Vulvar cancer

Vulvar cancer is a form of cancer that affects the female genitalia’s outer surface. The vulva, which includes the clitoris and labia, is the patch of skin that surrounds the urethra and vagina.

Vulvar cancer usually appears as a lump or sore on the vulva, causing irritation. Vulvar cancer is most typically diagnosed in elderly persons, while it can occur at any age.

Vulvar cancer is usually treated with surgery to remove the tumour as well as a small amount of healthy tissue around it. Vulvar cancer surgery may necessitate the removal of the entire vulva. The earlier vulvar cancer is detected, the less probable it will require significant surgery to treat. In nutshell:

• Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the vulva.
• Having vulvar intraepithelial neoplasia or HPV infection can increase the risk of vulvar cancer.
• Signs of vulvar cancer include bleeding or itching in the vulvar area.
• Tests that examine the vulva are used to diagnose vulvar cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Vulvar cancer forms in a woman’s external genitalia. The vulva includes:

Sign and symptoms of vulvar cancer

Symptoms depend on whether it is a cancer or pre-cancer and what kind of vulvar cancer it is.

Vulvar intraepithelial neoplasia

The majority of women with vulvar intraepithelial neoplasia (VIN) experience no symptoms. When a woman with VIN experiences a symptom, it is usually persistent itching that does not improve. VIN can have a distinct appearance than typical vulvar skin. It’s usually thicker and lighter than the surrounding skin. VIN can, however, look redder, pinker, or darker than the surrounding skin.

Some women are unaware that they may have a dangerous issue because these changes are commonly caused by other disorders that are not pre-cancerous. Some people attempt to remedy the problem using over-the-counter medications. At times, clinicians may fail to notice the disease at all.

Invasive squamous cell cancer of the vulva

Almost all women with invasive vulvar cancers will have symptoms. These can include:

• An area on the vulva that looks different from normal – it could be lighter or darker than the normal skin around it, or look red or pink.
• A bump or lump, which could be red, pink, or white and could have a wart-like or raw surface or feel rough or thick
• Thickening of the skin of the vulva
• Itching
• Pain or burning
• Bleeding or discharge not related to the normal menstrual period
• An open sore (especially if it lasts for a month or more)

Verrucous carcinoma, a subtype of invasive squamous cell vulvar cancer, looks like cauliflower-like growths similar to genital warts.

These symptoms are more often caused by other, non-cancerous conditions. Still, if you have these symptoms, you should have them checked by a doctor or nurse.

Vulvar melanoma

Patients with vulvar melanoma can have many of the same symptoms as other vulvar cancers, such as:

• A lump
• Itching
• Pain
• Bleeding or discharge

Most vulvar melanomas are black or dark brown, but they can be white, pink, red, or other colors. They can be found throughout the vulva, but most are in the area around the clitoris or on the labia majora or minora.

Vulvar melanomas can sometimes start in a mole, so a change in a mole that has been present for years can also indicate melanoma. The ABCDE rule can be used to help tell a normal mole from one that could be melanoma.

Asymmetry: One-half of the mole does not match the other.

Border irregularity: The edges of the mole are ragged or notched.

Color: The color over the mole is not the same. There may be differing shades of tan, brown, or black and sometimes patches of red, blue, or white.

Diameter: The mole is wider than 6 mm (about 1/4 inch).

Evolving: The mole is changing in size, shape, or color.

The most important sign of melanoma is a change in size, shape, or color of a mole. Still, not all melanomas fit the ABCDE rule.

If you have a mole that has changed, ask your doctor to check it out.

Bartholin gland cancer

A distinct mass (lump) on either side of the opening to the vagina can be the sign of a Bartholin gland carcinoma. More often, however, a lump in this area is from a Bartholin gland cyst, which is much more common (and is not a cancer).

Paget disease

Soreness and a red, scaly area are symptoms of Paget disease of the vulva.

Diagnosis of vulvar cancer

Some more tests are performed to know if the cancer has spread to other parts of body:

The process used to find out if cancer has spread within the vulva or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

Treatment of vulvar cancer

Surgery

Surgery used to treat vulvar cancer are:

Excision: This technique, also known as a wide local excision or radical excision, entails removing the malignancy as well as a small quantity of surrounding normal tissue. By removing a perimeter of normal-looking tissue, surgeons may confirm that all malignant cells have been eliminated.

Vulvectomy: Larger malignancies may require surgery to remove part of the vulva (partial vulvectomy) or the entire vulva, including the underlying tissue (radical vulvectomy). Larger malignancies may benefit from a treatment that combines radiation and chemotherapy to decrease the tumour before surgery, allowing for a less invasive procedure.

Sentinel node biopsy: To determine whether cancer has spread to the lymph nodes, the surgeon may use a procedure called sentinel node biopsy. This procedure identifies the lymph nodes most likely to contain cancer so they can be removed and analyzed. If cancer isn’t found in those first lymph nodes, it’s unlikely to be in any other lymph nodes.

Removing many lymph nodes. If the cancer has spread to the lymph nodes, many lymph nodes may be removed to reduce the risk that cancer will spread to distant areas of the body.

Complications from surgery include infection and issues with healing around the incision. Lymph node removal can result in fluid retention and leg swelling, a disease known as lymphedema.

Radiation therapy in vulvar cancer treatment

To kill cancer cells, radiation therapy uses high-powered energy beams such as X-rays and protons. In most cases, radiation therapy for vulvar cancer is delivered by a machine that moves about your body and distributes radiation to specific locations on your skin (external beam radiation).

Radiation therapy is occasionally used to reduce big vulvar tumours so that surgery can be performed successfully. Chemotherapy and radiation therapy are occasionally used together, which makes cancer cells more sensitive to the radiation.

If cancer cells are found in your lymph nodes, your doctor may suggest that you get radiation to the area surrounding your lymph nodes to destroy any cancer cells that may have survived surgery. In these cases, radiation is frequently coupled with chemotherapy.

Chemotherapy in treatment of vulvar cancer

Chemotherapy is a medicinal treatment that kills cancer cells by using chemicals. Chemotherapy medications are usually given by mouth or through a vein in your arm.

Chemotherapy may be an option for patients with advanced vulvar cancer that has progressed to other parts of the body.

Chemotherapy and radiation therapy are sometimes used together to decrease big vulvar tumours and make surgery more likely to be effective. Cancer that has progressed to the lymph nodes may be treated with a combination of chemotherapy and radiation.

More advanced vulvar cancers may be treated with one or more of these drugs:

• Cisplatin
• Carboplatin
• Vinorelbine
• Paclitaxel
• Erlotinib

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Targeted therapy might be an option for treating advanced vulvar cancer.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy might be an option for treating advanced vulvar cancer.