What Is Vulvar Cancer? What Causes
Vulvar Cancer?
Editor's Choice
Main Category: Women's Health /
Gynecology
Also Included In: Cancer / Oncology
Article Date: 05 Dec 2009
- 6:00 PST
Vulvar cancer, or vulval cancer is an uncommon cancer
of the outer surface area of the female genitalia. The
symptoms of
vulvar cancer include pain, itching and bleeding of the vulva.
The vulva
is made up of the outer part of the vagina, the clitoris, and two pairs of lips
surrounding the
entrance to the vagina, called the labia majora
(the outer pair) and the labia minora (the inner pair).
Primary vulvar
cancer begins inside the vulva, and secondary vulvar cancer begins in another
part of the
body (usually the reproductive system), such as the
cervix or ovaries, and then spreads to the vulva.
Types of primary
vulvar cancer
There are five main types of vulvar cancer. They are
classified according to the type of cells that the cancer
begins
in:
Squamous cell carcinoma is the most common type of vulvar cancer,
accounting for nine out of ten cases. It
develops from the squamous
cells, the cells in the outer layer of skin. Squamous cell carcinoma usually
grows slowly, over a few years.
Vulvar melanoma is the
second most common type, but is still rare. It develops from the
pigment-producing
cells of the skin.
Adenocarcinoma is very
rare, developing from the cells that line the glands in the
vulva.
Verrucous carcinoma is a very rare and slow-growing type of
vulvar cancer. It looks like a wart.
Sarcoma is extremely rare,
developing in tissue such as muscle or fat under the skin.
Cancer may occur
in any part of the vulva but the most common sites are the edges of the inner
and outer
lips.
Less often, vulvar cancer may affect the
clitoris or the two small glands on either side of the vagina
(Bartholin's glands).
Most cases of vulvar cancer are in women
aged over 60. Early-stage vulvar cancer can occasionally occur
in
young women in their 20s.
The outlook for vulvar cancer is generally
good if the cancer has not spread beyond the vulva. However, the
outlook for the melanoma type of vulvar cancer is poor because it is
very aggressive and spreads quickly.
The main treatment for vulvar
cancer is surgery to remove the cancerous tissue. Radiotherapy and
chemotherapy may also be given.
Getting regular gynecologic
exams may increase the chance of early detection of vulvar cancer. This results
in a better chance of successful treatment.
What are the signs
and symptoms of vulvar cancer?
A symptom is something the patient feels and
reports, while a sign is something other people, such as the
doctor
detect. For example, pain may be a symptom while a rash may be a
sign.
Recognizing possible signs and symptoms of vulvar cancer may help
detect the disease early. This may give
a better chance for
successful treatment and long-term recovery. Some of the signs and symptoms
are:
A lump, wart-like bumps
Bleeding that is not from
menstruation
Burning and pain
Open sore (ulcer)
Persistent
itching
Skin changes (such as color changes or
thickening)
Tenderness
Burning pain when passing urine
Some of the
above symptoms can also be symptoms of less serious conditions such as thrush.
However, it is
recommended to seek medical advice.
Vulvar
cancer usually does not develop quickly. There is at first a change in cells,
as normal cells become
abnormal. This is known as the pre-cancerous
stage, and does not mean that cancer will necessarily
develop. If
abnormal cells are found early on, pre-cancerous changes can be treated before
they become
invasive cancer of the vulva.
What causes vulvar
cancer?
Cancer begins with a change in the structure of DNA, which is found
in all human cells. DNA provides cells
with a basic set of
instructions, such as when to grow and when to reproduce. A genetic mutation
changes
these instructions so that the cells carry on growing and
reproducing uncontrollably. This produces a lump of
tissue known as
a tumor.
Left untreated, cancer can quickly grow and spread to other
parts of the body, usually through the lymphatic
system. Once the
cancer reaches the lymphatic system, it can spread to any other part of the
body, including
the bones, blood and organs.
The exact cause
of vulvar cancer is unclear.
However, evidence suggests that a number of
risk factors can increase the likelihood of developing vulvar
cancer:
Human papilloma virus (HPV): It is a family of viruses that
affect the skin and the moist membranes that line
the body, such as
those in the cervix, anus, mouth and throat. There are many different types of
HPV, some
of which are more high risk than others.
HPV is
known to cause changes in the cells of the cervix, which can lead to cervical
cancer. It is thought that
the virus could have a similar effect on
the cells of the vulva. HPV is spread during sexual intercourse,
including anal and oral sex. Using unsafe sex practices that increase
the risk of HPV infections augment the
risk of vulvar
cancer.
