Vulvar Cancer

Overview

Vulvar cancer is cancer of a woman’s external genitalia, known as the vulva. Usually, vulvar cancer develops slowly. Often, it begins as vulvar intraepithelial neoplasia, a precancerous skin condition where the healthy cells around the vulvar region undergo abnormal changes. If not treated on time, these abnormal cells can turn into cancer.

What is Vulvar Cancer?

A woman’s vulva consists of:

• The introitus

It is a tube-like opening that opens out from the vagina.

• The labia

The labia are two sets of skin folds that resemble lips. Labia majora is the fleshy part  on the outside. Labia minora is the set of thinner lips on the inside of labia majora.

• The mons pubis

It is a soft mound located in front of the pubic bones. The mons pubis gets covered with hair when a woman reaches puberty.

• The clitoris

The clitoris is a soft knob of tissue covered under a hood of skin where the labia minora meet.

• The perineum

It is a patch of skin between the vulva and the anus.

Vulvar cancer can occur on any of these parts of the vulva. Commonly, vulvar cancer forms a small lump or sore on the vulva that may cause itching and discomfort. Although vulvar cancer can occur in women of any age group, it is more commonly seen in older women. 

What are the Symptoms of Vulvar Cancer?

During the initial stages, vulvar cancer may not cause any symptoms. However, as cancer progresses, you may experience:

• Changes in the skin, such as discoloration or skin thickening.
• Abnormal bleeding, which is not due to menstruation.
• A lump, sore, or wart-like bumps in the vulvar region.
• Itching that does not go away. 
• Tenderness, pain, or a burning sensation in the vulvar region.
• Pain while urinating.

When Should You Visit a Doctor?

If you experience persistent symptoms of as described above, immediately visit a doctor. 

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What Causes Vulvar Cancer?

The exact causes of vulvar cancer are not known yet. However, the following factors are considered to increase your risk of developing vulvar cancer. 

• Age
• A weakened immune system
• Exposure to human papillomavirus, HPV
• Excessive use of tobacco products
• Having a history of precancerous skin conditions of the vulva
• Having a vulvar skin condition, such as lichen sclerosis

How is Vulvar Cancer diagnosed?

The doctor may carry out the following tests and procedures to confirm the diagnosis of vulvar cancer:

• Physical examination

The doctor may examine your vulvar region to look for abnormalities, such as skin discoloration, visible sores, lumps, or bumps.

• Colposcopy

Using a unique magnifying device, the doctor may closely examine your vulvar region for abnormalities that may not be visible to the naked eyes.

• Biopsy

If the doctor finds a suspicious area in your vulvar region, he/she may do a biopsy. It involves removing a small sample of skin from the suspicious area to analyze it in the laboratory. 

During the biopsy procedure, the doctor will numb the area with a local anesthetic. Then, the doctor will remove a tissue sample from the suspicious area.

How is Vulvar Cancer Staged?

Staging the cancer helps the doctor determine the severity . The factors used in staging vulvar cancer include the size and number of tumors, location of the primary tumor, and how much it has spread to the nearby lymph nodes.

The stages range from 0 to 4, with the highest stage being the most severe.

Stage 0: Initial stages of cancer with the cancerous cells being confined only to the surface skin of the vulva.

Stage 1: Cancer affects only the vulva or the perineum and has not spread to other lymph nodes.

Stage 2: Cancer spreads from the vulva to other nearby areas, such as the anus, vagina, or urethra.

Stage 3: Cancer spreads to the nearby lymph nodes.

Stage 4A: Cancer spreads more extensively to lymph nodes or the upper areas of the vagina or urethra.

Stage 4B: Cancer spreads to distant organs.

What are the Treatment Options Available for Vulvar Cancer?

Depending on your vulvar cancer stage, severity, and location, the doctor will devise a treatment plan for you.

The standard treatment options include:

1. Surgery

The surgical options for treating vulvar cancer include:

• Excision: Also known as local excision or radical excision, this surgical procedure involves removing the cancerous tissue along with a small amount of healthy tissue from the nearby areas. 
• Vulvectomy: This procedure involves removing the affected portion of the vulva. It is performed in two ways:

Partial vulvectomy – This involves removing a small part of the vulva. 

Radical vulvectomy – This involves removing the entire vulva, including the underlying tissue. 

In severe cases, the doctor may combine other treatment options, such as chemotherapy or radiation therapy, to help shrink the tumor before resecting it.

• Sentinel node biopsy: This procedure involves removing and analyzing the nearby lymph nodes to examine if cancer has spread further. If cancer is not detected in the first lymph nodes, it is unlikely to have spread further.

2. Radiation therapy

This treatment option kills cancer cells using high-powered energy beams such as protons and X-rays. In some cases, your doctor may combine radiation therapy with other treatment options to help shrink large tumors.

3. Chemotherapy

It is a type of drug treatment that involves using chemicals to kill cancer cells. The drugs are usually administered through a vein in your arm or given orally.

4. Targeted drug therapy

This treatment option focuses on specific abnormalities present within the cancer cells. Targeted drug treatments block these abnormalities in order to kill the cancer cells.

What are the Risks Associated with Vulvar Cancer Surgery?

Every surgery carries some risks or complications. The risks associated with vulvar cancer surgery include:

• Mild pain and discomfort.
• Infection around the incision site.
• Problems with wound healing.
• In severe cases where lymph nodes are also removed, it can lead to swelling in the legs or fluid retention, commonly known as lymphedema. 

Conclusion

Although initial stages of vulvar cancer do not show any visible symptoms, advanced stages can show severe symptoms. This is why you have to consult your doctor as soon as you experience persistent symptoms. An early diagnosis and proper treatment can help avoid vulvar cancer from progressing to advanced stages.

Frequently Asked Questions (FAQs)

What does vulvar cancer look like?

Vulvar cancer may look different in every individual. You may see the following changes in your vulva:

• A lighter or darker skin around the vulva than usual.
• A white, pink, or red lump or bump in the vulvar region.
• A raw vulvar surface that may feel rough or thick to the touch.

Does vulvar cancer smell a particular way?

Since vulvar cancer develops on the surface of the vulva, it may have a particular smell. However, during the initial stages of vulvar cancer, you may not experience any symptoms. In advanced stages, you may experience vaginal discharge with a foul smell. The vaginal discharge may or may not contain blood.

What are the different types of vulvar cancer?

There are two main types of vulvar cancer:

• Squamous cell carcinomas: In this type of vulvar cancer, the cancer cells develop in the outer layer of the skin. Squamous cell carcinoma of the skin account for about 80 percent of vulvar cancer cases.
• Adenocarcinoma: It is a rare type of vulvar cancer and only accounts for less than 10 percent of the cases. Adenocarcinoma develops in the glands located on each side of the vaginal opening, known as Bartholin glands. 
• Vulvar melanoma: This cancer starts in the pigment-producing cells that is found in the skin of the vulva.