct a colposcopy, using a magnifying tool called a colposcope to closely examine any suspicious areas in the vagina, vulva, and cervix. This procedure may also be referred to as a vulvoscopy.
Perform a biopsy, where a small sample of tissue is taken for examination under a microscope by a specialist.
Order imaging tests such as X-rays, CT scans, PET scans, and MRIs to obtain detailed pictures of the inside of your body, helping to determine if cancer is present and whether it has spread.

Stages of Vulvar Cancer:

After diagnostic tests, if cancer is detected, your doctor will assess its stage, considering the size of the tumor and whether it has spread. Staging includes:

Stage I: The tumor is small and confined to the vulva and perineum.
Stage II: Cancer has extended into nearby tissues but not to the lymph nodes.
Stage III: It has spread to nearby tissues and the lymph nodes in the groin.
Stage IV: Cancer has advanced to the upper part of the vagina, urethra, anus, or distant parts of the body.

Treatment Options:

Treatment depends on various factors, including the cancer type, stage, and overall health. The main treatment approaches are:

Surgery:
- Ultrasound surgical aspiration: Sound waves break up the tumor, and the doctor removes the pieces.
- Laser surgery: A laser is used to cut into or remove affected tissue, but it’s not suitable for invasive tumors.
- Excision: The tumor and surrounding tissue are surgically removed. This may involve:
  - Wide local excision: Removing some tissue around the tumor.
  - Radical local excision: Removing a significant amount of tissue, possibly including lymph nodes.
- Vulvectomy: Surgical removal of part or all of the vulva, which can be:
  - Skinning vulvectomy: Removing the top layer of skin from the vulva.
  - Simple vulvectomy: Removing the entire vulva and underlying tissue.
  - Partial or modified radical vulvectomy: Removing most of the vulva and nearby lymph nodes.
  - Radical vulvectomy: Removing the entire vulva and nearby lymph nodes.
- Pelvic exenteration: Removal of the vulva, lymph nodes, and adjacent organs like the lower colon, rectum, bladder, uterus, cervix, or vagina.
Radiation therapy: High-energy X-rays or radiation is used to kill cancer cells. This can be administered externally or internally via implanted radioactive needles or seeds.
Chemotherapy (chemo): Medications are used to kill or inhibit the growth of cancer cells. These drugs can be taken orally, intravenously, or applied as lotions or creams on the skin.
Biologic therapy or immunotherapy: This treatment targets the immune system to enhance its ability to fight cancer cells.

Prognosis and Follow-Up:

Following treatment, regular follow-up appointments with your doctor are essential. You may require pelvic exams every 3 to 6 months for the first 2 years, followed by appointments every 6 to 12 months for the next 3 to 5 years. Your doctor might also suggest additional screening tests.

The prognosis varies depending on the type and stage of cancer. Generally, more than 70% of women diagnosed with vulvar cancer survive for at least 5 years after diagnosis.

The 5-year survival rate is around 86% for women whose cancer hasn’t spread beyond the vulva. If cancer has spread to nearby tissues or lymph nodes, the rate drops to approximately 53%. For women with cancer that has spread further in the body, about 23% survive for 5 more years.

Experts estimate that approximately 1,350 women in the United States die from vulvar cancer each year.

Side Effects and Addressing Sexual Concerns:

Before starting treatment, discuss potential side effects with your doctor. Common issues after vulvar surgery include wound problems, emphasizing the importance of maintaining cleanliness and good hygiene.

Surgery, radiation, or chemotherapy can also lead to:

Irritation or damage to the bowels or bladder results in changes in bathroom habits that often resolve within a few weeks.
Scarring, dryness, and tissue shrinkage in the vagina.
Discomfort while wearing tight clothing.
Urinary infections.
Fluid-filled cysts near the surgical wound.
Blood clots that may travel to the lungs.
Severe swelling in the legs due to lymphatic fluid buildup (lymphedema).
Formation of an opening between the bladder or rectum and the vagina (fistula).

Inform your medical team about any treatment side effects so they can assist in managing them effectively.

Sexual concern:

After treatment for vulvar cancer, it’s common to experience sexual and psychological challenges. Changes in body appearance or sensation, pain during sex, difficulty achieving orgasm, or urinary issues might occur.

Don’t hesitate to discuss these changes with your medical team. Counseling can be beneficial, or you may consider reconstructive surgery.

Prevention Tips

Here are some steps you can take to lower your risk of vulvar cancer:

Limit sexual partners and practice safe sex (including condom use).
Get the HPV vaccine to protect against HPV infection.
Don’t smoke.
Schedule regular checkups with your doctor and report any unusual changes in your vulvar area promptly.

Sources:

American Cancer Society: https://www.cancer.org/cancer/types/vulvar-cancer.html
National Cancer Institute: https://www.cancer.gov/types/vulvar
Cleveland Clinic: https://www.cancer.org/cancer/types/vulvar-cancer/detection-diagnosis-staging/staging.html