Vulvar intraepithelial neoplasia (VIN): This condition can occur
in the skin of the vulva, and is linked to
infection by HPV. VIN is
a form of pre-cancerous changes in the skin of the vulva. Occasionally, the
cells
change from normal to abnormal, with the potential to become
cancerous.
The most common symptom of VIN is a persistent itch, along
with thickened, swollen or discolored patches
of affected skin.
This condition requires treatment or close medical monitoring.
Vulvar
skin conditions: Women who have long-term, non-cancerous skin conditions, such
as vulvar lichen
sclerosus and vulvar lichen planus, have an
increased risk of developing cancer of the vulva. However, this
risk is small. The most common symptoms of vulval lichen sclerosis and
lichen planus are itchy and sore,
discolored skin around the area,
which may split, causing stinging and pain. Specially prescribed ointment
can control symptoms.
Smoking: It increases the risk of
developing VIN and vulvar cancer, possibly because smoking damages the
immune system. Smoking exposes the body to cancer-causing chemicals
that may increase the risk of vulvar
cancer. Women with a history
of genital warts or HPV have an even further increased risk of vulvar cancer if
they smoke.
Age. About 50 percent of women with vulvar
cancers are older than 70 when they are diagnosed. This
cancer is
not limited to older women, however.
Human immunodeficiency virus (HIV):
This virus weakens the immune system, which may increase
susceptibility to HPV infections, thereby increasing the risk of vulvar
cancer.
History of melanoma or suspicious moles: A family or personal
history of this serious type of skin cancer
anywhere on the body,
or a family history of unusual moles increases the risk of vulvar
melanoma.
How is vulvar cancer diagnosed?
There will be a review of the
symptoms and medical history, physical examination to see if there are any
lumps or unusual areas of skin. In nine out of every ten women
diagnosed with vulvar cancer, their doctor
will be able to see a
lump or sore area.
If no obvious cause of the symptoms can be found,
there will be a referral to a gynecologist for further
testing.
Colposcopy and biopsy
Gynecologists use an
instrument called a colposcope to look for any abnormalities in the vulva,
cervix and
vagina. During the examination (colposcopy), a tissue
sample will also be taken (biopsy) from the place
where the cancer
might be.
Anesthetic cream is applied to the vulva and an injection of
local anesthetic is given. The tissue sample can
then be checked in
a laboratory.
There are two types of biopsies:
Excisional biopsy. If
the abnormal area is small a scalpel may be used to make an incision through
the skin
and remove the entire tumor. Some stitches may be used to
sew up the area depending on how much tissue
is
removed.
Punch biopsy. If the irregular area is larger, a portion of it
may be removed with a small incision or punch
biopsy technique.
This technique uses a small device to remove a cylindrical piece of skin about
one-sixth of
an inch (4 millimeters) across. Stitches are not
required after punch biopsy.
If the results of the biopsy suggest there is
cancer, and there is a risk that the cancer may have spread,
further testing may be required.
These tests may
include:
Cystoscopy: This is an examination of the inside of the bladder. It
is done to see if the cancer has spread to
the bladder. A thin,
hollow viewing tube is inserted into the bladder to look for tumors and take a
tissue
sample.
Proctoscopy: This is an examination of the
inside of the rectum. The doctor either uses a gloved finger on an
instrument called a proctoscope to check for abnormalities such as
growths on the rectal wall.
CT scan: This is a computerized X-ray that
can take detailed pictures of the inside of the body. It is useful
for showing up cancer tumors, and checking whether cancer cells have
spread.
MRI scan: This is a scan that uses radio waves and magnets to
produce detailed pictures of the inside of the
body. It is used to
verify whether cancer has spread.
X-ray: It may be recommended to make
sure that cancer has not spread to the lungs .
Pelvic examination under
anesthesia. With general anesthesia, the doctor can perform a more thorough
examination of the pelvis for potential spread of the cancer.
There
is currently no screening program in place because vulvar cancer is so rare.
However, an examination
of the vulva is carried out during routine
cervical smear tests. Pre-cancerous conditions can be identified
during this examination, and treated early on to prevent vulvar cancer
from developing.
Staging of vulvar cancer
Doctors may refer to the tumor
using the initials T, N and M. T stands for tumor extent. N is for lymph node
spread, and M is for the distant spread of the cancers. Each of
these letters has subcategories that further
help doctors define the
stage of vulvar cancer.
Stage 0 is an early cancer that has not spread past
the skin's surface.
Stage I signifies a deeper tumor, but one that is
less than about three-quarters of an inch (2 centimeters).
This
cancer has not spread to the lymph nodes or other areas.
Stage IItumors
are those that still have not spread, but are larger than about three-quarters
of an inch (2
centimeters).
