Vulvar Cancer

Vulvar cancer is a type of cancer that occurs on the outer surface area of the female genitalia. The vulva is the area of skin that surrounds the urethra and vagina, including the clitoris and labia. Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching. Though it can occur at any age, vulvar cancer is most commonly diagnosed in older adults. Vulvar cancer treatment usually involves surgery to remove 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. Vulvar cancer is a cancerous tumor growth, which comes about on the outer surface area of the female genitalia known as the vulva; the skin area that surrounds and protects a woman’s reproductive system, such as the urethra, vagina, clitoris, and labia. Vulvar cancer normally affects the labia majora (outer lips) of the vagina, but other parts of the vulva can also be affected. Vulvar cancer, the relatively rare form of cancer, normally forms a lump or a sore on the vulva, which often causes itching. Though it may occur at any age, it is, however, mostly diagnosed in old adults. Vulvar cancer treatment involves surgical removal of cancer and a small amount of healthy tissue that surrounds it, and sometimes the removal of the entire vulva.

Types of vulvar cancer

Vulvar cancer types are named after the cells cancer begins from. The most common types of vulvar cancer are;

• • Vulvar squamous cell carcinoma: This vulvar cancer begins in the thin, flat cells that line the surface of the vulva. It is the most commonly occurring of vulvar cancers.
  • Vulvar melanoma: This vulvar cancer originates in the pigment-producing cells of the skin of the vulva.
  • Adenocarcinoma: This vulvar cancer originates in the glandular tissues that line the glands in the vulva.
  • Sarcoma: This vulvar cancer develops in the connective tissue. They are usually malignant and rare.

Vulvar cancer staging The four-stage system of vulvar cancer is;

• Stage 0, or carcinoma in situ: The cancer is still only at the surface of the skin.
• Stage 1: The cancer is confined to the vulva or perineum and has grown to up to 2 cm in size.
• Stage 2: Cancer has spread from the vulva to the nearby structures; for instance, the lower part of the urethra, the vagina, and the anus.
• Stage 3: Cancer has gotten to the lymph nodes.
• Stage 4: Cancer has gotten to the lymph nodes on both sides of the groin. It may have also reached the bowel, the bladder or the urethra.

Diagnosis of vulvar cancer

Vulvar cancer can be diagnosed with several forms of investigations namely;

• Physical examination of the vulva to look for abnormalities.
• A review of medical history.
• A pelvic examination: A thorough examination of the pelvis area (such as uterus, vagina, ovaries, bladder, and rectum) for signs of cancer spread. 
• Colposcopy: Using a colposcope as a magnifying lens to get an up-close look at any problem areas in the vagina, vulva, and cervix.
• Biopsy:  Some pieces of tissue are cut out and examined microscopically.
• Imaging tests: Such as, X-rays, computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan and positron emission tomography (PET) scan, to generate detailed images of the inside of the body to know how far the vulvar cancer lump has spread.
• Cystoscopy: Examination of the bladder to determine if cancer has spread to that area.

Vulvar cancer treatment

Vulvar cancer treatment depends on many things; such as, the type, how far it has spread, and overall health. The four main treatments are: Vulvar cancer surgery  This is the most used vulvar cancer treatment option. It is of different procedures;

• Ultrasound surgical aspiration: Sound waves are used break up the tumours into small pieces, which are then taken out.
• Laser surgery: A laser is used to cut into or take out the affected tissues, such as the lymph nodes, some parts of the vulva, or other organs. This treatment is not used for invasive tumours.
• Excision: The tumours and tissues around it are taken out. This could be a wide local excision (which removes some of the tissue) or a radical local excision (which removes a large amount of tissue and possibly lymph nodes).
• Vulvectomy: The removal of part or all of the vulva. There are several types:
  • Skinning vulvectomy:  The top layer of the skin of the vulva is taken out.
  • Simple vulvectomy: This procedure takes out the entire vulva and the tissue just underneath the skin.
  • Partial or modified radical vulvectomy: This procedure takes out most of the vulva and possibly the lymph nodes nearby.
  • Radical vulvectomy: This procedure takes out the entire vulva and lymph nodes nearby.
• Pelvic exenteration: This procedure takes out the vulva and the lymph nodes, alongside one or more of the organs nearby, such as the lower colon, the rectum, the bladder, the uterus, the cervix, or the vagina.

Chemotherapy  This involves the use of very strong drugs to destroy cancer cells. It may be given through an IV or taken as a take a pill by mouth. Radiation therapy  The use of high energy X-rays or other forms of radiation to kill cancer cells. The radiation may be given through a machine, or with the aid of a needle, wire, or tiny sealed seed. Targeted therapy  Drugs or other substances are given to attack the cancer cells without causing harm to the rest of the body. Immunotherapy (biologic therapy)  This treatment is used to boost the immune system or to attack cancer cells.

Symptoms

Vulvar cancer symptoms include;

• Itching that persists.
• Pain, burning and tenderness.
• Bleeding, unrelated to menstruation.
• Skin changes; like colour changes or thickening.
• A lump, wart-like bumps, or an open sore (that is ulceration).
• Painful sexual intercourse.
• Dark discoloration; in cases of melanoma.
• Painful urination.
• Rawness and sensitivity.

Causes

It's not clear what causes vulvar cancer.
In general, however, cancers occur when a cell develops changes (mutations) in its DNA, which leads to uncontrollable multiplication of cells, which continue to live after normal cells die.

FAQ

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