• Vulvar Cancer

    Definition

    The vulva is the outer part of the female genitals that includes the labia, clitoris, and vaginal opening. There are different type of cancer that can occur in this area including:
    • Squamous cell carcinoma—cancers of the skin cells, most common type of vulvar cancer
    • Adenocarcinoma—from fluid producing glands, less common
    Cancerous (malignant) tumors can invade nearby tissue and spread to other parts of the body.

    Causes

    Cancer occurs when cells in the body, in this case vulvar cells, divide without control or order. Eventually these cells can develop into a mass of tissue called a growth or tumor.
    A healthy cell changes into a cancerous cell because of changes in the DNA. The exact reason the change happens is not clear but it is likely due to a combination of genetic and environmental factors.

    Risk Factors

    This condition is more common in women 65 to 75 years of age.
    Factors that may increase your chance of vulvar cancer include:
    • Human papillomavirus (HPV) infection
    • Vulvar intraepithelial neoplasia
    • Cervical precancer or cervical cancer
    • A weakened immune system due to conditions such as HIV
    • Lichen sclerosus
    • Melanoma or atypical moles
    • Smoking
    • Chronic vulvar irritation or skin condition

    Symptoms

    Symptoms may include:
    • Persistent itching, burning, or bleeding of the vulva
    • Changes in the color of the skin of the vulva
    • Skin changes, such as a rash, mole, or warts
    • Sores, scales, lumps, or ulcers on the vulva
    • Pelvic pain, especially during urination or sex

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. This will include a pelvic exam of your uterus, ovaries, cervix, and vagina. Your doctor may order blood tests.
    A biopsy, removal of a piece of suspicious tissue for testing, will be done. The sample will confirm a cancer diagnosis. A Pap test may also be done to look for signs of cancer in nearby tissue.
    Imaging studies, such as x-rays or CAT scans may be done to look for spreading of the tumor.
    The physical exam combined with all of your test results will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, vulvar cancer is staged from 0-IV.
    • Stage 0 is a cancer only on the surface of the skin
    • Stage 1 is in the vulva and tissue between rectum and vagina
    • Stage 2 is growth that has spread to anal tissue or vagina
    • Stage 3 is growth that has spread to nearby tissue and is present in the lymph node
    • Stage 4 is increased growth to nearby tissue and lymph nodes, may spread to other areas of the body
    The biopsy will determine the grade (1-4) and type of your tumor. These can predict how aggressive a tumor may be and help to determine the treatment.

    Treatment

    You and your doctor will determine which treatment or combinations of treatments work best for you, depending on the location, type, stage and grade of your tumor. Cancer treatment often includes a combination of the following treatments:

    Surgery

    Surgery involves removing as much of the cancer as possible. Types of surgery to treat vulvar cancer include:
    • Excision—The cancer and surrounding tissue are removed to make sure all cancer cells are removed. The procedure is called a simple partial vulvectomy.
    • Vulvectomy—All or part of the vulva is removed.
    • Pelvic exenteration—A vulvectomy is done along with removal of the pelvic lymph nodes. The lower colon, rectum, bladder, uterus, cervix, and vagina may also be removed depending on how far the cancer has spread.
    • Inguinal lymph node dissection—Lymph nodes in the groin are removed. May be done if cancer is found in the lymph nodes.
    • Sentinel lymph node biopsy—The lymph nodes closest to the area where the cancer is located are removed.

    Radiation Therapy

    Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. External radiation directs radiation at the tumor from a source outside the body. It is sometimes used along with chemotherapy to treat more advanced cancers. It may be used to shrink tumors before surgery or kill any remaining cancer cells after surgery.

    Chemotherapy

    Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including pill, injection, or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

    Prevention

    To help reduce your chance of getting vulvar cancer:
    • Take steps to prevent HPV infection. This may include practicing safe sex and talking to your doctor about the HPV vaccine.
    • If you smoke or use tobacco products, talk to your doctor about ways to quit.

    RESOURCES

    American Congress of Obstetricians and Gynecologists http://www.acog.org

    Centers for Disease Control and Prevention http://www.cdc.gov

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Vaginal and vulvar cancers. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cancer/vagvulv/index.html. Updated March 13, 2014. Accessed July 8, 2016.

    Vulvar cancer. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/vulvar-cancer/causes-risk-factors.html. Updated May 2014. Accessed July 8, 2016.

    Vulvar cancer—patient version. National Cancer Institute website. Available at: http://www.cancer.gov/types/vulvar. Accessed July 8, 2016.

    What is vulvar cancer? American Cancer Society website. Available at: http://www.cancer.org/cancer/vulvarcancer/detailedguide/vulvar-cancer-what-is-vulvar-cancer. Updated February 16, 2016. Accessed July 8, 2016.

    What is vulvar cancer? Canadian Cancer Society website. Available at: http://www.cancer.ca/en/cancer-information/cancer-type/vulvar/vulvar-cancer/?region=on. Accessed July 8, 2016.

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