Stage III cancer has spread to
lymph nodes, nearby tissue or both.
Stage IVA signifies a cancer that
has spread to the lymph nodes on both sides of the pelvis or to the urethra,
bladder, rectum or pelvic bone.
Stage IVB is a cancer that
has spread (metastasized) to distant sites in the body (such as your lungs or
brain)
What are the treatment options for vulvar cancer?
Treatment
options for vulvar cancer depend on the type and stage of cancer and the
general health of the
patient. Early-stage vulvar cancer can usually
be cured with surgery. But if vulvar cancer is at an advanced
stage
and has spread to other organs, a cure may not be possible. In this situation,
radiotherapy and
chemotherapy can relieve the symptoms and slow down
the spread of cancer.
Surgery
Surgery is the main treatment for
cancer of the vulva. The more advanced a vulvar cancer is, the more tissue
that may need to be surgically removed. Options include:
Laser
surgery. If the cancer is in the early noninvasive stages, laser surgery is an
option. A laser beam is
aimed at the layer of the vulva that
contains cancer, killing the cancer cells.
Excision. This procedure is
also called a wide local excision or radical excision. It involves cutting out
the
cancer and about a half-inch (1.3 centimeters) of the normal
tissue all the way around it. A margin of
normal-looking tissue is
cut out to help ensure that all of the cancerous cells have been
removed.
Vulvectomy. Several types of vulvectomy
exist:
Skinning vulvectomy removes only the top layer of skin where
the cancer is located. Skin can be grafted
from another part of the
body to cover this area.
Simple vulvectomy involves removing the entire
vulva.
These types of vulvectomies are performed in people with noninvasive
vulvar cancer.
Radical vulvectomy is when either the cancer and the deep
surrounding tissue (partial vulvectomy) or the
cancer and the
entire vulva, clitoris and nearby tissue (complete radical vulvectomy) are
removed.
Removing large areas of skin and tissue in the vulva may create
problems with healing, infection and the
ability of the skin grafts
to take. The risk of such complications rises with greater tissue
removal.
In addition, women who have undergone vulvectomy may have
difficulties achieving orgasm. In some cases,
this problem may be
temporary. Devices called vaginal dilators may help stretch the
opening.
Pelvic exenteration. If the cancer spread is extensive,
several organs may be removed: the lower colon,
rectum, bladder,
cervix, uterus, vagina, ovaries and nearby lymph nodes. If the bladder, rectum
or colon is
removed, an artificial opening in the body (stoma) will
be created to allow waste to be removed in a bag
(ostomy).
Lymph node removal. Vulvar cancer often spreads to the
lymph nodes in the groin. These lymph nodes may
be removed. This
might require tying off a major vein, the saphenous vein. Some doctors will try
to avoid
closing this vein to prevent additional risk of leg
swelling that can occur with this procedure. After the
procedure, a
suction drain is placed in the incision for several days.
Removing lymph
nodes can cause problems with fluid retention, leg swelling and an increased
risk of
infection of the lymph vessels (lymphangitis), a condition
called lymphedema. If this complication develops,
compression
devices or support stockings may be given to help ease the
symptoms.
Sentinel lymph node biopsy. This procedure may help avoid some
of the side effects of lymph node removal.
A sentinel node is one
that is closest to the area of the tumor that drains fluid from the cancerous
area. In this
procedure, a blue dye or a radioactive tracer is
injected into the tumor area on the day before surgery. The
area is
then scanned to see where the tumor drains, and this is the side where the
surgeon will focus during
the next day's surgery.
On the day
of surgery, blue dye or radioactive tracer is once again injected, making the
sentinel node easy to
find and remove. If no cancer cells are found
in the sentinel node, no additional surgery is needed. However,
if
cancerous cells are found additional lymph nodes on that side of the groin need
to be removed. If initial
testing reveals an already enlarged lymph
node, sentinel node biopsy is not usually performed. The surgeon
removes and biopsies the swollen node. Sentinel node biopsy is still
considered experimental and is not yet
widely
available.
Radiation therapy
Radiation given from outside the body
(external beam radiation) is usually used only to treat the lymph nodes
in the groin and pelvis, not the vulva itself. Sometimes it is used in
order to shrink a large tumor so that it can
be removed with less
extensive surgery. Treated skin may look and feel sunburned for six to twelve
months.
Chemotherapy
Chemotherapy uses drugs to destroy cancer
cells. It can be given through a vein, orally or through the skin
(topically). Like radiation, chemotherapy may be used to shrink a large
tumor before surgery.
Chemotherapy is usually used in combination
with radiotherapy or to control symptoms when a cure is not
possible (called palliative chemotherapy).
