Vulvar and Vaginal Cancer

Vulva cancer is a type of cancer that occurs on the outer surface area of the female genitalia. Vulva is the skin area surrounding the urethra and vagina, including the clitoris and inner lips (labia minors-small lips).

Vulvar cancer often appears as a lump or wound in the vulva, causing itching and pain. Vulvar cancer is rare and accounts for about 4% of all gynecologic cancers. Vulvar cancer can occur at any age; however, it is most common in advanced age, post-menopausal women.

Symptoms

Signs and symptoms of vulvar cancer may include:

Constant itching (pruritis)

Pain and tenderness

Skin changes, such as discoloration or thickening

A lump, wart-like or cauliflower-like mass, or open wound (ulcer)

Abnormal bleeding

Burning

Pain

Causes

It is not known exactly what causes vulvar cancer. In general, it is considered that cancer emerges due to abnormal changes (mutation) occurring in the DNA of a cell. Mutations cause the cell to grow and divide rapidly. Cells and other cells originating from these cells continue to live as normal cells die. Accumulating cells form a tumor, occupy the surrounding tissues and spread to other parts of the body.

Types of Vulvar Cancer

Vulvar squamous cell cancer: This cancer starts from the thin, flat cell layer that covers the vulva surface. Most vulvar cancers are squamous cell cancers (90%).

Vulvar melanoma: This cancer begins in the pigment-producing cells found in the skin of the vulva.

Adenocarcinomas

Bartholin gland cancer

Sarcomas

Metastatic

Risk factors

Although the exact cause of vulvar cancer is unknown, some factors increase the risk of vulvar cancer.

Advanced age: The average age of the patients at the time of diagnosis in vulvar cancer is 65.

HPV exposure: HPV, like cervical cancer, also causes vulvar cancer. The majority of people who are sexually active and exposed to HPV are cleared of the virus. In some patients, the infection persists and causes cellular changes. This increases the risk of developing cancer in the future.

Smoking: Smoking is known to increase the risk of vulvar cancer.

Weak immune system: People with organ transplants who use drugs that suppress the immune system or who have immune system suppression such as HIV, have an increased risk of vulvar cancer.

Presence of a pre-cancerous lesion on the vulva: Pre-cancerous lesions called vulvar intraepithelial neoplasia can rarely progress to cancer. Therefore, your physician may recommend treatment options for the treatment of this condition in that region.

Diagnosis

Examination of the vulva. Your doctor may perform a physical exam on the vulva to examine abnormalities.

Using a special lens for the examination of the vulva. During a colposcopic examination, your doctor uses a similar magnifier to closely examine abnormal areas in the vulva.

Taking a tissue sample (biopsy) for the test. A part of the skin is sampled to determine if a suspicious skin area on the vulva is cancerous. During a biopsy procedure, the area is numbed with local anesthesia and all or part of the suspected area is removed. Depending on the amount of skin part removed, stitches may be required.

Determination of cancer size. After the diagnosis is confirmed, your doctor will perform some studies to determine the size and stage of the cancer. Staging tests include:

Pelvic examination.

Imaging tests. Images obtained from the chest or abdomen may show whether the cancer has spread to other areas. Imaging tests can include x-ray, computed tomography (CT), and magnetic resonance imaging (MRI).

Vulvar Cancer Stages

Stage I refers to involvement of the skin area between the opening of the vagina (introitus) and the anus (perineum) or a small tumor limited to the vulva. At this stage, cancer has not spread to lymph nodes or other parts of the body.

Stage II tumors are cancers that spread to the lower parts of the urethra, including surrounding structures such as the vagina and anus.

Stage III cancer has spread to the lymph nodes.

Stage IVA means that the cancer has spread to more lymph nodes or has spread to the upper parts of the urethra or vagina, or to the bladder, rectum and hip bone.

Stage IVB indicates that cancer has spread to distant parts of the body (metastasis).

Treatment

The treatment of vulvar cancer is surgery. In vulvar cancer surgery, sometimes removal of the whole vulva is necessary. The earlier vulva cancer is diagnosed, the lower the risk of necessity for extensive surgery for treatment.

Treatment options for vulvar cancer depend on the type and stage of the cancer, your overall health, and your preferences.

