The vulva is the region around the opening of the vagina that forms the external genitalia in women. It includes labia minora, labia majora, clitoris, vaginal opening, and Mons pubis. Vulvar cancer is a result of uncontrolled growth of cells in the tissues of the vulva. It usually develops in labia majora (the outer lip of the vagina) or labia minora (Inner lip). The survival rate of women after Stage I vulvar cancer is 90%, while that after Stage IV is around 30%.
Associated Anatomy of Vulvar Cancer
Vulvar Cancer Epidemiology
Vulvar Carcinoma is predominantly a disease of postmenopausal women occurring in women between the age group 65 to 74. Eighty percent of women with untreated vulvar intraepithelial neoplasia are at risk of vulvar cancer.
Causes of Vulvar Cancer
The exact cause of vulvar cancer is not clear yet. It is believed to be related to :
- Human papillomavirus infection
- Lichen sclerosus - a skin condition
- Squamous hyperplasia
- Family history of melanoma
Risk factors of Vulvar Cancer
Not every woman is at risk of suffering from vulvar cancer. Several factors can increase the risk of vulvar cancer:
- History of genital warts
- Human Papillomavirus (HPV) infection
- Vulvar intraepithelial neoplasia (VIN)
- Abnormal pap smears
- Lichen sclerosus (skin condition involving vulva)
- Multiple sexual partners
- Weak immune system
- Old age
Symptoms of Vulvar Cancer
After suffering from any of the following symptoms in or around the vulva, women must visit a gynecologist:
- Vulvar mass, growth, lump, ulcer or wart
- Long standing history of vulval itching or burning
- Redness, white patches or pale skin colour of vulva
- Non-healing rashes or sore
- Bleeding in the vulva that is not due to menstruation
- Vulval discharge
- Burning during urination
- Occasionally a palpable metastatic mass in the groin
Typical Test to Diagnose Vulvar Cancer
There are various tests to diagnose cancer and its spread.
- Vulval and pelvic examination - It includes a physical examination of the vulva to check for lumps or anything unusual. Physical examination is followed by biopsy of suspicious looking area of vulva or vulvar growth. A biopsy helps to confirm or refute the diagnosis. Pap smear helps to check the presence of associated HPV infection.
- Colposcopy – A magnifying instrument called a colposcope visualizes the vulva, vagina, and cervix after application of medicated solution.
- Cystoscopy (Bladder and urethral examination) – A lighted tube with a camera or cystoscope is inserted in the urethra & bladder to look out for tumor extension into the urethra or bladder. Proctoscopy (Rectum and anal examination) –
- Proctoscope or a lighted tube with lens looks for tumour extension into the rectum and may collect some tissue samples for biopsy.
- Imaging modalities like CT Scan, MRI or PET CT scan to look for the disease extent.
Stages of Vulvar Cancer
It is mandatory to diagnose the stage to determine the spread of vulvar cancer in the body.
Stage I – Tumor is confined to the vulva.
Stage II – In this stage, cancer spreads to the lower 1/3 of vagina, anus, or lower 1/3 urethra, but not to the lymph nodes.
Stage III – If cancer spreads to inguino – femoral (groin) lymph nodes, it results in stage III. It is further divided into stages III A, III B, and III C depending upon the size and the number of lymph nodes involved.
Stage IV – This stage is divided into Stage IV A and IV B, depending upon the extent of cancer spread to the upper parts of the urethra, vagina, bladder mucosa, rectal mucosa, fixity to bone and other body parts.
Types of Vulvar Cancer
The most common type of vulvar cancer is squamous cell carcinoma accounting for 90% of the cases. Other less common types of vulvar cancer include adeno carcinoma, melanoma, sarcoma & verrucous carcinoma.
Natural Progression of
This cancer develops slowly over years. Precancerous lesions are abnormal cells in the outermost layer of the skin or epidermis. These are termed vulvar intraepithelial neoplasia (VIN).
Possible Treatment of Vulvar Cancer
Management of vulvar cancer requires an experienced multidisciplinary team approach. The treatment depends upon the stage of the cancer, age and general health of the patient. Various treatment options available for vulvar cancer are:
Surgery for Vulvar Cancer
Surgery removes all the cancerous cells without affecting sexual functioning. The types of surgeries include -
- Radical wide local excision - cancerous growth over vulva is removed with a margin of healthy tissue.
- Radical Vulvectomy – The doctor removes the vulval growth and groin lymph nodes. Skin grafts may be used to replace the removed skin.
- Removal of groin lymph nodes
- Closure of large skin defects by flaps
- Pelvic exenteration - When the primary disease involves the anus, rectum or proximal urethra, then surgery involves removal of bladder, urethra, anus, rectum, vagina, uterus, cervix and both ovaries along with Radical vulvectomy and bilateral groin lymph node removal.
- Definitive radiation therapy - External radiation therapy delivers high-energy radiation through the skin to the targeted region using a machine and kills the cancerous cells. Internal radiation therapy transfers the radioactive substances sealed in needles, wires, or catheters directly into the cancerous cells.
- Chemo-radiation therapy
- Chemotherapy - includes medications that kill cancerous cells
Primary Prevention of Vulvar Cancer
There is no screening test for vulvar cancer, so it is necessary to be aware of the signs and symptoms for early diagnosis. Prevention of HPV -
Prevention of infection by Human Papillomavirus (HPV) can prevent women from vulvar cancer.
Vaccines – There are two types of vaccines to prevent infection with high risk HPV: Recombinant HPV Quadrivalent Vaccine and Recombinant HPV Nonavalent Vaccine.
Secondary Prevention of Vulvar Cancer
Follow-up after the treatment includes physical examination and some tests to determine the effectiveness of treatment and to detect any recurrent growth.
- Regular checkups and physical examinations by the gynaecologist
- Avoid smoking
- Self-examination of vulva
Expected Prognosis of Vulvar Cancer
The survival rate of vulvar cancer is very high. Nearly 70% of the survivors live for at least 5 years after the diagnosis.
Possible Complications of Vulvar Cancer
- Spread of cancer to lymph nodes, anus, or lower vagina
- Spread of cancer to the bladder, pelvic bone or urethra
- Urinary tract infections
- Lower limb swelling
Our BLK-Max Medical Experts
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