The side effects of
chemotherapy may include hair loss, nausea, vomiting and fatigue. Not everyone
has side
effects, however, and there are now better ways to control
some of them. The side effects should stop once
treatment has
finished.
Reconstructive surgery
Treatment of vulvar cancer often
involves removal of some skin from the vulva. The wound or area left
behind
can usually be closed without grafting skin from another area of the body.
However, depending on
how widespread the cancer is and how much
tissue is removed, reconstructive surgery can be performed.
Vulvar
intraepithelial neoplasia
Generally, the tissue containing these
precancerous changes is surgically removed before these cells have a
chance
to turn into cancer. However, some research has found that imiquimod (Aldara),
an immune system
modulating medication, may reduce the size of
these lesions, possibly offering an additional treatment
option.
Follow-up
One in ten women experiences recurrence of
vulvar cancer. It is important to see a gynecologist at least
twice
a year after the treatment is finished.
Clinical trials
As vulvar
cancer is rare, patients may be asked to take part in a clinical trial.
Clinical trials are an important
way for health professionals to
learn more about the best way to treat specific conditions. Most clinical
trials
involve comparing a new treatment with an existing treatment
to determine whether the new treatment is
more or less effective.
There is no guarantee of a cure.
Coping and support
Living with
cancer is challenging and dealing with the physical effects of vulvar cancer
and its treatment can
be especially difficult. It may be difficult
to come to terms psychologically with the physical changes that are
experienced. Although there are no easy answers for coping with vulvar
cancer, the following suggestions
may help:
Find ways to make
life easier. If there are problems with incontinence or need to change an
ostomy bag, for
example, sitting in the back of a movie theater,
concert hall or meeting room. Sit in an aisle seat on an
airplane or
train. Allow for breaks when planning long trips, seminars or
excursions.
If chronic fatigue is an issue, make rest a priority and
take assistance when it is offered. Exercise may help
feeling less
fatigued and boost spirits. Talk to your doctor about what kind of exercise
might be right for you.
Share your concerns with others. Consider
talking to someone you trust about your concerns. This might be
a
friend, a family member, your doctor, a social worker, a spiritual adviser or a
counselor. Talking to other
people with vulvar cancer might be
helpful. They can explain how they are coping with similar
problems.
Join a support group for people with vulvar or gynecologic
cancers. They can sometimes be a good
resource for practical
information about the disease. You may also find strength and encouragement in
being
with people who are facing challenges similar to yours. After
deciding to participate in a group, try it out a
few times. If it
does not seem useful or comfortable, do not feel forced to continue.
Do
not fear intimacy. A natural reaction to changes in your body may be to avoid
intimacy. Although it may
not be easy, it is essentially important
to discuss these feelings with your partner. For example, a light touch
and use of lubricant may help you avoid painful irritation. You may
also find it helpful to talk to a therapist,
either on your own or
together. Touching, holding, hugging and caressing may become far more
important to
you and your partner. In fact, the closeness you
develop may produce greater intimacy than you have ever
had.
Intimacy issues may be even more difficult to address for
women who are not currently in a committed
relationship. They may
worry that no one will ever find them attractive or desirable. In that case,
the advice
and understanding of a medical social worker or other
therapist who is knowledgeable about vulvar cancer
can be a
tremendous help.
How can vulvar cancer be prevented?
Avoiding
risks
Avoiding sexual behaviors that increase risk of sexually
transmitted diseases such as HPV and HIV, since
both conditions
increase risk of vulvar cancer. These behaviors include not having sex at a
young age, not
having multiple partners, and not having sex with
someone who has had multiple partners. Condoms may
lessen the risk
of HPV transmission, but they cannot fully protect against HPV. Before
beginning a sexual
relationship with a new partner, it is a good
idea for both partners to be tested for sexually transmitted
infections.
HPV vaccination
There is now a vaccine that
provides protection against the strains of HPV that are thought to be
responsible
for most cases of vulvar cancer. HPV vaccination also
protects against cervical cancer, which is far more
common than
vulvar cancer.
Girls should be offered the HPV vaccine as part of their
routine childhood immunization program. The
vaccine should be given
to girls who are 12 to 13 years old, with three doses given over six
months.
Having regular exams
Help prevent invasive vulvar cancer
by being aware of the signs and symptoms of vulvar cancer and having
regular
gynecologic exams to monitor for precancerous changes that may lead to vulvar
cancer. When vulvar
cancer is detected early, it is highly
treatable.
Quit smoking
By not smoking, the chances of getting
vulvar cancer decrease. Smokers are less able to get rid of the HPV
infection from the body, which can develop into cancer.
Written by
Stephanie Brunner B.A.
http://www.medicalnewstoday.com/articles/173108.php
Vulvar Cancer?
