Vulvar Cancer

By:    Published: February 2, 2012

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Vulvar cancer is a rare cancer that develops on the vulva, which is comprised of the opening of the vagina, the labia majora (the outer vaginal lips), the labia minora (the vaginal inner lips), and the clitoris.  Vulvar cancer most often affects the labia majora and commonly presents as a lump on the vulva that may cause pain and itching. Vulvar cancer accounts for approximately 4% of all gynecological cancers and typically affects older women. An estimated 1 in 372 women will be diagnosed with vulvar cancer during their lifetime. Vulvar cancer is classified into three main types, according to the type of tissue where the cancer began. Treatment for vulvar cancer typically involves surgical removal of the cancer and some surrounding healthy tissue. However, the extent of surgery depends on the type of vulvar cancer and its stage.

Symptoms

The following are symptoms associated with vulvar cancer:

  • A lump, sore, or wart-like bumps on the vulva
  • Bleeding that is not associated with menstruation
  • Persistent itching in the vulvar area
  • Tenderness or pain in the vulvar area
  • Skin changes, such as pigment changes or thickening of the vulvar skin

Causes And Risk Factors

The exact cause of vulvar cancer is currently unknown. However, certain factors may put you at a greater risk for developing vulvar cancer. These risk factors include:

  • Getting older. The risk of vulvar cancer increases with age. The average age at diagnosis is 65.
  • Having had human papillomavirus (HPV).
  • Smoking
  • Being human immunodeficiency virus (HIV) positive.
  • Having a history of vulvar intraepithelial neoplasia (VIN). VIN is associated with particular changes that can occur in the skin that covers the vulva. This is a precancerous condition may increases the risk of vulvar cancer, although most women with VIN will never develop cancer.

Types of Vulvar Cancer

Vulvar cancer is often classified into three main types of cancer. These are:

  • Squamous cell carcinoma. This type of cancer occurs in the cells that line the surface of the vulva. This type of cancer accounts for a majority of vulvar cancers and is usually found on the labia majora.
  • Melanoma. This type of cancer occurs in the melanoctyes, the skin pigment producing cells. It most often develops in clitoris or the labia minora and accounts for about 2 to 4 percent of vulvar cancers.
  • Adenocarcinoma. This type of cancer begins in the tissue that lines the Bartholin’s glands or vulvar sweat glands. It is usually found on the sides of the vaginal opening and accounts for a small percentage of vulvar cancers.

Diagnosis

In order to diagnose vulvar cancer your doctor will initially perform a physical exam (this will include examining your vulva for abnormalities) and take a comprehensive medical history. Your doctor may order the following tests in order to confirm a bone cancer:

  • Colposcopy exam. Your doctor will utilize a colposcope, a device that works like a magnifying glass to closely inspect the vulva for abnormalities.
  • Biopsy. To ascertain if any vulvar abnormalities are cancerous, your doctor may remove a sample of skin for testing.

If you are diagnosed with vulvar cancer, your doctor will then determine the size and stage of your cancer.  In order to do so your doctor may order additional tests including:

  • Magnetic Resonance Imaging (MRI)
  • Computed tomography (CT) Scan
  • Pelvic exam

Stages of vulvar cancer include:

  • Stage I. This stage indicates a small tumor that is confined to the vulva and hasn't spread to your lymph nodes or parts of the body.
  • Stage II. This stage indicates tumors have grown and invaded adjacent structures, such as the lower portions of the urethra, vagina and anus.
  • Stage III. This stage indicates that the cancer has spread to lymph nodes.
  • Stage IVA. This stage indicates that the cancer that has spread more extensively to the lymph nodes, or to the upper portions of the urethra, or vagina, or to the bladder, or rectum or pelvic bone.
  • Stage IVB. This stage indicates that the cancer that has spread (metastasized) to distant parts of the body.

Treatment

There is a vast array of treatment options available for patients with vulvar cancer. The extensiveness of treatment is most often determined by the stage of vulvar cancer. Some standard treatments include:

Surgery.This is the most common treatment for vulvar cancer. The goal of surgery is to remove all the cancer without affecting the woman's sexual function. Surgical options include:

  • Excision. This procedure involves removing the cancer and some of the surrounding normal tissue (wide local excision) or a large amount of surrounding tissue (radical local excision).
  • Vulvectomy. This procedure involves removing a part of the vulva (partial vulvectomy) or all of the vulva (radical vuvlvectomy).  
  • Pelvic exenteration. This procedure involves removing all of the vulva as well as nearby organs such as lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes. Artificial openings are made for urine and stool to flow from the body into a collection bag. This option is only recommended if your cancer has spread beyond the vulva and involves other closely juxtaposed organs.

In some cases, patients maybe prescribed adjuvant therapy, which is the provision of chemotherapy or radiation therapy after surgery to kill any microscopic cancer cells that are left.

  • Radiation therapy. This type of therapy utilizes high-energy x-rays or other types of radiation to kill cancer cells. External radiation therapy uses a machine that aims radiation toward the cancer. In contrast, with internal radiation therapy the source of radiation is placed inside of your body, via needles, seeds, wires, or catheters that are placed directly into or near the cancer.
  • Chemotherapy. Chemotherapy is a cancer treatment that uses drugs to kill cells that are rapidly dividing. Systemic chemotherapy is when the chemotherapeutic agent is administered orally or intravenously. Regional chemotherapy involves directly placing the drugs in or on the areas affected by cancer.

Sources:

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