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.
References:
- Vulvar Cancer Treatment – NCI. https://www.cancer.gov/types/vulvar/patient/vulvar-treatment-pdq
Types of Cancer
- Myelodysplastic neoplasms: a rare blood disorders
- Myeloproliferative Neoplasm: abnormal proliferation of blood cells
- Cervical Cancer: abnormal growth of the tissues of the cervix
- Vaginal Cancer: cancer of the female reproductive system
- Ovarian cancer: cancer that begins in the ovaries
- Astrocytoma- a tumor that develops in the brain and spinal cord
- Histiocytosis
- Ductal Carcinoma In Situ (DCIS)
- ACC or Adrenocortical Carcinoma
- Chronic Lymphocytic Leukemia or CLL
- Bile Duct Cancer: Signs and Symptoms and Treatment
- Understanding the Causes and Treatment of Medulloblastoma
- Adrenocortical Carcinoma: Symptoms & Treatments
- The Latest Research on Germ Cell Tumors and Prognosis
- Anal Cancer: Treatment and Screening Tests
Consult a doctor
- Dr. Nilesh Chordiya – oncologist at Nanavati Hospital Mumbai
- Dr. Nagraj G. Huilgol – oncologist at Nanavati Hospital Mumbai
- Dr. Pawan Gupta- oncologist at Max Hospital
- Dr. Rohit Nayyar- oncologist at Max Hospital
- Dr. Sandeep Batra- oncologist at Max Hospital
- Dr. Gagan Gautam- oncologist at Max Hospital
- Dr. Vimal Dassi- oncologist at Max Hospital
- Dr. Harit Chaturvedi- oncologist at Max Hospital
- Dr. Anil Kumar Anand- oncologist at Max Hospital
- Dr. Arun Goel- oncologist at Max Hospital
- Dr. Kanika Gupta- oncologist at Max Hospital
- Dr. Nitesh Rohatgi- oncologist at Max Hospital
- Dr. Gagan Saini- oncologist at Max Hospital
- Dr. Gopal Sharma- oncologist at Max Hospital
- Dr. Akshay Tiwari- oncologist at Max Hospital