Vulvar cancer

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:

  • Inner and outer lips of the vagina.
  • Clitoris (sensitive tissue between the lips).
  • Opening of the vagina and its glands.
  • Mons pubis (the rounded area in front of the pubic bones that becomes covered with hair at puberty).
  • Perineum (the area between the vulva and the anus).

The outer vaginal lips are the most commonly affected by vulvar cancer. Cancer of the inner vaginal lips, clitoris, or vaginal glands occurs less frequently.

Vulvar cancer normally develops over a long period of time. For a long time, abnormal cells might proliferate on the surface of the vulvar skin. Vulvar intraepithelial neoplasia is the medical term for this disorder (VIN). Because VIN can progress to vulvar cancer, it is critical to get treatment.

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

Vulvar cancer often does not cause early signs or symptoms. Signs and symptoms may be caused by vulvar cancer or by other conditions. Check with your doctor if you have any of the following:

  • A lump or growth on the vulva that looks like a wart or ulcer.
  • Itching in the vulvar area that does not go away.
  • Bleeding not related to menstruation (periods).
  • Pain in the vulvar area.

Tests involved in vulvar cancer

The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check general signs of health, including checking the vulva for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
  • Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal.
  • Human papillomavirus (HPV) test: A laboratory test used to check DNA or RNA for certain types of HPV infection. Cells are collected from the vulva and DNA or RNA from the cells is checked to find out if an infection is caused by a type of human papillomavirus that is linked to vulvar cancer. This test may be done using the sample of cells removed during a Pap test. This test may also be done if the results of a Pap test show certain abnormal vulvar cells.
  • Biopsy: The removal of cells or tissues from the vulva so they can be viewed under a microscope by a pathologist to check for signs of cancer.
  • Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Stages of vulvar cancer

  • After vulvar cancer has been diagnosed, tests are done to find out if cancer cells have spread within the vulva or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • In vulvar intraepithelial neoplasia (VIN), abnormal cells are found on the surface of the vulvar skin.
  • The following stages are used for vulvar cancer:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
  • Vulvar cancer can recur (come back) after it has been treated.

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:

  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a for signs of cancer.
  • Proctoscopy: A procedure to look inside the rectum and anus to check for abnormal areas, using a proctoscope. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the rectum and anus. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Chest x-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. To stage vulvar cancer, x-rays may be taken of the organs and bones inside the chest.
  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters and bladder, x-rays are taken to see if there are any blockages. This procedure is also called intravenous urography.
  • Biopsy: The removal of cells or tissues from the bladder or rectum so they can be viewed under a microscope by a pathologist to check for signs of cancer, if it is suspected that cancer has spread there.

 

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.

Take second opinion on vulvar cancer treatment

  • Comments Closed
  • January 12th, 2022

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