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Vulvar Cancer

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  3. Vulvar Cancer

Overview of Vulvar Cancer

Vulvar Cancer Meaning in Urdu

اس کینسر کی وجہ سے خواتین کے اعضائے مخصوصہ کے بیرونی حصے میں سیلز بننے لگتے ہیں۔ ان سیلز کو ہٹانے کے لیے عام طور پر سرجری کی ضرورت ہے جس کی مدد سے ان سیلز سمیت کئی صحت مند سیلز کو بھی ہٹا دیا جاتا ہے تا کہ یہ دوسرے اعضاء کو متاثر نہ کرے۔ اس کینسر کی وجہ سے دائمی خارش، درد، حیض کے بغیر اعضائے مخصوصہ سے خون آنا، جِلد کی رنگت میں تبدیلی، یا السر کا سامنا کرنا پڑ سکتا ہے۔ یہ کینسر خواتین کو کسی بھی عمر میں متاثر کر سکتا ہے۔

Vulvar cancer is a rare type of cancer that affects any of the external parts of the female genitalia. Vulvar cancer is also known as cancer of the vulva or vulval cancer. Vulvae cancer most commonly develops in the inner lips (labia minora), outer lip (labia majora), and the skin between the anus and vagina (perineum). 

What is Vulva?

Vulva is the outer part of the female genitalia. It includes

  • Outer Lip or Labia majora (two large, fleshy lips or folds of the skin)
  • Inner Lip or Labia minora (small lips inside the labia majora surrounding the opening of the vagina and urethra)
  • Prepuce (a fold of the skin that is formed by the labia minora and covers the clitoris)
  • Vestibule (space between the vaginal opening)
  • Clitoris (a small protrusion of the nerve tissue that is sensitive to stimulation)
  • Fourchette (area between the vaginal opening and where the labia minora meet)
  • Perineum (area between the anus and vagina)
  • Anus (opening at the end of the anal canal)
  • Urethra (connecting the tube to the bladder)

Prevalence 

Vulvar cancer is not common. It usually affects females that have gone through menopause. But, it can also affect young females as well. 

As per 2022 cancer stats, 400 people were diagnosed with vulvar cancer. Vulvar cancer accounts for about 0.6% of all cancers in women. It ranks 28th number in terms of common types of cancer.

Signs and Symptoms of Vulvar Cancer

The vulvar cancer symptoms may not be visible at the start. However, if you observe the following signs and symptoms, you need to visit a gynecologist:

  • Pain, soreness, itching, and burning in the vulva
  • Sore, swelling, lump, or wart-like growth on the vulva
  • White, red, or dark brown raised and thickened skin patches in the vulva
  • Mole on the vulva that changes in colour or shape
  • Pus, blood, or other discharge from the sore spot or lesion in the vulva
  • Swollen or hard lymph nodes in the groin area
  • Bleeding in the vulvar region that is not linked to the periods
  • Pelvic pain during peeing or while having sex
  • Tenderness on the vulvar area

It is difficult to self-examine the vulvar cancer symptoms. But, if you notice any symptoms or feel any pain in the genital area you need to consult a medical health practitioner as soon as possible. 

Types of Vulvar Cancer

Most vulvar cancers are squamous cell carcinomas. Another common type of vulvar cancer is melanoma. It is normally found in the clitoris or labia minora. Other vulvar cancer types are as follows:

  • Squamous cell carcinoma (SCC) is one of the most common types of cancer. It starts as thin and flat (squamous) cells that cover the vulvar.
  • Melanoma (mucosal) vulvar cancer constitutes about 2-4 % of the type of vulvar cancer. It starts in the melanocytes cells. These cells are responsible for providing skin colour. Melanocytes are also found in the lining of the vulva. They are not linked to overexposure to UV radiation from the Sun. 
  • Adenocarcinoma is a rare type of vulvar cancer that develops from the mucus-producing glandular cells present in the vulvar glands.
  • Sarcoma is another rare form of vulvar cancer that starts to form in the cells of the muscle fat along with other tissues under the skin. 
  • Basal Cell Carcinoma (BCC) is an extremely rare type of vulvar cancer and it starts from the basal cells that are present in the skin’s lower layer.

Vulvar Cancer Stages

There are different vulvar cancer stages just like any other stage. The stages are as follows:

  • Stage 0: In this stage, the cell changes are present on the surface of the skin.
  • Stage 1: Cancer is only limited to the perineum or vulva.
  • Stage 2: Cancer starts to reach nearby structures such as the vagina but not the lymph nodes.
  • Stage 3: Cancer may not necessarily reach nearby structures but it has spread into the lymph nodes
  • Stage 4: Cancer has started to reach other organs from their original site

Treatment of cancer depends upon the stage of vulvar cancer a patient is suffering from.

Causes of Vulvar Cancer

There is no clear cause of vulvar cancer. Cancer normally starts to form when there is a change in DNA. The mutation in DNA leads to an increased and rapid growth of cells. These abnormal cells continue to live even when normal cells die. Accumulation of these cells forms a tumour that may be cancerous or non-cancerous. These cells invade and spread to other body parts as well.