Editor's Choice
Main Category: Women's Health /
Gynecology
Also Included In: Cancer / Oncology
Article Date: 05 Dec 2009
- 6:00 PST
Vulvar cancer, or vulval cancer is an uncommon cancer
of the outer surface area of the female genitalia. The
symptoms of
vulvar cancer include pain, itching and bleeding of the vulva.
The vulva
is made up of the outer part of the vagina, the clitoris, and two pairs of lips
surrounding the
entrance to the vagina, called the labia majora
(the outer pair) and the labia minora (the inner pair).
Primary vulvar
cancer begins inside the vulva, and secondary vulvar cancer begins in another
part of the
body (usually the reproductive system), such as the
cervix or ovaries, and then spreads to the vulva.
Types of primary
vulvar cancer
There are five main types of vulvar cancer. They are
classified according to the type of cells that the cancer
begins
in:
Squamous cell carcinoma is the most common type of vulvar cancer,
accounting for nine out of ten cases. It
develops from the squamous
cells, the cells in the outer layer of skin. Squamous cell carcinoma usually
grows slowly, over a few years.
Vulvar melanoma is the
second most common type, but is still rare. It develops from the
pigment-producing
cells of the skin.
Adenocarcinoma is very
rare, developing from the cells that line the glands in the
vulva.
Verrucous carcinoma is a very rare and slow-growing type of
vulvar cancer. It looks like a wart.
Sarcoma is extremely rare,
developing in tissue such as muscle or fat under the skin.
Cancer may occur
in any part of the vulva but the most common sites are the edges of the inner
and outer
lips.
Less often, vulvar cancer may affect the
clitoris or the two small glands on either side of the vagina
(Bartholin's glands).
Most cases of vulvar cancer are in women
aged over 60. Early-stage vulvar cancer can occasionally occur
in
young women in their 20s.
The outlook for vulvar cancer is generally
good if the cancer has not spread beyond the vulva. However, the
outlook for the melanoma type of vulvar cancer is poor because it is
very aggressive and spreads quickly.
The main treatment for vulvar
cancer is surgery to remove the cancerous tissue. Radiotherapy and
chemotherapy may also be given.
Getting regular gynecologic
exams may increase the chance of early detection of vulvar cancer. This results
in a better chance of successful treatment.
What are the signs
and symptoms of vulvar cancer?
A symptom is something the patient feels and
reports, while a sign is something other people, such as the
doctor
detect. For example, pain may be a symptom while a rash may be a
sign.
Recognizing possible signs and symptoms of vulvar cancer may help
detect the disease early. This may give
a better chance for
successful treatment and long-term recovery. Some of the signs and symptoms
are:
A lump, wart-like bumps
Bleeding that is not from
menstruation
Burning and pain
Open sore (ulcer)
Persistent
itching
Skin changes (such as color changes or
thickening)
Tenderness
Burning pain when passing urine
Some of the
above symptoms can also be symptoms of less serious conditions such as thrush.
However, it is
recommended to seek medical advice.
Vulvar
cancer usually does not develop quickly. There is at first a change in cells,
as normal cells become
abnormal. This is known as the pre-cancerous
stage, and does not mean that cancer will necessarily
develop. If
abnormal cells are found early on, pre-cancerous changes can be treated before
they become
invasive cancer of the vulva.
What causes vulvar
cancer?
Cancer begins with a change in the structure of DNA, which is found
in all human cells. DNA provides cells
with a basic set of
instructions, such as when to grow and when to reproduce. A genetic mutation
changes
these instructions so that the cells carry on growing and
reproducing uncontrollably. This produces a lump of
tissue known as
a tumor.
Left untreated, cancer can quickly grow and spread to other
parts of the body, usually through the lymphatic
system. Once the
cancer reaches the lymphatic system, it can spread to any other part of the
body, including
the bones, blood and organs.
The exact cause
of vulvar cancer is unclear.
However, evidence suggests that a number of
risk factors can increase the likelihood of developing vulvar
cancer:
Human papilloma virus (HPV): It is a family of viruses that
affect the skin and the moist membranes that line
the body, such as
those in the cervix, anus, mouth and throat. There are many different types of
HPV, some
of which are more high risk than others.
HPV is
known to cause changes in the cells of the cervix, which can lead to cervical
cancer. It is thought that
the virus could have a similar effect on
the cells of the vulva. HPV is spread during sexual intercourse,
including anal and oral sex. Using unsafe sex practices that increase
the risk of HPV infections augment the
risk of vulvar
cancer.
