Vulvar Cancer – What it is, Symptoms and Treatments

Causes of Vulvar Cancer:  It is unclear what causes Vulvar Cancer . In general, doctors know that cancer starts when a cell develops mutations in its DNA. Mutations allow the cell to grow and divide rapidly. The cell and its offspring continue to live when other normal cells would die. The accumulator cells form a tumor that can be cancerous, invading nearby tissue and spreading to other parts of the body.

Vulvar Cancer Types:  The type of cell in which vulvar cancer starts helps your doctor plan the most effective treatment. The most common types of Vulvar Cancer include:

• Vulvar squamous cell carcinoma. This cancer starts in the thin, flat cells that line the surface of the vulva. Most vulvar cancers are squamous cell carcinomas.
• Vulvar Melanoma. This cancer starts in the pigment-producing cells found in the skin of the vulva.

Symptoms of Vulvar Cancer:  Signs and symptoms of Vulvar Cancer can include:

• Itching that doesn’t go away
• pain and tenderness
• Bleeding that is not from menstruation
• Skin changes, such as color changes or thickening
• A lump, wart bumps, or an open sore (ulcer)

When to See a Doctor:  Make an appointment with your primary care physician or gynecologist if you have any vulvar signs or symptoms that worry you, such as:

• abnormal bleeding
• Burning
• Itch
• Pain

Vulvar Cancer Risk Factors:  While the exact cause of Vulvar Cancer is not known, certain factors appear to increase your risk of the disease, including:

• Age increase. The risk of Vulvar Cancer  increases with age, although it can occur at any age. The median age at diagnosis is 65 years.
• Being exposed to human papillomavirus (HPV). HPV is a sexually transmitted infection that increases the risk of several types of cancer, including cancer of the vulva and cervical cancer. Many young, sexually active women are exposed to HPV, but for most, the infection clears up on its own. For some, the infection causes cellular changes and increases their risk of future cancer.
• Smoke. Smoking cigarettes increases the risk of Vulvar Cancer .
  Being infected with the human immunodeficiency virus (HIV). This sexually transmitted virus weakens your immune system, which can make you more susceptible to HPV infections, thus increasing your risk of Vulvar Cancer .
• Having a history of precancerous conditions of the vulva. Vulvar intraepithelial neoplasia is a precancerous condition that increases the risk of Vulvar Cancer . Most women with vulvar intraepithelial neoplasia will never develop cancer, but a small number will develop invasive Vulvar Cancer . For this reason, your doctor may recommend treatment to remove the area of ​​abnormal cells and periodic follow-up checks.
• Having a skin condition involving the vulva. Lichen sclerosus, which causes the vulvar skin to become thin and itchy, increases the risk of  Vulvar Cancer.

Vulvar Cancer Tests and Diagnosis  :  Diagnosing Vulvar Cancer : Tests and procedures used to diagnose Vulvar Cancer include:

• Examining your vulva. Your doctor will likely perform a physical exam of your vulva to look for abnormalities.
• Using a special magnifying device to examine your vulva. During a colposcopy exam, your doctor uses a device that works like a magnifying glass to closely inspect your vulva for abnormal areas.
• Removing a tissue sample for testing (biopsy). To determine whether a suspected area of ​​skin on your vulva is cancer, your doctor may recommend removing a skin sample for testing. During a biopsy procedure, the area is stuffed with a local anesthetic and a scalpel or other special cutting tool is used to remove all or part of the suspicious area. Depending on the amount of skin removed, you may need stitches.

Determining the Extent of Vulvar Cancer:  Once your diagnosis is confirmed, your doctor works to determine the size and extent (stage) of your cancer. Test tests can include:

• Examination of your pelvic area for cancer spread. Your doctor may do a more thorough examination of your pelvis for signs that the cancer has spread.
• Image tests. Images of your chest or abdomen can show whether the cancer has spread to these areas. Imaging tests may include X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET).

