Cancer occurs when abnormal cells reproduce uncontrollably. Cancer can occur anywhere in the body, and the symptoms and treatment depend on the type of cancer and its location. There are various types of cancer that can affect the female reproductive organs, including vulvar cancer.
Vulvar cancer is a cancer of the vulva or a woman’s external genitalia. The vulva is comprised of the inner and outer lips of the vagina, the clitoris, and the opening of the vagina. Glands near the opening are also included. This cancer typically affects the outer vaginal lips, although other parts of the vulva can also be affected.
This kind of cancer is usually slow growing. First, abnormal cells grow on the vulva. This is called dysplasia or vulvar intraepithelial neoplasia (VIN). Without treatment, the abnormal cells can develop into cancer.
In its early stages, vulvar cancer may not cause any symptoms. When symptoms occur, they can include:
- itching in the vulvar area
- abnormal bleeding
- tenderness of the vulva
- lump in the vulvar area
There is not one single cause of vulvar cancer. However, being of older age or getting infected with the human papillomavirus (HPV) have been identified as risk factors (Cleveland Clinic).
Your doctor will perform a physical examination and closely examine the vulva. He or she will also review your health history and ask about your general health habits.
Your doctor will also do a biopsy. This involves taking small samples of tissue from the vulva for microscopic examination by a pathologist. The procedure may be done with a local anesthetic.
If the biopsy results show vulvar cancer, a doctor who specializes in cancers of the female reproductive tract or a gynecologic oncologist will stage the cancer.
Staging helps your doctor classify the severity and extent of the cancer. This dictates treatment decisions, and gives a better sense of long-term outlook for the patient. Factors in staging include where the primary tumor is located, whether it has spread to the lymph nodes, and the size and number of tumors. Stages are typically 0 through IV, in the order of ascending severity. Stage 0 is noninvasive, while Stage IV is cancer that has spread to other organs.
There are a number of tests that help your doctor stage the cancer, including:
- pelvic examination under general anesthesia to allow in-depth examination of the area
- computed tomography (CT) scan
- magnetic resonance imaging (MRI)
- cystoscopy and proctoscopy, which are procedures that help the doctor see the inside of your bladder and rectum to determine whether the cancer has spread
Treatment will depend on the stage of your cancer, but there are four types of standard treatment.
Laser therapy uses a beam of high-intensity light to kill cancer cells. It is frequently administered using a thin tube called an endoscope, through which the beam is aimed to destroy the tumor cells. Lasers treatment tends to produce less scarring and bleeding. Laser therapy can often be performed on an outpatient basis, allowing the patient to leave the hospital on the same day.
Surgery, the most commonly used treatment, is performed in different ways. Depending on the spread of disease, the doctor may remove the abnormal area and a margin of normal tissue surrounding it. Lymph nodes may also be removed. This is called a local excision.
A vulvectomy or removal of a part or the entire vulva is another surgical option.
For extensive disease, pelvic extenteration is performed. This is a radical procedure and removes the cervix, vagina, lower colon, rectum, bladder, vulva, ovaries, and lymph nodes. With the removal of these organs, the doctor creates artificial openings called stoma so that urine and stool can leave the body.
Radiation therapy uses powerful X-rays to kill cancer cells. This may be administered externally, when rays are aimed at the abnormal area from a machine; or it may be given internally, through the insertion of radioactive seeds or wires.
Chemotherapy is the use of drugs to slow down or stop cancer cells from growing. The medications can be taken orally or given intravenously, depending on the drugs. It may also be given as a topical cream for vulvar cancer.
Clinical trials are not standard treatment, but are part of scientific research. Participants are selected to receive new treatments and are monitored very carefully to evaluate the effectiveness of the treatments. Talk with your doctor about whether a clinical trial is appropriate for you.
After your treatment, follow-up appointments are necessary. These appointments involve exams to ensure your body is healing from any procedures, to monitor for the recurrence of cancer, and check for side effects from treatments.
Vulvar cancer is a rare and potentially fatal condition. The long-term outlook for vulvar cancer depends on the stage of cancer and the size of the tumor. It also depends on whether the cancer has spread and its particular type, such as squamous cell carcinoma, adenocarcinoma, or vulvar melanoma. If diagnosed and treated early, the survival rate is quite high. According to the National Cancer Institute, relative five-year survival rate ranges from 83 to 100 percent if diagnosed at Stage I, while relative 10-year survival rate at Stage I ranges from 71 to 89 percent (NCI).