Vulvar cancer appears in the vulva, that is in the external genital area of a woman’s reproductive system. Vulvar cancer may affect any part of the vulva, together with the labia, the mons pubis (the skin and tissue covering the pubic bone), the clitoris, or the vaginal or urethral openings. Most frequently, it has an effect on the inner edges of the labia majora or labia minora.
According to the data of the American Cancer Society, over 90 per cent of vulvar cancers are squamous cell carcinomas. This kind of cancer begins in the squamous cells, the major kind of cells structuring the skin. Squamous cell cancer normally develops gradually over a few years. Before the cancer develops, anomalous cells normally develop in the surface layer of the skin, known as the epithelium. This state is known as vulvar intraepithelial neoplasia.
The second most widespread type of vulvar cancer is melanoma. According to the estimates of the American Cancer Society, melanoma represents approximately 4 per cent of vulvar cancers and normally appears on the labia minora or the clitoris. Less frequent types of cancer of the vulva include: Bartholin gland adenocarcinoma and Paget’s disease. Less than 2 per cent of vulvar cancers are sarcomas, cancer of the connective tissue underlying the skin. Sarcomas may develop at any age.
The American Cancer Society claims that vulvar cancer is unusual, representing about 4 per cent of cancers of the female reproductive system and 0.6 per cent of all cancers in women. 75 per cent of women suffering from vulvar cancer are over the age of fifty, and 66 per cent of women over the age of seventy when they are first diagnosed. Nonetheless, more cases are recognized in younger women. 15 per cent of new cases now occur in women below the age of forty.
Symptoms
Frequent symptoms of cancer of the vulva and vulvar intraepithelial neoplasia include:
* Persistent itching or burning pain anywhere on the vulva
* A red, pink or white lump with a wart-like or raw surface
* A white and rough area on the vulva
* Aching urination or bleeding
* A discharge not connected with your menstruation
* An ulcer that lasts over a one month period
Symptoms of vulvar melanoma may include: a black or brown raised area or a alteration in the size, shape or color of a pre-existing mole.
First symptoms of a Bartholin’s gland adenocarcinoma may include a lump at the opening to the vagina. A lump may also be a more ordinary benign cyst, however you ought to have an examination in order to be sure that it is not cancerous. A sore, red, scaly area of the vulva may also constitute a sign of Paget’s disease.
Bear in mind that several signs and symptoms of cancer of the vulva may also appear with other, noncancerous conditions, including infection or trauma.
Diagnosis
The disease is normally diagnosed during a biopsy. In the course of this procedure, a small sample of tissue is removed and analyzed by a pathologist under a microscope in order to recognize cancer cells or precancerous cells.
An instrument known as a colposcope, that comprises magnifying lenses, may also be used to select the biopsy site. Before colposcopy, the skin is treated with a dilute solution of acetic acid that makes suspicious-looking skin appear white. This white color is temporary and can best be seen through the colposcope.
If the healthcare provider suspects abnormalities in various areas of the vulva, more than one biopsy may be necessary. In excisional biopsy, small areas of abnormality can be removed completely. During punch biopsy, a very small cylinder of skin is removed. The biopsy specimen is sent to a laboratory to be examined and diagnosed.
If cancer is detected during a biopsy, additional examinations may also be performed in order to find out if it has spread beyond the vulva. These additional tests may include:
* Cystoscopy — An examination with a lighted tube to inspect the inside surface of the bladder
* Proctoscopy — An examination of the rectum using a lighted tube
* Pelvic examination — A more thorough pelvic exam under anesthesia
* Chest X-ray — To check for any spread to the lungs
* Computed tomography (CT) scan — An imaging method using a rotating X-ray beam and a computer to create a detailed view of internal organs
These examinations may help predict whether the vulvar cancer has already spread to nearby pelvic organs or to more distant parts of the body.
Expected Duration
Cancer of the vulva will keep on growing until it is fully treated.
Prevention
You have a chance to take several steps to decrease your risk of developing vulvar cancer. You can also take steps to recognize and treat precancerous conditions before they turn into invasive cancer.