Vulvar intraepithelial neoplasia (VIN): This condition can occur
in the skin of the vulva, and is linked to
infection by HPV. VIN is
a form of pre-cancerous changes in the skin of the vulva. Occasionally, the
cells
change from normal to abnormal, with the potential to become
cancerous.
The most common symptom of VIN is a persistent itch, along
with thickened, swollen or discolored patches
of affected skin.
This condition requires treatment or close medical monitoring.
Vulvar
skin conditions: Women who have long-term, non-cancerous skin conditions, such
as vulvar lichen
sclerosus and vulvar lichen planus, have an
increased risk of developing cancer of the vulva. However, this
risk is small. The most common symptoms of vulval lichen sclerosis and
lichen planus are itchy and sore,
discolored skin around the area,
which may split, causing stinging and pain. Specially prescribed ointment
can control symptoms.
Smoking: It increases the risk of
developing VIN and vulvar cancer, possibly because smoking damages the
immune system. Smoking exposes the body to cancer-causing chemicals
that may increase the risk of vulvar
cancer. Women with a history
of genital warts or HPV have an even further increased risk of vulvar cancer if
they smoke.
Age. About 50 percent of women with vulvar
cancers are older than 70 when they are diagnosed. This
cancer is
not limited to older women, however.
Human immunodeficiency virus (HIV):
This virus weakens the immune system, which may increase
susceptibility to HPV infections, thereby increasing the risk of vulvar
cancer.
History of melanoma or suspicious moles: A family or personal
history of this serious type of skin cancer
anywhere on the body,
or a family history of unusual moles increases the risk of vulvar
melanoma.
How is vulvar cancer diagnosed?
There will be a review of the
symptoms and medical history, physical examination to see if there are any
lumps or unusual areas of skin. In nine out of every ten women
diagnosed with vulvar cancer, their doctor
will be able to see a
lump or sore area.
If no obvious cause of the symptoms can be found,
there will be a referral to a gynecologist for further
testing.
Colposcopy and biopsy
Gynecologists use an
instrument called a colposcope to look for any abnormalities in the vulva,
cervix and
vagina. During the examination (colposcopy), a tissue
sample will also be taken (biopsy) from the place
where the cancer
might be.
Anesthetic cream is applied to the vulva and an injection of
local anesthetic is given. The tissue sample can
then be checked in
a laboratory.
There are two types of biopsies:
Excisional biopsy. If
the abnormal area is small a scalpel may be used to make an incision through
the skin
and remove the entire tumor. Some stitches may be used to
sew up the area depending on how much tissue
is
removed.
Punch biopsy. If the irregular area is larger, a portion of it
may be removed with a small incision or punch
biopsy technique.
This technique uses a small device to remove a cylindrical piece of skin about
one-sixth of
an inch (4 millimeters) across. Stitches are not
required after punch biopsy.
If the results of the biopsy suggest there is
cancer, and there is a risk that the cancer may have spread,
further testing may be required.
These tests may
include:
Cystoscopy: This is an examination of the inside of the bladder. It
is done to see if the cancer has spread to
the bladder. A thin,
hollow viewing tube is inserted into the bladder to look for tumors and take a
tissue
sample.
Proctoscopy: This is an examination of the
inside of the rectum. The doctor either uses a gloved finger on an
instrument called a proctoscope to check for abnormalities such as
growths on the rectal wall.
CT scan: This is a computerized X-ray that
can take detailed pictures of the inside of the body. It is useful
for showing up cancer tumors, and checking whether cancer cells have
spread.
MRI scan: This is a scan that uses radio waves and magnets to
produce detailed pictures of the inside of the
body. It is used to
verify whether cancer has spread.
X-ray: It may be recommended to make
sure that cancer has not spread to the lungs .
Pelvic examination under
anesthesia. With general anesthesia, the doctor can perform a more thorough
examination of the pelvis for potential spread of the cancer.
There
is currently no screening program in place because vulvar cancer is so rare.
However, an examination
of the vulva is carried out during routine
cervical smear tests. Pre-cancerous conditions can be identified
during this examination, and treated early on to prevent vulvar cancer
from developing.
Staging of vulvar cancer
Doctors may refer to the tumor
using the initials T, N and M. T stands for tumor extent. N is for lymph node
spread, and M is for the distant spread of the cancers. Each of
these letters has subcategories that further
help doctors define the
stage of vulvar cancer.
Stage 0 is an early cancer that has not spread past
the skin's surface.
Stage I signifies a deeper tumor, but one that is
less than about three-quarters of an inch (2 centimeters).
This
cancer has not spread to the lymph nodes or other areas.
Stage IItumors
are those that still have not spread, but are larger than about three-quarters
of an inch (2
centimeters).
Stage III cancer has spread to
lymph nodes, nearby tissue or both.
