Vulvar Cancer: abnormal growth of cancerous cells in the vulva

Vulvar cancer is an abnormal growth of malignant (cancerous) cells in the vulva, constituting 3% of all female genital tract cancers. About 90% of vulvar cancers are squamous cell carcinomas, which typically develop at the edges of the labia majora/ minora or in the vagina.
Vulvar cancer most commonly occurs in postmenopausal women.

Stages of vulvar cancer

Stage 0 – Carcinoma in situ.
Stage I Tumor confined to the vulva and/or perineum; 2 cm or less in diameter.
Stage II Tumor confined to the vulva and/or perineum; more than 2 cm in diameter.
Stage III Tumor of any size with (1) adjacent spread to the lower urethra and/ or vagina, or the anus, and/or (2) unilateral regional lymph node metastasis.
Stage IVA Tumor invades the upper urethra, bladder mucosa, rectal mucosa, pelvic bone, and/or bilateral, regional node metastasis.
Stage IVB Any distant metastasis, including pelvic lymph nodes.

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What Causes Vulvar Cancer?

Though the cause is unknown, it was found to be linked to DNA mutations.
Vaginal cancer can be caused by one of the following reasons :

Studies have linked the role of Human papillomavirus (HPV) with vaginal cancer. Persistent infection with HPV – turn off the tumour suppressor genes. This further leads to cancerous growth affecting the cells lining the vagina.
Mutations of the p53 tumor suppressor gene.

What are the Risk factors?

Age
Smoking cigarettes
Diseases such as cervical cancer or cervical precancerous conditions show an increased risk of vaginal cancer.
Vulvar intraepithelial neoplasia – precancerous cells in the vulvar
HPV infection
Lichen sclerosis – causes the vulvar skin to become very thin and itchy.

Signs and symptoms: Vulvar Cancer

Itching in the vulvar area ( lasts for more time).
Bleeding not related to menstruation (periods).
Pain in the vulvar area
An area on the vulva that looks different from normal could be lighter or darker than the normal skin or look red or pink.
A bump or lump could be red, pink, or white and have a wart-like or raw surface.
Thickening of the skin of the vulva
An open sore (lasts for a month or more).

What are the Complications?

Lymphedema, cellulitis, bone metastasis, and urethral obstruction.

Diagnosis: How to diagnose Valvar’s cancer?

Medical history – Check for symptoms and other risk factors.
Physical examination – Pelvic exam
Diagnostic tests – The tests performed are:
- Biopsy: Removal of a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells ( Punch biopsy, LEEP, Conization, ECC).
- Endoscopy
- Colposcopy
Imaging tests :
- CT scan: A procedure that makes a series of detailed pictures of areas inside the body
- Chest X-ray: An X-ray is anenergy beam that can go through the body and onto film, picturing areas inside the body.MRI: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
- PET scan: A procedure to find malignant tumour cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein.
- The PET scanner rotates around the body and shows where glucose is used.
- Malignant tumour cells appear brighter in the picture because they are more active and consume more glucose than normal cells.
Other tests – Blood tests

Treatment: How is Valvar cancer treated?

Radiation therapy – 1. External radiation therapy uses a machine outside the body to send radiation toward cancer. 2. Internal radiation therapy uses a radioactive substance placed directly into or near the cancer.
Surgery is used for small stage I or II vaginal cancers and cancers not cured with radiation.
- Laser surgery is a surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or remove a surface lesion such as a tumour.
- Wide local excision: A surgical procedure that takes out the
- Vulvectomy: Surgery to remove all or part of the vulva. Skin grafts from other body parts may be needed to reconstruct the vulva.
- Lymph node dissection: Surgery to remove lymph nodes is called lymphadenectomy
- Pelvic exenteration is a major operation that includes vulvectomy, removing the pelvic lymph nodes, and removing one or more of the following: the lower colon, rectum, bladder, uterus, vagina and/or cervix.
Chemotherapy –
- Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Drugs used to treat vulvar cancer are – Cisplatin, 5-fluorouracil, mitomycin, vinorelbine, paclitaxel etc.

Prevention: Can we prevent Vulvar cancer?

Prevention of Vulvar cancer –
- HPV vaccine
- Routine physical tests
- Quit smoking
- Self-examination of the vulva
- Practice safe sex by using barrier methods, e.g. condoms.

Living with Vulvar cancer –
- Follow-up care ( doctor visits and tests)
- Avoid smoking
- Staying at a healthy weight
- Regular physical activities

When to see a doctor? :

It is wise to consult with a gynaecologist immediately if symptoms like persistent itching are observed. The typical consultation fee for a gynaecologist ranges from Rs. 500 to Rs. 1500 in India.