Vulva cancer is a type of cancer that occurs on the outer surface of the female genitals. Vulva is the area of skin surrounding the urethra and vagina, including the clitoris and small lips.
Vulva cancer is usually seen as a lump or wound in the vulva and causes itching and pain. Vulva cancer is rare and accounts for about 4% of gynecologic cancers. It can occur at any age; however, vulvar cancer is most common in postmenopausal women.
The signs and symptoms of vulvar cancer may include:
Continuous itching (pruritis)
Pain and tenderness
Skin changes such as discoloration or thickening
A lump, wart-like or carnival-like mass or an open wound (ulcer)
It is not clear what caused Vulva cancer. In general, cancer is considered to start because of abnormal changes in the DNA of a cell (mutation). Mutations lead to rapid development and division of the cell. Cells and other cells dividing from these cells continue to live as normal cells die. Accumulating cells form a tumor, occupy the surrounding tissues and spread to other parts of the body.
VULVA CANCER TYPES
Vulva squamous cell cancer: This cancer starts from a thin, flat cell layer covering the vulva surface. Most vulvar cancers are squamous cell cancer (90%).
Vulvar melanoma: This cancer begins in cells that produce pigment in the vulva skin.
Bartholin Gland Cancer
The exact cause of vulvar cancer is not known, but it is thought that certain factors, including:
Increased age: Risk of vulva cancer increases with old age, but may occur at any age. The mean age at diagnosis was 65 years.
Human papillomavirus (HPV) infection: HPV is a sexually transmitted disease that increases the risk of various cancers, including vulva cancer and cervical cancer. Sexually active, many young women are exposed to HPV. However, mostly infection does not trigger cancer. For some women the infection causes the change of cells and increases the risk of cancer in the future.
Smoking: Smoking increases the risk of vulva cancer.
To be infected with human immunodeficiency virus (HIV): This sexually transmitted virus weakens the immune system, makes you vulnerable to HPV infections and thus increases the risk of vulva cancer.
To have a history of precancerous conditions of the vulva: Vulvar intraepithelial neoplasia is a precursor condition that increases the risk of vulvar cancer. Most women with vulvar intraepithelial neoplasia will not develop any cancer; however, few women develop invasive vulva cancer. Therefore, your doctor may recommend taking out the area of abnormal cells and performing periodic follow-up.
The presence of a skin disease involving the vulva: Lichen sclerosis, which causes the skin to become thin and itchy, increases the risk of vulva cancer.
Examination of the vulva: Your doctor may perform a physical examination on the vulva to examine for abnormalities.
Using a special lens for the examination of the vulva: During a colposcopy examination, your doctor uses a similar tool to enlarge the abnormal areas in your vulva.
Obtain a tissue sample for testing (biopsy): It is a part of the skin to determine whether a suspected skin area in the vulva is cancerous. During a biopsy procedure, this area is anesthetized by local anesthesia and all or part of the suspicious area is taken using a scalpel or other special cutting tool. Stitching may be required depending on how much skin section is taken.
Determining the Size of the Cancer After the diagnosis is verified, your doctor does some work to determine the size and level (stage) of cancer.
Staging tests include;
Imaging tests. Images in the chest or abdomen may indicate whether the cancer has spread to other areas. imaging tests may include x-ray, computed tomography (CT), and magnetic resonance imaging (MRI).
The stages of vulvar cancer include
Stage I refers to a small tumor confined to the skin area or vulva between the entrance to the vagina and the anus (perinum). This cancer has not spread to the lymph nodes or other parts of your body.
Stage II tumors are cancers that spread to the lower part of the urethra, including surrounding structures such as the vagina and anus.
Stage III cancer is spread to the lymph nodes.
Stage IVA means that the cancer is more likely to spread to the lymph nodes or spread to the upper parts of the urethra or vagina, or to the bladder, rectum and femur.
Stage IVB means cancer is spread to distant areas of the body (metastasis).
