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Vulvar Cancer

Vulvar cancer is a type of cancer that occurs on the outer surface area of the female genitalia. The vulva is the area of skin that surrounds the urethra and vagina, including the clitoris and labia. Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching. Vulvar cancer usually forms slowly over years, most often on the vaginal lips or the sides of the vaginal opening.  Infection with human papillomavirus (HPV) causes about half of all vulvar cancers.

Signs & Symptoms

Types

Causes & Risks

Prevention

Treatments

Signs & Symptoms

Signs and symptoms of vulvar cancer can vary, but common ones include:

  1. Persistent itching: Chronic itching in the vulvar area.
  2. Pain or tenderness: Ongoing pain or tenderness in the vulva.
  3. Lumps or growths: The presence of a lump, thickening, or ulceration on the vulva.
  4. Skin changes: Changes in color (such as becoming redder or whiter than normal) or texture of the vulvar skin.
  5. Sores or ulcers: Open sores that do not heal.
  6. Bleeding: Unusual bleeding not related to menstrual periods.
  7. Discharge: Unusual discharge from the vulvar area.
  8. Painful urination: Discomfort or pain when urinating.
  9. Pain during intercourse: Pain experienced during sexual intercourse.
  10. Swelling: Swelling in the vulvar area or groin.

If any of these symptoms persist, it’s important to consult a healthcare provider for further evaluation and possible diagnosis. Early detection is key to effective treatment.

Types of Vulvar Cancer

Vulvar cancers are most common in the labia majora and labia minora. Most vulva cancers are squamous cell carcinomas, a type of cancer that starts in the skin cells. Vulvar squamous cell carcinomas form when the thin, flat cells lining the surface of the vagina change (mutate). The mutated cells can multiply quickly.

The following are other, less common types of vulvar cancer.

  • Melanoma: The second-most common type of vulvar cancer typically presents as a pigmented lesion on the vulva. Amelanotic lesions can also occur.
  • Basal cell carcinoma: This accounts for 2% to 7% of vulvar cancers.
  • Bartholin gland carcinoma: Up to 5% of vulvar cancers originate from the Bartholin gland, which is a small gland just inside the vagina opening.
  • Sarcoma: This accounts for 1% to 2% of vulvar cancers. These soft-tissue sarcomas include leiomyosarcomas, rhabdomyosarcomas, liposarcomas, angiosarcomas, neurofibrosarcomas, epithelioid sarcomas and undifferentiated/unclassified sarcomas.
  • Paget’s disease of the vulva: This accounts for less than 1% of vulvar cancers.

Causes & Risks of Vulvar Cancer

The exact cause of vulvar cancer is not fully understood, but several risk factors are associated with an increased likelihood of developing the disease. These include:

Causes

  • Genetic Mutations: Changes in the DNA of vulvar cells can lead to cancer. These mutations can be sporadic or inherited.
  • Chronic Inflammation: Long-term irritation or inflammation in the vulvar area may contribute to the development of cancer.

 

Risk Factors

  1. Human Papillomavirus (HPV) Infection: Certain strains of HPV, a sexually transmitted infection, are strongly linked to vulvar cancer.
  2. Age: Vulvar cancer is more common in women over the age of 60.
  3. Smoking: Tobacco use increases the risk of developing vulvar cancer, particularly when combined with HPV infection.
  4. Immunosuppression: Conditions or medications that weaken the immune system, such as HIV infection or immunosuppressive drugs, can increase the risk.
  5. Vulvar Intraepithelial Neoplasia (VIN): This precancerous condition involves abnormal cells on the surface of the vulva, which can develop into cancer if not treated.
  6. Lichen Sclerosus: This chronic skin condition causes thin, white patches on the vulva and is associated with an increased risk of vulvar cancer.
  7. History of Cervical Cancer: A history of cervical cancer or precancerous changes in the cervix can increase the risk of vulvar cancer.
  8. Sexual History: Having multiple sexual partners or an early age at first sexual intercourse can increase the risk of HPV infection, thereby increasing the risk of vulvar cancer.
  9. Family History: A family history of vulvar cancer or other related cancers may increase the risk.
 

Preventions of Vulvar Cancer

Preventing vulvar cancer involves addressing the known risk factors and adopting healthy practices. Here are some key prevention strategies:

  1. HPV Vaccination
    • Vaccination: Receiving the HPV vaccine can significantly reduce the risk of HPV-related cancers, including vulvar cancer.
  1. Regular Gynecological Exams
    • Routine Screenings: Regular pelvic exams and Pap smears can help detect precancerous conditions or early-stage cancers when they are most treatable.
  1. Safe Sexual Practices
    • Protection: Using condoms and having a mutually monogamous relationship can reduce the risk of HPV infection and other sexually transmitted infections (STIs).
    • Limiting Number of Sexual Partners: Reducing the number of sexual partners can decrease the risk of HPV exposure.
  1. Quit Smoking
    • Smoking Cessation: Avoiding tobacco use lowers the risk of vulvar cancer and improves overall health.
  1. Self-Examinations
    • Awareness: Performing regular self-examinations to check for any unusual changes or symptoms in the vulvar area can help in early detection.
  1. Education and Awareness
    • Public Awareness: Educating women about the signs, symptoms, and risk factors of vulvar cancer can lead to earlier detection and prevention.

Adopting these preventive measures can help reduce the risk of developing vulvar cancer. Regular communication with healthcare providers about any concerns or symptoms is also crucial for early detection and effective treatment.

Treatments for Vulvar Cancer

The treatment of vulvar cancer depends on the stage of the disease, the location and size of the tumor, and the patient’s overall health. Here are the main treatment options:

  1. Surgery
    • Local Excision: Removal of the cancerous tissue along with some surrounding healthy tissue.
    • Vulvectomy: Partial or complete removal of the vulva. This can be:
      • Partial Vulvectomy: Removal of part of the vulva.
      • Radical Vulvectomy: Removal of the entire vulva, and sometimes nearby lymph nodes.
    • Lymph Node Dissection: Removal of lymph nodes in the groin to check for cancer spread.
  1. Radiation Therapy
    • External Beam Radiation: Uses high-energy rays to target and kill cancer cells.
    • Brachytherapy: Internal radiation treatment where radioactive seeds are placed near the tumor.
  1. Chemotherapy
    • Topical Chemotherapy: Creams applied to the skin for precancerous lesions.
    • Systemic Chemotherapy: Drugs given orally or through IV that travel throughout the body to kill cancer cells.
  1. Targeted Therapy
    • Targeted Drugs: Focus on specific molecules involved in cancer growth. This approach is less common and typically used in specific cases where certain genetic markers are present.
  1. Immunotherapy
    • Immune System Boosters: Medications that help the immune system recognize and attack cancer cells. This treatment is still being researched for vulvar cancer.

The choice of treatment is personalized, taking into consideration the specific characteristics of the cancer and the patient’s preferences and overall health. Early detection and a tailored treatment plan can significantly improve outcomes.

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