Vulvar Cancer - Causes, Symptoms, Types, Stages, Risk Factors, Diagnosis, and Treatment

What Is Vulvar Cancer?

Vulvar cancer usually occurs at the opening of the vagina or the urethra. The women’s external genitalia is called the vulva. The vulva is the fatty tissue folding on the two sides of the vaginal opening, the labia majora and labia minora. Cancer on the vulva most commonly occurs in the labia. But it less commonly occurs in the clitoris and on the glands in the vaginal opening called Bartholin’s gland, which secrete mucus-like fluid for lubricating. Cancer is the growth of healthy tissue that grows uncontrollably and forms a mass called a tumor. A cancerous tumor can be malignant, which means that it can spread to other parts of the body. The most common form of vulvar cancer, depending upon the tissue, is squamous cell carcinoma. The less common type of vulvar cancer is sarcoma, adenocarcinoma, melanoma, and verrucous carcinoma.

What Causes Vulvar Cancer?

Cancer can be caused due to cells that grow uncontrollably. Malignancy occurs when the cancerous cells manage to spread to other parts of the body through blood or lymph nodes. The healthy tissues are destroyed through a process called an invasion. The cell division and growth occurs by angiogenesis, which makes new blood vessels and feeds themselves. When cancer develops and spreads to other parts, it is called metastasis. So with the help of lymph nodes, it can spread to other parts of the body and other organs. The cells that promote growth are called oncogenes, and those slow down cell growth and cell death are tumor suppressor genes. Any change in the DNA is called a mutation. These DNA mutations can initiate oncogenes and suppress tumor suppressor genes.

What Are the Signs and Symptoms of Vulvar Cancer?

The signs and symptoms of vulvar cancer may include,

• Pain and burning.

• Pain during sexual intercourse.

• Bleeding.

• Painful urination.

• Rawness and sensitivity.

• Wart-like growths.

• Ulceration.

• Dark discoloration.

• Persistent itching.

• Thickening of skin.

Who Are All at Risk for Vulvar Cancer?

The risk factors for vulvar cancer include:

• HPV infection.

• Age.

• Smoking.

• Precancerous conditions.

• Lichen Sclerosus.

• Poor immune system.

• HIV or sexually transmitted infections.

• Vulvar intraepithelial neoplasia.

• Atypical moles or melanoma.

• Kidney transplant.

What Are the Types of Vulvar Cancer?

• Squamous Cell Carcinoma- This is the most common type of vulvar cancer. 90% of the vulvar cancers are of this type. It usually occurs on the outer lips (labia majora) of the vulva, and it can also start on the inner lips of the vulva like labia minora, perineum, and clitoris.

• Vulva Melanoma- This is the second most common form of vulvar cancer. It is most commonly seen in women above 50 years of age. White women are more affected than black women. The signs and symptoms may include pain, bleeding, itching, and change in color in the vulva.

• Paget’s Disease of the Vulva- It is a rare type of skin cancer, and it usually occurs on the surface skin of the vulva. It causes itching, and the skin may appear red and flaky. It usually occurs in females above 50 years of age.

• Sarcomas- Sarcomas are cancers that occur in the tissues like muscles or fat under the skin. Types of sarcomas are neurofibrosarcomas, malignant fibrous histiosarcoma, rhabdomyosarcomas, leiomyosarcomas, epithelioid sarcomas, and angiosarcomas.

• Adenocarcinoma- Vulvar cancer that is formed in the glands of the vulval skin is called adenocarcinoma. Bartholin’s glands are the two glands that produce mucus that acts as a lubricant during sexual intercourse are present in the opening of the vagina.

• Verrucous Carcinoma- It is sporadic and looks like a large wart. It is a squamous cell carcinoma of a slow-growing type.

• Basal Cell Carcinoma- It occurs in the deepest layer of the skin, and it is a scarce type of cancer.

What Are the Stages of Vulvar Cancer?

Stage 0- Here, the cancer is present only on the surface of the skin.

Stage 1- The cancer is limited to the vulva or the perineum, and it is up to 2 cm in size.

Stage 2- It is the same as stage 1, but the cancer is at least 2 cm in size.

Stage 3- In this stage, cancer has now reached the nearby tissues like the anus or vagina and the lymph nodes.

Stage 4- In this stage, cancer might have reached both sides of the groin and may have spread to the urethra, bladder, or bowel.

What Are the Methods Used for the Diagnosis of Vulvar Cancer?

The tests used to diagnose vulvar cancer are:

1. Examination of the vulva with a medical history.

2. Biopsy to confirm vulvar cancer, and the staging is done with imaging scans. A biopsy is required if there is any ulceration, mass or a lump is present. Depending on the biopsy reports further testing can be done.

3. Proctoscopy.

4. Cystoscopy

5. Imaging scans can be used to check whether cancer has spread to nearby structures. MRI and CT scan can be done. X-rays can be taken to check whether cancer has spread to the lungs.

How Vulvar Cancer Can Be Treated?

The treatment for vulvar cancer includes:

1. Surgery- The common treatment of vulvar cancer is surgery. It usually aims to remove cancer while leaving the sexual function intact. If the cancer is diagnosed at an early stage, limited surgery is required. The later stage may spread to the other nearby organs like the urethra, rectum, and vagina, and the surgery will be more extensive. The types of surgery include:

• Laser surgery.

• Radical vulvectomy.

• Skinning vulvectomy.

• Excision.

2. Radiation therapy- This helps to shrink the deep lesions before surgery so that it will be easier to remove. Its usage depends on the stage of cancer.

3. Biologic therapy- It is also called immunotherapy. It uses synthetic or natural substances to help the body to fight against cancer on its own. Imiquimod, in the form of a cream, is applied topically to treat vulvar cancer.

4. Chemotherapy- It is a part of palliative care along with radiotherapy. A cream or lotion is applied topically on cancer, but it depends on how far cancer has spread.

How to Prevent Vulvar Cancer?

Vulvar cancer can be prevented by avoiding risk factors and treating precancerous lesions in the early stage.

• Having safer sex by using condoms.

• By getting HPV vaccination.

• Regular check-ups of the pelvic area.

• Regular cervical smear tests.

• Not smoking.

For more information, consult a doctor online at iCliniq.com.