Stage IVA signifies a cancer that
has spread to the lymph nodes on both sides of the pelvis or to the urethra,
bladder, rectum or pelvic bone.
Stage IVB is a cancer that
has spread (metastasized) to distant sites in the body (such as your lungs or
brain)
What are the treatment options for vulvar cancer?
Treatment
options for vulvar cancer depend on the type and stage of cancer and the
general health of the
patient. Early-stage vulvar cancer can usually
be cured with surgery. But if vulvar cancer is at an advanced
stage
and has spread to other organs, a cure may not be possible. In this situation,
radiotherapy and
chemotherapy can relieve the symptoms and slow down
the spread of cancer.
Surgery
Surgery is the main treatment for
cancer of the vulva. The more advanced a vulvar cancer is, the more tissue
that may need to be surgically removed. Options include:
Laser
surgery. If the cancer is in the early noninvasive stages, laser surgery is an
option. A laser beam is
aimed at the layer of the vulva that
contains cancer, killing the cancer cells.
Excision. This procedure is
also called a wide local excision or radical excision. It involves cutting out
the
cancer and about a half-inch (1.3 centimeters) of the normal
tissue all the way around it. A margin of
normal-looking tissue is
cut out to help ensure that all of the cancerous cells have been
removed.
Vulvectomy. Several types of vulvectomy
exist:
Skinning vulvectomy removes only the top layer of skin where
the cancer is located. Skin can be grafted
from another part of the
body to cover this area.
Simple vulvectomy involves removing the entire
vulva.
These types of vulvectomies are performed in people with noninvasive
vulvar cancer.
Radical vulvectomy is when either the cancer and the deep
surrounding tissue (partial vulvectomy) or the
cancer and the
entire vulva, clitoris and nearby tissue (complete radical vulvectomy) are
removed.
Removing large areas of skin and tissue in the vulva may create
problems with healing, infection and the
ability of the skin grafts
to take. The risk of such complications rises with greater tissue
removal.
In addition, women who have undergone vulvectomy may have
difficulties achieving orgasm. In some cases,
this problem may be
temporary. Devices called vaginal dilators may help stretch the
opening.
Pelvic exenteration. If the cancer spread is extensive,
several organs may be removed: the lower colon,
rectum, bladder,
cervix, uterus, vagina, ovaries and nearby lymph nodes. If the bladder, rectum
or colon is
removed, an artificial opening in the body (stoma) will
be created to allow waste to be removed in a bag
(ostomy).
Lymph node removal. Vulvar cancer often spreads to the
lymph nodes in the groin. These lymph nodes may
be removed. This
might require tying off a major vein, the saphenous vein. Some doctors will try
to avoid
closing this vein to prevent additional risk of leg
swelling that can occur with this procedure. After the
procedure, a
suction drain is placed in the incision for several days.
Removing lymph
nodes can cause problems with fluid retention, leg swelling and an increased
risk of
infection of the lymph vessels (lymphangitis), a condition
called lymphedema. If this complication develops,
compression
devices or support stockings may be given to help ease the
symptoms.
Sentinel lymph node biopsy. This procedure may help avoid some
of the side effects of lymph node removal.
A sentinel node is one
that is closest to the area of the tumor that drains fluid from the cancerous
area. In this
procedure, a blue dye or a radioactive tracer is
injected into the tumor area on the day before surgery. The
area is
then scanned to see where the tumor drains, and this is the side where the
surgeon will focus during
the next day's surgery.
On the day
of surgery, blue dye or radioactive tracer is once again injected, making the
sentinel node easy to
find and remove. If no cancer cells are found
in the sentinel node, no additional surgery is needed. However,
if
cancerous cells are found additional lymph nodes on that side of the groin need
to be removed. If initial
testing reveals an already enlarged lymph
node, sentinel node biopsy is not usually performed. The surgeon
removes and biopsies the swollen node. Sentinel node biopsy is still
considered experimental and is not yet
widely
available.
Radiation therapy
Radiation given from outside the body
(external beam radiation) is usually used only to treat the lymph nodes
in the groin and pelvis, not the vulva itself. Sometimes it is used in
order to shrink a large tumor so that it can
be removed with less
extensive surgery. Treated skin may look and feel sunburned for six to twelve
months.
Chemotherapy
Chemotherapy uses drugs to destroy cancer
cells. It can be given through a vein, orally or through the skin
(topically). Like radiation, chemotherapy may be used to shrink a large
tumor before surgery.
Chemotherapy is usually used in combination
with radiotherapy or to control symptoms when a cure is not
possible (called palliative chemotherapy).