Vulvar Cancer Stages:  Your Vulvar Cancer  is designated with a Roman numeral that denotes your stage. The stages of Vulvar Cancer include:

• Stage I describes a small tumor that is confined to the vulva or the area of ​​skin between the vaginal opening and the anus (perineum). This cancer has not spread to your lymph nodes or other areas of your body.
• Stage II tumors are those that have grown to include nearby structures, such as the lower portions of the urethra, vagina , and anus.
• Stage III cancer has spread to the lymph nodes.
• Stage IVA means a cancer that has spread more extensively to the lymph nodes or has spread to the upper parts of the urethra or vagina , or has spread to the bladder, rectum or pelvic bone.
• Stage IVB is a cancer that has spread (metastasized) to distant parts of your body

Vulvar Cancer Treatments:  Treatment options for Vulvar Cancer depend on the type and stage of your cancer, your overall health, and your preferences.

Surgery To Remove Vulvar Cancer:  Operations used to treat Vulvar Cancer include:

• Removing the cancer and a margin of healthy tissue (excision). This procedure, which can also be called a large local excision or radical excision, involves cutting out the cancer and a small amount of the normal tissue that surrounds it. Cutting what doctors refer to as a margin of normal-looking tissue helps ensure that all the cancer cells have been removed.
• Removing a portion of the vulva (partial vulvectomy). During a partial vulvectomy, a portion of the vulva is removed, along with its underlying tissues.
• Removing the entire vulva (radical vulvectomy). Radical vulvectomy involves removing the entire vulva, including the clitoris and underlying tissues.
• Extensive surgery for advanced cancer. If the cancer has spread beyond the vulva and involves nearby organs, your doctor may recommend removing the entire vulva and the organs involved in a procedure called pelvic exenteration.

Depending on where your cancer has spread, your surgeon may remove the colon, rectum, bladder, cervix, uterus, vagina , ovaries, and nearby lymph nodes. If your bladder, rectum or colon is removed, your doctor will create an artificial opening in your body (stoma) for your waste to be removed into a bag (ostomy).

• Reconstructive surgery. Vulvar cancer treatment usually involves removing some skin from your vulva. The wound or area left behind can usually be closed without grafting skin from another area of ​​your body. However, depending on how the cancer has spread and how much tissue your doctor needs to remove, your doctor may perform reconstructive surgery – grafting skin from another part of your body to cover that area. Surgery to remove the entire vulva carries a risk of complications, such as infection and healing problems around the incision. Also, with some or all of the vulvar filling gone, it can be uncomfortable to sit for long periods. Your genital area may feel numb and it may not be possible to reach orgasm during intercourse.

Surgery To Remove Nearby Lymph Nodes:  Vulvar cancer usually spreads to the lymph nodes in the groin, so your doctor can remove these lymph nodes at the time you undergo surgery to remove the cancer. Depending on your situation, your doctor may remove just a few lymph nodes or many lymph nodes. Removing lymph nodes can cause fluid retention and swelling in the legs, a condition called lymphedema.

In certain situations, surgeons may use a technique that allows them to remove fewer lymph nodes. Called a sentinel lymph node biopsy, this procedure involves identifying the lymph node where the cancer is most likely to spread first. The surgeon then removes that lymph node for testing. If cancer cells are not found in that lymph node, the cancer cells are unlikely to spread to other lymph nodes.

Radiation Therapy: Radiation  therapy uses high-powered energy beams, like X-rays, to kill cancer cells. Radiation therapy for Vulvar Cancer is usually given by a machine that moves around your body and directs the radiation to precise points on your skin (external beam radiation).

Radiation therapy is sometimes used to shrink large vulvar cancers to make surgery more likely to be successful. Radiation is sometimes combined with chemotherapy, which can make cancer cells more vulnerable to radiation therapy. If cancer cells are discovered in your lymph nodes, your doctor may recommend radiation to the area around your lymph nodes to kill any cancer cells that may remain after surgery.

Chemotherapy:  Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are usually given through a vein in the arm or by mouth. For women with advanced Vulvar Cancer that has spread to other areas of the body, chemotherapy may be an option. Sometimes chemotherapy is combined with radiation therapy to shrink large vulvar cancers to make surgery more likely to be successful.

Follow-up Tests After Treatment:  After you complete treatment for Vulvar Cancer , your doctor may recommend periodic follow-up tests to look for cancer recurrence . Even after successful treatment, Vulvar Cancer can return. Your doctor will determine the follow-up exam schedule that is right for you, but doctors generally recommend exams two to four times a year for the first two years after your Vulvar Cancer treatment .