Vulvar cancer is a rare type of cancer where the proliferation of cancer cells happens on the outer region of the female genitalia, i.e. the vulva. Vulvar cancer usually appears on the outer vaginal lips and is noticed in the form of a lump or a sore that is usually characterised by an intense itching sensation.
The vulva chiefly includes the vagina (the tube that leads to the uterus), the two sets of skin folds or lips (i.e. labia majora and labia minora), the clitoris (a sensitive knob-like tissue, hooded by a thin skin fold), the mons pubis (a soft mound of tissue protecting the pubic bones that usually gets covered by pubic hair after puberty), and the perineum (a small patch of skin in between the anus and the vulvar region). Although vulvar cancer can occur at any age, it is chiefly diagnosed in older adults.
Vulvar cancer can be classified into two types depending upon the type of cell that becomes cancerous.
Vulvar Squamous Cell Carcinoma: Deemed as the most common type of vulvar cancer, cancer usually starts in the thin, flat cells that line the surface of the vulva. It can often happen due to human papillomavirus (HPV), especially in younger women.
Melanoma: This type of vulvar cancer usually starts metastasizing in the pigment-producing cells found in the skin of the vulva.
Just like any other type of cancer, the exact cause of vulvar cancer is yet unknown. But various studies suggest that it usually occurs when there are changes in the genetic mutation of the DNA strands of the vulvar cells that turn the healthy cells into abnormal ones. This causes them to divide and grow rapidly, without dying and eventually piling up to form tumorous structures.
Certain causative factors that increase the risk of vulvar cancer include:
Age: It is more common in women over the age of 70
Weakened Immune system: A weakened immunity due to organ transplant or people living with diseases such as HIV or AIDS are more at risk of vulvar cancer.
Infections: People exposed to Human papillomavirus have an aggravated risk of getting diagnosed with this type of cancer.
Other Cancerous Conditions: The chances of vulvar cancer are more in people diagnosed with or who have a family history of melanoma, vaginal or cervical cancer. Even a precancerous condition like vulvar intraepithelial neoplasia can increase the risk.
Skin Conditions: Unusual moles or skin conditions like Lichen sclerosus (a condition where the vulvar skin becomes thin and itchy) can increase the risk of this type of cancer.
Diagnostics: A history of unusual Pap tests can increase the risk of vulvar cancer.
Unhealthy Habits: Lifestyle choices like smoking can increase your chances of vulvar cancer in the later stages.
Although the early stage of vulvar cancer doesn’t usually show any symptoms, the later years are marked by these common characteristic symptoms including:
- Intense and continuous itching
- Pain, soreness and inflammation
- Change in the color of the vulva
- Unusual growths or lumps that feel rough and may turn red, pink, or white
- Thickened skin on your vulva
- Wart-like lumps or open sores
- Unusual vaginal bleeding or discharge
- Pain while urinating
Diagnosis And Treatment
If you notice any of the above-mentioned signs and symptoms, do consult a gynaecologist or specialist to get it checked right away and start the treatment at the earliest. The doctor usually does a thorough physical checkup, acknowledges the patient’s past medical history followed by conducting some diagnostics which include:
- Examination of the pelvis and the vulva
- Imaging techniques like Ultrasound, Chest X-ray, CT-scan, or MRI-scan
Staging Of Vulvar Cancer
Stage I: The tumor is quite small and hasn’t spread past the vulvar region and perineum.
Stage II: The cancer has spread into the nearby tissues apart from the lymph nodes.
Stage III: This stage marks the spread of cancer into the nearby tissues and lymph nodes in the groin region.
Stage IV: An advanced stage where the cancer cells have reached the upper part of the vagina, urethra, anus, or even to distant organs.
Treatment options usually depend upon the stage of the cancer, and the health of the patient. This includes:
- Surgery: This includes ultrasound surgical aspiration or laser surgical technique
- Excision: This comprises of wide local aspiration technique or radical local excision technique to remove the affected tissue.
- Vulvectomy: This surgical procedure includes Skinning vulvectomy, Partial or modified radical vulvectomy, Simple vulvectomy, and Radical vulvectomy.
- Pelvic exenteration: This procedure usually removes the affected vulva and lymph nodes as well as one or more of the nearby organs where the cancer has already spread.
- Radiation therapy
- Immunotherapy or Biological therapy