The side effects of
chemotherapy may include hair loss, nausea, vomiting and fatigue. Not everyone
has side
effects, however, and there are now better ways to control
some of them. The side effects should stop once
treatment has
finished.
Reconstructive surgery
Treatment of vulvar cancer often
involves removal of some skin from the vulva. The wound or area left
behind
can usually be closed without grafting skin from another area of the body.
However, depending on
how widespread the cancer is and how much
tissue is removed, reconstructive surgery can be performed.
Vulvar
intraepithelial neoplasia
Generally, the tissue containing these
precancerous changes is surgically removed before these cells have a
chance
to turn into cancer. However, some research has found that imiquimod (Aldara),
an immune system
modulating medication, may reduce the size of
these lesions, possibly offering an additional treatment
option.
Follow-up
One in ten women experiences recurrence of
vulvar cancer. It is important to see a gynecologist at least
twice
a year after the treatment is finished.
Clinical trials
As vulvar
cancer is rare, patients may be asked to take part in a clinical trial.
Clinical trials are an important
way for health professionals to
learn more about the best way to treat specific conditions. Most clinical
trials
involve comparing a new treatment with an existing treatment
to determine whether the new treatment is
more or less effective.
There is no guarantee of a cure.
Coping and support
Living with
cancer is challenging and dealing with the physical effects of vulvar cancer
and its treatment can
be especially difficult. It may be difficult
to come to terms psychologically with the physical changes that are
experienced. Although there are no easy answers for coping with vulvar
cancer, the following suggestions
may help:
Find ways to make
life easier. If there are problems with incontinence or need to change an
ostomy bag, for
example, sitting in the back of a movie theater,
concert hall or meeting room. Sit in an aisle seat on an
airplane or
train. Allow for breaks when planning long trips, seminars or
excursions.
If chronic fatigue is an issue, make rest a priority and
take assistance when it is offered. Exercise may help
feeling less
fatigued and boost spirits. Talk to your doctor about what kind of exercise
might be right for you.
Share your concerns with others. Consider
talking to someone you trust about your concerns. This might be
a
friend, a family member, your doctor, a social worker, a spiritual adviser or a
counselor. Talking to other
people with vulvar cancer might be
helpful. They can explain how they are coping with similar
problems.
Join a support group for people with vulvar or gynecologic
cancers. They can sometimes be a good
resource for practical
information about the disease. You may also find strength and encouragement in
being
with people who are facing challenges similar to yours. After
deciding to participate in a group, try it out a
few times. If it
does not seem useful or comfortable, do not feel forced to continue.
Do
not fear intimacy. A natural reaction to changes in your body may be to avoid
intimacy. Although it may
not be easy, it is essentially important
to discuss these feelings with your partner. For example, a light touch
and use of lubricant may help you avoid painful irritation. You may
also find it helpful to talk to a therapist,
either on your own or
together. Touching, holding, hugging and caressing may become far more
important to
you and your partner. In fact, the closeness you
develop may produce greater intimacy than you have ever
had.
Intimacy issues may be even more difficult to address for
women who are not currently in a committed
relationship. They may
worry that no one will ever find them attractive or desirable. In that case,
the advice
and understanding of a medical social worker or other
therapist who is knowledgeable about vulvar cancer
can be a
tremendous help.
How can vulvar cancer be prevented?
Avoiding
risks
Avoiding sexual behaviors that increase risk of sexually
transmitted diseases such as HPV and HIV, since
both conditions
increase risk of vulvar cancer. These behaviors include not having sex at a
young age, not
having multiple partners, and not having sex with
someone who has had multiple partners. Condoms may
lessen the risk
of HPV transmission, but they cannot fully protect against HPV. Before
beginning a sexual
relationship with a new partner, it is a good
idea for both partners to be tested for sexually transmitted
infections.
HPV vaccination
There is now a vaccine that
provides protection against the strains of HPV that are thought to be
responsible
for most cases of vulvar cancer. HPV vaccination also
protects against cervical cancer, which is far more
common than
vulvar cancer.
Girls should be offered the HPV vaccine as part of their
routine childhood immunization program. The
vaccine should be given
to girls who are 12 to 13 years old, with three doses given over six
months.
Having regular exams
Help prevent invasive vulvar cancer
by being aware of the signs and symptoms of vulvar cancer and having
regular
gynecologic exams to monitor for precancerous changes that may lead to vulvar
cancer. When vulvar
cancer is detected early, it is highly
treatable.
Quit smoking
By not smoking, the chances of getting
vulvar cancer decrease. Smokers are less able to get rid of the HPV
infection from the body, which can develop into cancer.
Written by
Stephanie Brunner B.A.
http://www.medicalnewstoday.com/articles/173108.php