Vulvar Cancer

Vulvar Cancer

Overview of Vulva

The vulva is the external part of the female reproductive system, consisting of skin and fatty tissue surrounding the clitoris, vaginal opening, and urethral opening. Two folds of tissue surround the vaginal opening:

• Labia Majora (Outer layer)

• Labia Minora (Inner layer)

Most vulvar cancers originate in the labia, with some cases developing in the clitoris or Bartholin’s glands.

What is Vulvar Cancer?

Vulvar cancer occurs when the healthy cells in the vulva begin to grow uncontrollably, forming a tumor. These tumors can be:

• Benign (Non-cancerous)

• Malignant (Cancerous)

Types of Vulvar Cancer

1. Squamous Cell Carcinoma

• Accounts for 90% of vulvar cancers.

• Often develops from a precancerous condition called Vulvar Intraepithelial Neoplasia (VIN), where abnormal changes occur in the skin cells before cancer forms.

2. Verrucous Carcinoma

• A slow-growing variant of squamous cell carcinoma, resembling wart-like growths.

3. Adenocarcinoma

• Develops in the Bartholin’s glands or vulvar sweat glands and is very rare.

4. Melanoma

• Accounts for 2-4% of vulvar cancers, usually appearing on the clitoris or labia minora.

5. Sarcoma

• A cancer of the connective tissues beneath the skin.

Statistics

• Annually, 3,447 cases of vulvar cancer are diagnosed in India.

Survival Rate

• The 5-year survival rate for vulvar cancer is 70%.

Risk Factors

Several factors increase the risk of vulvar cancer, although they may not directly cause it:

• HPV Infection:

• Human Papillomavirus (HPV) is associated with more than half of vulvar cancer cases, often transmitted through sexual contact.

• Smoking:

• Smokers have a higher risk of vulvar cancer.

• Age:

• Most cases occur in women over 50 years.

• Weakened Immune System:

• Conditions such as HIV infection, organ transplantation, or cancer treatments can reduce immunity, increasing the risk.

• Precancerous Conditions:

• Women diagnosed with Vulvar Intraepithelial Neoplasia (VIN) are more likely to develop vulvar cancer.

• Lichen Sclerosus:

• A skin condition causing itchiness in the vulva, with a 4% chance of developing into cancer.

Prevention

Reducing HPV infection risk can help lower the chances of developing vulvar cancer:

• Delay sexual activity until the late teenage years or later.

• Avoid having multiple sexual partners.

• Use condoms for safer sex practices.

• Visit a gynecologist regularly for screenings.

Symptoms of Vulvar Cancer

• Growth or lump on the vulva or in the groin area.

• Changes in the vulvar skin compared to surrounding areas.

• Persistent itching, pain, or burning in the vulva.

• Painful urination.

• Unusual vaginal bleeding outside of menstrual periods.

• Wounds or sores on the vulva that do not heal within a month.

Diagnosis

1. Pelvic Examination:

• A thorough examination of the pelvic region to detect abnormalities.

2. Biopsy:

• A small sample of tissue from the affected area is examined under a microscope to confirm the presence of cancer.

3. Colposcopy:

• A colposcope magnifies the cervix, vulva, and vagina to detect changes. This test is often recommended if an abnormal Pap test or HPV test result is found.

4. Imaging Tests:

• X-ray, CT scan, MRI, and PET-CT scans help assess the spread of cancer.

Treatment

1. Treatment of VIN (Vulvar Intraepithelial Neoplasm)

• VIN is a precancerous stage where surgery is often performed to remove abnormal tissue.

2. Surgery

• Surgery is the primary treatment for vulvar cancer, removing both the tumor and some healthy tissue around it. Common surgeries include:

• Radical Local Excision: Removes tumors smaller than 4 cm (Stage I or II).

• Modified Radical Vulvectomy: Removes only the affected part of the vulva.

• Radical Vulvectomy: Removes the entire vulva.

• Laser Surgery: Uses a focused light beam to remove precancerous cells (not used for invasive cancer).

• Lymphadenectomy: Removes lymph nodes in the groin to check for cancer spread.

3. Radiation Therapy

• Uses high-energy radiation to destroy cancer cells.

• External Beam Radiation Therapy (EBRT) delivers radiation from outside the body.

• Brachytherapy involves placing a radioactive source inside the body near the tumor.

• Chemoradiation: A combination of chemotherapy and radiation is used to shrink large tumors before surgery.

• Side Effects: Fatigue, skin changes, urinary issues, diarrhea, and vaginal narrowing may occur.

4. Chemotherapy

• Uses drugs to kill cancer cells.

• Cisplatin is commonly used during chemoradiation.

• For metastatic vulvar cancer, carboplatin and paclitaxel are often prescribed.

• Patients concerned about fertility may be referred to a reproductive endocrinologist before treatment.

Follow-Up Care

After treatment, regular follow-ups are necessary to monitor for recurrence and manage side effects. Follow-up care includes:

• Physical examinations.

• Blood tests.

• Imaging tests like CT or MRI.

Vulvar cancer, though rare, can be successfully treated if detected early. Regular gynecological check-ups, preventive measures against HPV, and prompt attention to unusual symptoms can significantly improve outcomes.

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