Vulvar Cancer

Overview

Vulvar cancer is a type of cancer that affects the female external genitals or, the vulva. The vulvar region includes-

The labia – these are the inner and outer lips of the vagina,

The clitoris, and

The opening of the vagina,

The mons pubis: This is the soft area in front of the pubic bones that get covered with hair during puberty

The perineum: It is the patch of skin between the vulva and the anus Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching. It can also affect the glands in and around the vaginal opening. As the cancer spreads, it also starts affecting the outer lips of the vagina and the other parts of the vulva. Though it can occur at any age, vulvar cancer is most commonly diagnosed in older adults Cancers of these types undergo a slow growth, starting as vulvar intraepithelial neoplasia, which happens when the healthy skin cells around the vulva undergo asymmetrical changes. In absence of treatment, such abnormal growth of cells results in cancer. There are five types of vulvar cancers:

Squamous cell carcinoma is the most common. It starts in the skin cells. Some types of it are linked to HPV — human papilloma virus. That’s an infection you get from having sex with someone who has it. Younger women are more likely to get vulvar cancer that’s linked to HPV

Adenocarcinoma usually starts in cells located in the glands just inside the opening of the vagina. It can look like a cyst, so you might not pay attention to it at first

Melanoma forms in cells that make pigment, or skin colour. You’re more likely to get it on skin that’s exposed to sun, but it can show up in other areas too, like the vulva. It makes up about 6 out of every 100 vulvar cancers.

Sarcoma starts in bone, muscle, or connective tissue cells. It differs from other vulvar cancers because it can happen at any age, including childhood.

Basal cell carcinoma is the most common type of skin cancer. It usually appears on skin that’s exposed to sun. Very rarely, it occurs on the vulva.

Vulvar cancer treatment usually involves surgery to remove the cancer and a small amount of surrounding healthy tissue. Sometimes vulvar cancer surgery requires removing the entire vulva. The earlier vulvar cancer is diagnosed, the less likely an extensive surgery is needed for treatment.

Symptoms

In its initial stages, symptoms of Vulvar cancer may be dormant. However, in early stages, they include:

Abnormal bleeding

Itching in the vulvar area

A discolored patch of skin

Pain with urination

Pain and tenderness in the vulvar area

A lump or wart-like sores on the vulva

Causes

While specific causes remain undetected, few of the likely reasons for development of vulvar cancer could be:

Age & Gender– It mostly occurs in females above 55 years of age.

Smoking habits

Due to vulvar intraepithelial neoplasia

Due to HIV or AIDS

Due to human papillomavirus (HPV) infection

Due to a history of genital warts

Due to a skin condition that can affect the vulva, such as lichen planus

Diagnosis

There are a number of tests to find the stage of the cancer, some of it includes:

Examining your vulva: The doctor will likely conduct a physical exam of the vulva to look for abnormalities.

Biopsy: To determine whether an area of suspicious skin on your vulva is cancer, your doctor may recommend removing a sample of skin for testing. During a biopsy procedure, the area is numbed with a local anaesthetic and a scalpel or other special cutting tool is used to remove all or part of the suspicious area. Depending on how much skin is removed, you may need stitches.

Pelvic examination: The doctor may do a more thorough examination of the pelvis for signs that the cancer has spread.

CT scan- to identify enlarged lymph nodes in the groin area.

MRI scan– to find pelvic tumours and tumours that may have spread to the brain or spinal cord.

Cystoscopy and proctoscopy- to determine whether the cancer has spread to the bladder or the rectum.

Basis the diagnosis, the doctor will be able to determine the stage of vulvar cancer. It can be broadly classified into:

Stage I: In this stage, there is a small tumour that is confined to the vulva or the area of skin between your vaginal opening and anus (perineum). This cancer hasn’t spread to your lymph nodes or other areas of your body.

Stage II: Here the tumours are those that have grown to include nearby structures, such as the lower portions of the urethra, vagina and anus

Stage III: In this stage the cancer has spread to lymph nodes

Stage IV: This stage signifies a cancer that has spread more extensively to the lymph nodes, or that has spread to the upper portions of the urethra or vagina, or that has spread to the bladder, rectum or pelvic bone. Cancer may have spread (metastasized) to distant parts of your body.

It is important to note that vulvar melanoma uses a different staging system.

Treatment

Laser Therapy- Laser therapy uses high-intensity light to destroy cancer cells, while causing less scarring and bleeding than other forms of treatment.

Surgery- This is the most common treatment for vulvar cancer, depending on the stage of cancer and condition.

Local Excision- Local excision is performed only if the cancer hasn’t affected the distant nodes or organs. The process involves removal of the affected area, along with a minor quantity of normal tissue around it.
Vulvectomy- This is another surgical option where a part of the vulva may be removed (partial vulvectomy) or there could be complete removal of the vulva (radical vulvectomy).
Pelvic Exenteration: In case of advanced or severe vulvar cancer, pelvic exenteration may be performed. It is a radical surgical treatment that removes all organs from a person’s pelvic cavity. The urinary bladder, urethra, rectum, and anus are removed. The procedure leaves the person with a permanent colostomy and urinary diversion

Radiation Therapy: One of the most important forms of therapy is Radiation therapy, which uses high-energy radiation to shrink tumours or to destroy cancer cells. Radiation therapy for vulvar cancer is usually administered by a machine that moves around your body and directs radiation to precise points on your skin (external beam radiation). Radiation therapy is sometimes used to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Radiation is sometimes combined with chemotherapy, which can make cancer cells more vulnerable to radiation therapy.

Chemotherapy: Chemotherapy is a common form of chemical drug therapy. It helps in slowing down or preventing cancer cells from growing further. It is administered usually through a vein in the arm or through the mouth. Chemotherapy is sometimes combined with radiation therapy to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Chemotherapy may also be combined with radiation if there’s evidence cancer has spread to the lymph nodes.