Surgery

Surgical operations for treating vulvar cancer include:

Removal of the Cancer and the Edge of Healthy Tissue (Excision). Also called wide local excision or radical excision, this procedure involves cutting at least 3/4 inch (2 cm) of the cancer and the normal, healthy tissue around it. Excision of the normal-looking tissue edge by your doctor helps make sure all cancerous cells are removed.

Removing Part of the Vulva (Partial Vulvectomy): During partial vulvectomy, part of the vulva and the underlying tissues are removed.

Removing the Whole Vulva (Radical Vulvectomy): Radical vulvectomy involves removing the entire vulva, including the clitoris and the underlying tissue.

Extensive Surgery for Advanced Cancer: If the cancer has spread outside of the vulva and surrounding organs, your doctor may recommend removing the entire vulva and surrounding organs through an operation called pelvic exenteration. Depending on where the cancer has spread, the surgeon may remove the lower colon, rectum, bladder, cervix, uterus, vagina, ovaries, and surrounding lymph nodes. If the bladder, rectum, or colon is removed, an artificial opening (stoma) will be created in your body to excrete urine into a bag (ostomy).

The wound or remaining area can usually close without skin grafted from another part of your body. However, depending on how much the cancer has spread and how much tissue needs to be removed, a reconstructive surgery can be performed; this procedure involves preparation of skin grafts from another part of your body to cover this area.

Surgery for the removal of the entire vulva carries the risk of complications such as infection and healing problems around the incision. In addition, it may be uncomfortable to sit for a long time when some or all of the vulvar fatty pad is removed. Numbness may be felt in the genital area and it may be difficult to reach orgasm during sexual intercourse.

Surgery to remove the surrounding lymph nodes Vulvar cancer often spreads to the lymph nodes in the groin, so your doctor can also remove these lymph nodes during surgery to treat cancer. Depending on your condition, your doctor may remove only a few lymph nodes or many of them.

Removal of lymph nodes causes fluid retention and swelling of the legs (called lymphedema). If this complication develops, Compression socks and stockings can be used to help reduce symptoms.

This procedure, called sentinel lymph node biopsy, involves identifying the lymph node where cancer is most likely to spread first. The surgeon removes the lymph node for later testing. If the cancer cells are not detected in this lymph node, it means that cancer cells have not spread to other lymph nodes, so less lymphadenectomy is performed in patients who undergo sentinel lymph node biopsy, and therefore less lymphedema is seen.

Radiotherapy

Radiotherapy uses high-power energy beams (for example, X-rays) to kill cancer cells. Radiotherapy for vulvar cancer is usually performed by a machine that rotates around your body and applies radiation to certain points on your skin (external beam radiotherapy).

Radiotherapy is sometimes used to reduce the size of vulvar cancers to increase the success rate of the surgery. Radiotherapy is sometimes used in combination with chemotherapy, so that cancer cells can be made more sensitive to radiotherapy. If cancer cells are identified in the lymph nodes, it is recommended to apply radiotherapy after surgery.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are usually given as an infusion into a vein; some chemotherapy drugs can be taken in pill or capsule form.

Chemotherapy may be an option for women with advanced vulvar cancer that spreads to other areas of the body. Sometimes chemotherapy is used in combination with radiotherapy to reduce the size of vulvar cancers to increase the chance of success of the operation.

Follow-up tests after treatment: After completing vulvar cancer treatment, your doctor may recommend periodic follow-up examinations to see if there is a cancer recurrence. Even after successful treatment, vulvar cancer may recur. In general, it is recommended to perform an examination every 3-4 months during the first two years after the treatment of vulvar cancer, and at 6 month intervals in the next 3 years. After five years, annual follow up will suffice.

Protection

Reduce your risk of sexually transmitted diseases. To reduce the risk of vulvar cancer, reduce the risk of sexually transmitted diseases such as HPV and HIV. To reduce the risk of these diseases,

Limit the number of sexual partners. The more sexual partners you have, the higher the risk of HPV transmission.

Use a condom. A condom can protect you against HIV transmission. Condoms can reduce the risk of HPV contagion but cannot completely protect you against it.

Get the HPV vaccine.

Have a periodic pelvic exam. These examinations allow your doctor to visually inspect the vulva and examine internal organs to check for abnormalities.


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