Treatment of vulva cancer is surgery. In vulva cancer surgery, sometimes all vulva should be removed. The earlier the vulva is diagnosed, the lower the risk of a comprehensive surgery for treatment.
Treatment options for vulva cancer depend on the type and stage of the cancer, your general health and preferences.
Surgery: The surgeries used in the treatment of vulva cancer include:
Taking the Edge of Cancer and Healthy Touch (Excision):Also called wide local excision or radical excision, this procedure involves the removal of at least 2 cm of the cancer and its normal surrounding. The fact that your doctor cuts off the visible tissue edge helps to ensure that all cancer cells are removed.
Removal of a Part of the Vulva (Partial Vulvectomy): During partial vulvectomy, a portion of the vulva and underlying tissues are removed.
Removal of the Vulva (Radical Vulvectomy): Radical vulvectomy involves the removal of the entire vulva, including the clitoris and the underlying tissue.
Comprehensive Surgery for Advanced Cancer: If cancer is spread out of the vulva and surrounding organs, your doctor may recommend taking the entire vulva and surrounding organs with a surgery called pelvic exenteration. Depending on where the cancer is spreading, the surgeon can take the lower colon, rectum, bladder, uterus, uterus, vagina, ovaries and surrounding lymph nodes. If the bladder, rectum or colon is taken, an artificial outflow (stoma) will be created in your body to expel urine into a bag (ostomy).
The wound or the area behind it can usually close without skin grafting from another part of your body. However, a reconstructive surgery can be performed depending on how much cancer is spreading and how much tissue should be removed – a skin graft is made from another part of your body to cover this area.
Surgery for the removal of the entire vulva carries the risk of complications such as infection and healing problems around the incision. In addition, it may be uncomfortable to sit for a long time when part or all of the vulva pad is removed. The numbness can be felt in the genitalia and it may be difficult to reach orgasm during sexual intercourse.
Surgery to take the surrounding lymph nodes: Vulva cancer is often spread to the inguinal lymph nodes, so your doctor may also take these lymph nodes during surgery for cancer. Depending on your condition, your doctor may only take a few lymph nodes or many lymph nodes. This procedure, called a sentinel lymph node biopsy, involves the identification of the lymph node, where the cancer is most likely to spread first. The surgeon then takes the lymph node to be tested. If cancer cells are not detected in this lymph node, cancer cells do not spread to other lymph nodes. Taking lymph nodes causes fluid retention and swelling of the legs (this is called lymphedema). If this complication develops, compression tools or support stockings can be given to help reduce symptoms.
Therefore, less lymphadenectomy is performed in patients who have sentinel lymph node biopsy and therefore less lymphodem is seen.
Radiotherapy: In radiotherapy, high power energy beams are used to kill cancer cells. Radiotherapy for vulva cancer is usually performed by a machine that rotates around your body and applies radiation to precise spots on your skin (external beam radiotherapy).
Radiotherapy is sometimes used to increase the chance of surgery by reducing the size of vulva cancers. Radiotherapy is sometimes administered in combination with chemotherapy, so that cancer cells can be made more susceptible to radiotherapy.
Chemotherapy: Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are usually administered via a vein or mouth.
Chemotherapy for women with advanced vulva cancer may be an option if the other areas of the body are spread. Sometimes chemotherapy is used in conjunction with radiotherapy to increase the chance of surgery by reducing the size of vulva cancers.
Post-treatment follow-up tests may recommend periodic follow-up examinations to check for cancer recurrence after completing treatment for Vulva cancer. Even after a successful treatment, the vulva can recur. It is generally recommended to have an examination every 3 months, every 3 months, every 3 months after the treatment of vulva cancer every 3 months.
Reduce your risk of STDs Reduce the risk of sexually transmitted diseases such as HPV and HIV to reduce the risk of vulva cancer. To reduce the risk of these diseases:
Limit your sexual partner count…