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The vulva is the outer layer of the skin of the female genital organ surrounding the vagina, clitoris, labia, and urethra. It is a rare type of cancer affecting the women’s vulva and is known as vulvar cancer.
An itchy lump or sore on the vulva is a common onset of vulvar cancer which can occur at any age but mostly found in adult women. Surgery may be done to remove the whole vulva or parts of it. If detected early, vulvar cancer may not require an extensive surgery.
Symptoms
The following are the signs and symptoms of vulvar cancer:
- Tenderness and pain
- Burning sensation in the vulvar area
- Persistent itchiness
- Vulvar skin thickening or color changes
- An open ulcer or wart-like lump
- Bleeding not related to menstrual period
- Pelvic pain during sexual intercourse or urination.
If you notice these symptoms, consult a gynecologist.
Causes
The cause of vulvar cancer is unclear. Generally, cancer starts when the cell’s DNA mutates. This mutation causes the cells to grow and divide rapidly outliving the healthy cells, and forms a tumor which can invade surrounding tissues or spread to the other parts of the body.
Types of vulvar cancer
The type of treatment will be based on the type of cell of the origin of vulvar cancer.
These are the types of vulvar cancer that are usually found:
- Squamous cell carcinoma. The most common type of vulvar cancer is squamous cell carcinoma. It starts at the vulvar surface with thin and flat cell lining.
- Melanoma. Melanoma is type of skin cancer that develops form pigment producing cells in the skin. Melanoma most often spreads to other part of the body.
Risk factors
They following risk factors may cause vulvar cancer:
- Old age. As women age (average is 65 years old), the risk of getting vulvar cancer also increases. Although, any age group can have the disease.
- Human Papillomavirus (HPV) exposure. Having HPV has a high risk of having a couple of cancers such as vulvar or cervical cancer. It is a sexually transmitted infection which can occur in the sexually active and younger generation. This infection may disappear on its own or undergo cell mutations which pose a high chance of having cancer later on.
- Smoking. May increase the chance of having vulvar cancer.
- Weak immune system. Having a disease that compromises the immune system such as Human Immunodeficiency Virus (HIV) or those who are taking immunosuppressant medications such as those who have undergone organ transplant have higher risks of having vulvar cancer.
- Having a history of precancerous conditions of the vulva. This may further develop into vulvar cancer. The doctor may advise to remove the affected part with regular follow up visits.
- Having a skin condition involving the vulva. A skin condition that causes itchiness and thinning of the vulva called lichen sclerosus may pose a higher risk of developing vulvar cancer.
- Multiple sexual partners.
Diagnosis
Diagnosing the cancer
The following procedures may be done to diagnose vulvar cancer:
- Vulva examination. Doctor will perform physical assessment of the vulva to evaluate for any abnormalities.
- Using a special magnifying device to examine your vulva. A colposcopy uses a magnifying glass device to perform close inspection and find any abnormalities of the vulva.
- Tissue biopsy. A small portion of the vulvar tissue is removed under local anesthesia and sent to the lab for examination under a microscope.
Determining the extent of the cancer
After a cancer diagnosis, staging has to be done by the doctor as follows:
- Examination of your pelvic area for cancer spread. A pelvic exam may be performed for a more extensive assessment of the pelvis to evaluate if there is a spread of cancer.
- Imaging tests. An X-ray, Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) may be recommended by the doctor for further testing and to determine if the cancer has spread to other parts of the body (e.g., to the chest or abdomen.)
Vulvar cancer may be staged from 0 to IV (Roman Numerals). The lowest stage means that the cancer is localized to the vulva but when it reached stage IV, it means that the cancer is advanced and has spread to nearby tissues or other parts of the body.
Treatment
The treatment for vulvar cancer depends on its type, stage, and location. The patient’s general health and treatment options are also considered.
Surgery
The following surgical techniques may be done for vulvar cancer:
- Excision. Also known as wide local excision or radical excision which removes only the cancer part and a small portion of its surrounding healthy tissues to make sure that all cancer cells have been removed.
- Vulvectomy. Can be done partially (only some parts of the vulva) or radically (removes the entire vulva and its underlying tissue for larger type of cancer). If a larger cancer has been found, some surgery may be combined with radiation therapy and chemotherapy to reduce the size of the tumor and make it easily accessible for surgical removal.
- Sentinel node biopsy. The lymph nodes which are most likely to have cancer are determined for removal and testing for cancer. Once cancer is not detected, it indicates that cancer has not spread to the lymph nodes.
- Removing many lymph nodes. A huge amount of lymph nodes may be removed if cancer has already spread into them to decrease the risk of spreading the cancer to distant lymph nodes of the body.
Radiation therapy
Uses X-rays and protons with high-power energy beams to destroy cancer cells. It can be used in vulvar cancer treatment by utilizing a machine that surrounds the body and targets specific points on the skin (external beam radiation). Radiation therapy may be utilized to decrease the size of the tumor making it more accessible for surgical removal. Furthermore, it can also be used in combination with chemotherapy to make the cancer cells easily targeted by radiation. Radiation therapy may also be used to target the lymph nodes that has cancer or to kill any residual cancer cells post-surgery. It is commonly done in combination with chemotherapy.
Chemotherapy
Chemotherapy uses medications containing chemicals that kill cancer cells administered orally or intravenously. It may be used in advanced stage of vulvar cancer. Chemotherapy can be combined with radiation therapy to decrease the size of tumor and facilitate easy access to remove the tumor or treat cancer that has spread to the lymph nodes.
Targeted drug therapy
Focuses on specific cancer cell abnormalities and blocks them until they die. It may be a treatment option for an advanced vulvar cancer stage.
Immunotherapy
Utilizes the body’s own immune system to counteract cancer. Cancer cells produce proteins that hides them from the body’s own disease-fighting immune system. Hence, the body will not fight the cancer cells. Immunotherapy counteracts this process. It may also be a treatment option for an advanced vulvar cancer stage.