However, most vulvar squamous cell cancer is caused by HPV and the other half are linked with chronic skin conditions such as lichen sclerosus.

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Risk Factors of Vulvar Cancer

Certain factors are the leading vulvar cancer causes. These factors increase your risk of suffering from vulvar cancer and are:

  • Increasing age
  • Human papillomavirus (HPV)
  • VAIN or vaginal intraepithelial neoplasia is a precancerous condition and has no symptoms
  • Abnormal cell changes during the cervical cancer screening test
  • Skin health issues such as vulvar lichen or vulvar lichen sclerosus
  • Have had vaginal cancer or cervical cancer
  • Had an organ transplant
  • Infected with HIV
  • Smoking tobacco
  • Weak immune system
  • History of precancerous conditions of the vulva

Is there any Health Complication Due to Vulvar Cancer?

 

Health complications due to vulvar cancer are rare. However, if cancer progresses it can lead to a urethral obstruction, cellulitis, bone metastasis, and lymphedema.

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Prevention

You can reduce the vulvar cancer risk by especially reducing the risk of STD infection due to HPV. You can do this by

  • Using a condom while having sex
  • HPV vaccine

Other major vulvar cancer prevention tips are:

  • Avoiding known risk factors
  • Avoid smoking
  • Delaying the onset of sexual activity
  • Regular health checkups
  • Regular pelvic examination or pap tests
  • Regular examination of the body for irregular growth of moles especially on the vulva

It should be noted that the HPV vaccine can prevent vaginal, cervical, and vulvar cancers. The HPV Vaccine can only prevent certain types of HPV. It cannot treat existing HPV infections. For efficacy, it is recommended that vaccines should be given when the person has become sexually active.

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Diagnosis

First of all your healthcare provider would ask you questions regarding your health, medical history, or any concerning signs and symptoms. After this, the doctor will conduct your physical examination and general health checkup.

Depending on your condition, the doctor would recommend other tests for vulvar cancer diagnosis such as:

  • Pap Smear Test- In a pap smear test, samples from the cervical cells are taken and then later assessed in a laboratory.
  • Cystoscopy is used to examine the bladder and look for the signs of cancer.
  • Proctoscopy would be done to check the rectum in case any cancer is present.
  • An MRI, CT Scan, PET Scan, or even X-ray would be done to look for any other signs and symptoms of cancer in the body. 
  • A biopsy would also be conducted. If the result of the biopsy is positive then the doctor will stage it with the help of other imaging tests.
  • A specialized lymph node biopsy would also be done. In this procedure, the first few lymph nodes that are present near the cancer cells are removed. A tissue biopsy would be taken to find out if the cancer has spread to these lymph nodes or not. If no cancer is found then it is mean that it’s unlikely that the cancer has spread. 

Treatment of Vulvar Cancer | When to Consult a Doctor

The vulvar cancer treatment varies according to the health condition of the patient along with the type and stage of vulvar cancer. 

Treatment options for vulvar cancer include:

  1. Surgery

Surgery is the major treatment option for vulvar cancer. The type of surgical operation would depend on the stage of cancer. In surgery, the doctor will remove all of the cancer cells along with some healthy tissue which is called the margin. This is considered a necessary step as it helps in reducing the risk of cancer coming back. 

Some of the common vulvar surgical treatments are:

  • Laser Surgery - to remove the lesions with the help of a laser beam.
  • Excision - It involves removing the cancerous tissues along with healthy tissues around them.
  • Skinning vulvectomy - It involves the removal of the layer of the skin that is affected by cancer. It is then repaired with the skin graft.
  • Radical Vulvecyomy is used to remove the vulva, clitoris, opening to the vagina, vaginal lips, and normally nearby lymph nodes as well.

  1. Radiotherapy 

It is also known as radiation therapy. Radiotherapy uses X-ray radiation to damage or kills cancerous cells. Whether a patient would have radiation therapy or not, would depend on the stage, spread, and size of the cancer. You might have to undergo radiation therapy before or after the surgery as well.

  1. Chemotherapy

Chemotherapy is the use of medication to kill and reduce cancerous cell growth. For patients suffering from vulvar cancer chemotherapy is recommended:

  • During radiotherapy in order to make the treatment more effective
  • To control cancer that has spread into other parts of the body
  • As a palliative care treatment, in order to relieve the pain and symptoms of vulvar cancer.

Chemotherapy may be given in the form of tablets, injections, or in the form of cream to be applied to the vulva. 

Other Treatment Options

Apart from the aforementioned treatments, some other therapies are also used to treat vulvar cancer. 

  • Target Drug Therapy - This therapy targets specific functions such as the development of cancer cells. These target drugs are responsible for stopping or slowing cancer by interfering with its function.
  • Biological Therapy- It is a type of immunotherapy. It uses either natural substances or synthetic substances to help our body in fighting against cancer. 

What is the survival rate for Vulvar Cancer?

After diagnosis, a person has about a 71% chance of surviving another 5 years. But, it varies from case to case. The reason is that this survival rate can be high or low depending upon the stage of cancer, diagnosis, patient’s overall health, and other factors. 

In case of any concerning signs and symptoms, you need to visit a certified cancer doctor as soon as possible. 

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