About Vulvar Cancer
Vulvar cancer occurs when a change in the DNA of a vulvar cell (mutation) causes abnormal growth that may be cancerous. The exact cause of the mutation is unknown. There are several factors associated with vulvar cancer.
Non-modifiable risk factors (factors a person cannot change or control):
- Age: More than 50% of vulvar cancers occur in females aged 70 years and older, with fewer than 20% occurring in females below 50 years.
- Lichen sclerosus: This inflammatory condition causes thinning and itching of the vulvar skin, which increases the risk of vulvar cancer. Approximately 4% of people with lichen sclerosus later develop vulvar cancer.
- Immunodeficiency: Certain types of immunodeficiency, whether due to genetic causes or diseases like HIV, can also increase the risk.
- Cervical cancer: Having a history of cervical cancer can also increase the risk of developing vulvar cancer.
- Moles and melanoma: People with moles or melanoma anywhere on their body may have a higher chance of developing vulvar cancer.
Modifiable risk factors (factors a person potentially can change or control):
- Human papillomavirus (HPV): Having an HPV infection increases the risk of vulvar cancer.
- Certain types of HPV, such as HPV 16 and 18, are responsible for more than half of all vulvar cancers.
- Smoking: Smoking exposes the body to cancer-causing chemicals and increases the risk of vulvar cancer, especially in individuals who have had previous HPV infections.
- Radiation therapy: Individuals who have undergone radiation therapy in the vulvar region have a higher risk of developing vulvar cancer.
Symptoms of vulvar cancer may include:
- Changes in skin color and texture
- Appearance of warts, lumps, bumps on the skin
- Itching, burning, and irritation
- Pain during sex or when urinating
- Pain, bleeding, or itching in the vulva that does not go away on its own or keeps coming back
- Sores on the vulva that do not go away or that come back
These symptoms usually appear first on the lips of the vagina.
It is important to note that these symptoms can be similar to those of other diseases. Therefore, it is crucial to consult a doctor for a proper diagnosis if any changes occur around the vulva or vagina. An early diagnosis can significantly improve the outlook for individuals with vulvar cancer.
To diagnose vulvar cancer, doctors may perform the following examinations, tests, and procedures:
- Physical examination and history: The doctor will ask about your symptoms and medical history. They will also perform a physical examination to look for any abnormalities on the vulva.
- Pelvic examination: This involves examining the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina to visualize the vagina and cervix for signs of disease. The doctor or nurse may also insert one or two lubricated, gloved fingers into the vagina to feel the size, shape, and position of the uterus and ovaries.
- Pap smear: This test involves collecting cells from the cervix using a small brush or spatula. These cells are then examined under a microscope to check for any abnormal changes that could indicate cancer.
- Colposcopy: This procedure uses a special magnifying instrument called a colposcope to closely examine the vulva for any abnormal areas. If any suspicious areas are found, a biopsy may be performed.
- Biopsy: A biopsy is a procedure where a small sample of tissue is taken from the vulva and sent to a laboratory for testing. This helps confirm if cancerous cells are present.
- HPV testing: Human papillomavirus (HPV) is a common virus that can cause changes in the cells of the vulva. HPV testing may be done to determine if HPV is present and if it is associated with any abnormal cell changes.
In addition to these diagnostic tests, there are additional examinations, tests, and procedures used to determine if the cancer has spread and to determine the stage of vulvar cancer.
- Cystoscopy: A small lighted tube with a camera is used to check the bladder for signs of cancer spread.
- Proctoscopy: A small lighted tube with a camera is used to check the rectum for signs of cancer spread
- Imaging studies: Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-CT (PET-CT) scans may be used to determine if cancer has spread beyond the vulva to nearby structures or lymph nodes.
To summarize, common examinations, tests, and procedures used to diagnose and determine the stage of vulvar cancer include physical examination, pelvic examination, Pap smear, HPV testing, and biopsy. Additional examinations include colposcopy, cystoscopy, protcoscopy, and imaging studies like MRI or CT scans.
The goals of treatment for vulvar cancer are to remove all of the cancer while preserving sexual function and to improve the overall well-being of the patient. Here are the different treatment options and how they work to achieve these goals:
Surgery:
- Wide local excision: This surgical procedure removes the cancer and some surrounding normal tissue. It is a less extensive procedure that aims to save more healthy tissue for less advanced vulvar cancers.
- Radical local excision: This surgical procedure removes the cancer and a larger amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.
- Vulvectomy: This surgical procedure involves removing part or all of the vulva.
- Modified radical vulvectomy: Surgery to remove most of the vulva, with possible removal of nearby lymph nodes
- Radical vulvectomy: Surgery to remove the entire vulva, along with nearby lymph nodes
- Pelvic exenteration: A more extensive surgical procedure that removes the lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. Artificial openings (stoma) are created for urine and stool to flow into a collection bag.
Radiation therapy:
- High-energy rays are used to treat cancer cells.
- Radiation can be used before surgery to shrink the tumor or after surgery to destroy any remaining cancer cells.
- It can also be used as a main treatment alongside or without chemotherapy for individuals who cannot undergo surgery.
Chemotherapy:
- Drugs are administered intravenously or topically to kill cancer cells.
- Chemotherapy is often used for vulvar cancer that has recurred after surgery or has spread.
Immunotherapy:
- This type of biological therapy uses specific substances to enhance the body's natural defense against cancer.
- Immunotherapy is still being studied for its effectiveness in treating vulvar cancer.
It's important to note that each treatment option has its own benefits and potential side effects. The choice of treatment depends on several factors, including the stage of the cancer, overall health of the patient, and individual preferences. Healthcare professionals will aim to provide the most effective treatment while minimizing negative impacts on sexual function and quality of life.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.
Vulvar cancer is a type of cancer that affects the area around the female genitalia, including the labia and clitoris. The natural progression of vulvar cancer can vary from person to person, but it generally involves the growth and spread of cancer cells over time.
Complications that may occur with vulvar cancer or its treatment include:
- Metastasis: If vulvar cancer spreads to other parts of the body, it can cause complications specific to those areas, such as liver, lung, or bone problems.
- Wound dehiscence: This refers to the separation or opening of surgical incisions or wounds. It can occur after surgery for vulvar cancer and may require additional treatment or care.
- Lymphedema: This is a condition where there is swelling in the arms or legs due to a buildup of lymph fluid. It can occur as a result of damage to the lymphatic system during surgery for vulvar cancer.
- Infection: Infections can occur after surgery for vulvar cancer, leading to discomfort and potentially requiring additional treatment with antibiotics.
- Wound healing issues: Some individuals may experience delayed wound healing or complications with wound closure after surgery for vulvar cancer.
It's important to note that every individual's situation is unique, and treatment plans may vary. If you have any concerns about vulvar cancer or its complications, it's best to consult with a healthcare professional who can provide personalized advice based on your specific needs.