Vulvar Cancer

Vulvar cancer is a rare cancer in which cancer cells form on the outer surface of the female genitalia.

The vulva is the area of skin that surrounds the urethra and vagina, including the clitoris and labia.

An itchy lump on the vulva is a typical sign of vulvar cancer. It can affect females of any age but seems to be more common in older women.

If you are diagnosed with a vulvar cancer, you may be recommended a surgery to remove the affected part and a portion of nearby healthy tissue.

Sometimes, if the cancer is more advanced, surgery may be performed to remove the entire vulva.

As with other cancers, early diagnosis and prompt treatment yield better outcomes.

The common signs and symptoms of vulvar cancer are:

• Persistent itching
• Pain and tenderness
• Abnormal bleeding (not caused by menstruation)
• Changes in skin color or thickening
• A lump, wart-like bumps or an open sore (ulcer)

When to see a doctor?

Visit your doctor or gynecologist if you experience any of the above signs or symptoms.

The exact cause of vulvar cancer has not been identified yet. Normal cells in vulva turn into cancer cells due to changes in the DNA (DNA mutations).

DNA mutations cause an “out-of-control” cell growth and multiplication leading to accumulation of abnormal cells (tumor). These cancer cells can affect surrounding tissues or dislodge from site of origin and spread to other body parts (metastasis).

Vulvar cancer is divided into following types according to the type of cells where the cancer originated: 

Vulvar squamous cell carcinoma: This cancer begins in the thin, flat cells that line the surface of the vulva. Most vulvar cancers are squamous cell carcinomas.

Vulvar melanoma: This cancer begins in the pigment-producing cells found in the skin of the vulva.

Your gynecologist may refer you to a gynecologic oncologist (who specializes in surgery for gynecologic cancers) if vulvar cancer is suspected or diagnosed.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor.

Some typical questions can be:

• What could be possible causes of my symptoms?
• What are the tests that I need?
• What are my treatment options and side effects of each option?
• Can treatments affect my sexuality?
• Do I need to follow any restrictions?
• Has my cancer spread to other parts?
• What is the stage of my cancer?
• What are my chances of recovery?
• Should I see a specialist?
• What surgical options are available?
• Can treatment affect my ability to have child?
• Will the cancer come back again?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did the symptoms start appearing and how severe are they?
• Have your symptoms been continuous or occasional?
• Does anything improve or worsen your symptoms?
• Have you ever been diagnosed with lichen sclerosus?
• Have you ever been diagnosed with other cancers or human papillomavirus (HPV)?
• Has your Pap test shown any abnormalities?

Diagnosing vulvar cancer

Tests and procedures used to diagnose vulvar cancer include:

• Examining your vulva: Your doctor uses a special magnifying device to inspect vulva for any abnormality.
• Biopsy: All or a portion of the affected area is removed and sent to lab for further analysis. You may need stitches to seal the cut areas.

Staging your cancer

Staging helps to determine the extent of cancer and can guide the selection of treatment option. Staging tests include:

• Examination of pelvic area to detect spread of cancer.
• Imaging tests: Images tests like X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) can help to detect if cancer has spread to chest or abdomen.

Vulvar cancer stages include:

• Stage I: The cancer is restricted to the vulva or the area of skin between your vaginal opening and anus (perineum). Lymph nodes or other areas of your body are not affected.
• Stage II: The cancer has spread to nearby structures, such as the lower portions of the urethra, vagina and anus.
• Stage III: Lymph nodes are affected.
• Stage IVA: More lymph nodes are affected, or the cancer has spread to the upper portions of the urethra or vagina, or that has spread to the bladder, rectum or pelvic bone.
• Stage IVB: Distant body parts are affected (metastasis).

The choice of treatment for vulvar cancer is determined by the type and stage of cancer, overall health and preferences.

Surgery to remove vulvar cancer

Operations used to treat vulvar cancer include:

• Wide local excision or radical excision: The cancer and a portion of surrounding tissue are removed.
• Partial vulvectomy: A portion of the vulva and underlying tissues are removed.
• Radical vulvectomy: Entire vulva, including the clitoris and underlying tissues are removed. This surgery can cause infection discomfort while sitting, numbness in the genital area, and inability to achieve orgasm.
• Pelvic exenteration: If the cancer is advanced that has spread to other body parts, an extensive surgery is required to remove the entire vulva and the affected organs including lower colon, rectum, bladder, cervix, uterus, vagina, ovaries and nearby lymph nodes.
• Reconstructive surgery: This surgery is done to repair the cut open areas of the vulva. To close the wound on the vulva, skin from another part of your body can be used to cover the wound.

Surgery to remove nearby lymph nodes

This surgery removes the lymph nodes in the groin. Few lymph nodes or many lymph nodes may be removed. Lymph node removal can cause fluid retention and leg swelling, lymphedema.

Radiation therapy

It uses ionizing radiations like X-rays, to destroy cancer cells. Usually for vulvar cancer, the source of radiation is kept outside your body. Radiation therapy can be used before surgery to shrink large vulvar cancers. It may also be used in combination with chemotherapy.

Chemotherapy

It uses injectable or oral form of chemical drugs to kill cancer cells. As chemotherapy drugs travel throughout your body, they may be used to treat the cancer that has spread to other areas of the body. Chemotherapy can also be used in combination with radiation therapy to shrink cancers.

Follow-up tests after treatment

Follow-up exams are required to detect if your cancer has returned. For the first two years after treatment, you may need follow-up visits two to four times each year.

Reducing the risk of HPV and HIV can prevent vulvar cancer. Here is what you can do:

• Have physical relation only with trusted partners.
• Use a condom during every sexual relationship.
• Get vaccinated for HPV.
• Discuss about pelvic exams: Talk to your doctor to determine which screening test is suitable for you.

Here are some lifestyle tips that may help you in coping with vulvar cancer:

• Expand your knowledge on your condition.
• Find a listener: Share your feelings with someone who is close to you, a friend, a family member, your doctor, a social worker, a spiritual adviser or a counselor.
• Join a support group in your community or online. You may also contact support organizations, such as the American Cancer Society. Online message boards, such as those offered by the American Cancer Society's Cancer Survivors Network, can also connect you to other women with vulvar cancer.
• Stay close to your partner: You may discuss your feelings with your partner.
• Keep your romance alive through other expressions of sexuality such as touching, holding, hugging and caressing.

There are several risks associated with vulvar cacner, which include:

• Age: Increasing age may increase your risk. The average age at diagnosis is 65.
• Human papillomavirus (HPV): Having HPV, a sexually transmitted infection, increases the risk of several cancers, including vulvar cancer and cervical cancer.
• Smoking: Smoking increases your risk of vulvar cancer.
• Human immunodeficiency virus (HIV): HIV, a sexually transmitted virus, reduces your resistance against infections including HPV infections that consequently increases your risk of vulvar cancer.
• History of vulvar intraepithelial neoplasia, precancerous conditions of the vulva. If you have vulvar intraepithelial neoplasia, you are at an increased risk of having vulvar cancer.
• Having Lichen sclerosus: It is a skin condition that causes thinning and itchy vulvar skin which increases the risk of vulvar cancer.