Vulvar cancer occurs on the external surface of the female genitalia. The vulva is the region of skin that covers the urethra, vagina, labia, and clitoris. Vulvar cancer usually appears as an itchy lump or sore on the vulva. Although vulvar cancer occurrence can happen at any age, diagnosis of vulvar cancer often occurs in older women.
To plan the best treatment a doctor must determine what cell type vulvar cancer originates. The two most common vulvar cancer are:
- Vulvar squamous cell carcinoma. This cancer starts in the thin, flat cells lining the vulva surface. Most vulvar cancers are in this form.
- Vulvar melanoma. This cancer originates in the pigment-forming cells of the vulva skin.
The exact cause of vulvar cancer remains unknown, but the following lists common factors which increase your risk:
Aging: The likelihood of developing vulvar cancer increases with age. Most diagnosis occurs around the age of 65.
Exposure to human papillomavirus (HPV): HPV, a sexually transmitted disease, increases the risk of many cancers, namely, vulvar and cervical cancer. In some cases, the disease leads to cell changes increasing your risk for vulvar cancer.
Smoking: Smoking raises your chance of developing vulvar cancer.
Weakened immune system: Those at greater risk of developing vulvar cancer due to a weakened immune system involve two groups. Those who take prescriptions that weaken the immune system, usually seen in organ transplant recipients comprise one group. The second group involves people with conditions that weaken the immune system, such as the human immunodeficiency virus (HIV).
History of precancerous conditions of the vulva: Precancerous conditions, as seen with vulvar intraepithelial neoplasia, can increase your risk of vulvar cancer. In most cases, vulvar intraepithelial neoplasia will never develop into cancer; however, some few times it does develop into invasive vulvar cancer.
Skin conditions affecting the vulva: Lichen sclerosis causes thin and itchy vulvar skin and increases the risk of vulvar cancer.
Signs & symptoms
Common signs and symptoms of vulvar cancer:
- Itching that will not go away
- Pain and soreness
- Abnormal bleeding (not from menstruation)
- Changes in the skin like color changes or thickening
- Wartlike bumps or an open sore (ulcer)
For women with no symptoms, routine screening is not common. For women with symptoms, a doctor can perform an ultrasound scan. Vulvar cancer is often detected at early stages as it commonly produces abnormal vaginal bleeding.
Examining your vulva: Your doctor conducts a physical exam to observe any abnormalities on your vulva.
Inspecting the vulva more closely: For a colposcopy exam, the doctor uses a colposcope, a magnifying device, to carefully observe your vulva for abnormal areas.
Removing some tissue for testing (biopsy): Upon finding an irregular skin area, your doctor may remove some of the tissue. This tissue piece goes to the laboratory for further testing.
If the diagnosis finds you to have vulvar cancer, the doctor must determine the extent of your cancer (cancer stage). To do this, the doctor will perform more tests. Some tests used to determine are blood tests, chest X-rays, and computerized tomography (CT) scans. Vulvar cancer ranges from I to IV. Stage IV vulvar cancer indicates cancer has spread to neighboring organs like the bladder.
Treatment and Side Effects
Creating a treatment plan for vulvar cancer depends on different factors such as the cancer stage, additional health problems you may have, and your preferences. Treatment often consists of surgery, chemotherapy, radiotherapy, or a combination of the three. In certain events, other treatment therapies exist.
Surgical operations for the treatment of vulvar cancer:
- Removing cancerous cells and some healthy tissue. This protocol called a wide local excision or radical excision includes cutting out the cancerous cells and a small number of surrounding normal tissue.
- Removing a portion of the vulva or the entire vulva. In this surgery, a doctor will remove part of the vulva (partial vulvectomy) or the whole vulva. In cases of extensive cancer, the surgeon may also remove the underlying tissue (radical vulvectomy).
- Removing a few nearby lymph nodes. Sentinel node biopsy is a procedure used to find if cancer has spread to your lymph nodes. If found, the lymph nodes are removed from the body. This procedure is to prevent cancer from spreading to other body parts.
Radiation therapy utilizes high-powered energy beams to eliminate cancer cells. Radiation therapy for vulvar cancer often entails a machine that moves around your body and targets radiation to the exact region on your skin (external beam radiation). Radiation therapy can be used before surgery as the therapy can decrease large vulvar cancers. This therapy can also be used with chemotherapy to further the treatment of vulvar cancer.
Chemotherapy involves the use of chemical drugs designed to kill cancer cells. Chemotherapy drugs can be taken by mouth or injected into your vein (intravenously). In advanced-cancer stages, chemotherapy is a great option. Besides being combined with surgical treatment options, chemotherapy can also help with radiation therapy for cancerous lymph nodes.
Targeted drug therapy
Targeted drug treatments use distinct weaknesses within cancer cells to eliminate them. This treatment is a plausible option for those with late-stage vulvar cancer.
Immunotherapy activates your immune system to fight cancer by disrupting cancerous cells’ ability to hide from your immune system.