According to the American Cancer Society and the American College of Obstetrics and Gynecology, human papilloma virus (HPV) infection is discovered in 20 per cent to 50 per cent of invasive vulvar cancers. Particular kinds of HPV are transmitted in the course of sexual contact. You can reduce your likelihood of HPV by:
* Using latex condoms (the female condom protects a broader area of the lower genital tract and vulva in comparison to the male condom)
* Minimizing the number of sexual partners
* Avoiding sexual contacts with someone who has had a lot of sexual partners
The likelihood of getting infected with HPV and developing vulvar cancer is also lower if you avoid having sex before the age of eighteen. Early detection and treatment of precancerous conditions helps to prevent a lot of cases of invasive squamous cell vulvar cancer. Precancerous and cancerous conditions may be detected early if your reproductive system is inspected every year and any problems, including vulvar rashes, moles and lumps, are inspected carefully.
Your vulva is usually inspected at the same time you have a Pap test and pelvic examination. Generally, healthcare providers suggest that women should start to have annual pelvic examinations and regular Pap tests when they become sexually active or by the age of twenty one at the latest. After three negative Pap tests at least one year apart, your physician may perform the test every two to three years, depending on your age and whether you have particular risks of experiencing cervical cancer.
Removing unusual or "funny-looking" moles discovered on the vulva will help prevent some vulvar melanomas. Giving up smoking and avoiding the use of tobacco can decrease the likelihood of developing various cancerous conditions of the body, such as vulvar cancer and precancerous changes in the vulva.
Treatment
The treatment of cancer of the vulva depends upon the kind of the disease, its stage at diagnosis and its location on the vulva. Treatment will be influenced by the patient’s age and general health and the significance of maintaining sexual function balanced against the necessity of removing entire cancer. The major types of treatment include: surgery, radiation and chemotherapy.
Surgery is the most widespread form of treatment for vulvar cancer. It may have many forms, depending on how much tissue needs to be removed. The surgeon will try to remove all of the cancer cells but at the same time preserving as much sexual function as possible. The procedures mentioned below are listed in order of the least to most aggressive tissue removal.
* Laser surgery burns off the layer of anomalous cells. It is used for the treatment of vulvar intraepithelial neoplasia but not invasive cancer.
* Excision (known also as wide local excision) removes the cancer and a small portion of surrounding normal cells.
* Vulvectomy can involve removing part or all of the vulva and its underlying tissue. A simple vulvectomy removes only the vulva. A partial radical vulvectomy includes the removal of a part of the vulva and the underlying tissue. A total vulvectomy removes the whole vulva and the tissue underneath it, together with the clitoris. The sexual functions after the therapy depend on how much of the vulva is removed.
* Pelvic exenteration is an extensive surgery including vulvectomy, the removal of the pelvic lymph nodes and elimination of one or more of the following: vagina, rectum, lower colon, bladder, uterus and cervix.
Radiation may be applied before or after surgery. If cancer has already spread to the lymph glands, external-beam radiation therapy may be directed at the lymph nodes after surgery. This kind of therapy watchfully targets a beam of radiation at the cancer. If tumor cells are discovered at the edges of the tissue that has been removed, radiation therapy directed at these areas may be suggested after surgery. If the cancer has attacked a large area, radiation may be applied before the surgery to decrease its size.
The use of chemotherapy (anticancer medications) for cancer of the vulva is still being researched. Studies are being carried out on a new method of treatment for serious cases, in which the cancer has spread to other tissues, organs and lymph nodes in the closest area. In this treatment, chemotherapy medicines are given intravenously (into a vein) together with radiation therapy before surgery.
When To Contact A Specialist
It is enormously relevant to observe and examine your entire vulvar area yourself. If you observe any persistent rash, persistent itching or pain of the vulva, any alterations in the skin of the vulva or abnormal growths, bumps or ulcers, visit your healthcare provider for an evaluation without the slightest hesitation. Itchiness, abdominal pain or fever can signal infection instead of cancer. You ought to contact your physician the same day if you have any abdominal pain with fever.
Prognosis
If vulvar cancer is detected in an early stage, chances of full recovery are tremendous. For cancers in which the lymph nodes are not invaded, 90% per cent of women survive five years or more. If vulvar cancer has affected the lymph nodes, then the five-year rate of survival decreases from 30 per cent to 55 per cent. The prognosis is dependent on the number of lymph nodes involved.
