Vulva Cancer: What is it, Types, Symptoms, Diagnosis and Treatment

Vulvar cancer is the name given to malignant tumors that can occur on the outer surface of the female genital organ. The vulva is the skin area that includes the clitoris and vaginal lips called labia and surrounds the urethra (urinary canal) and vagina. Vulvar cancer often presents as a mass or sore on the vulva that causes itching. Although it can occur at any age, it is a type of cancer that is most commonly diagnosed in older adults. Treatment for vulvar cancer usually involves surgery to remove the cancerous tissue and a small amount of surrounding healthy tissue. Sometimes this surgery may require removal of the entire vulva. The earlier it is diagnosed, the less likely it is that extensive surgery will be needed. Therefore, early diagnosis and treatment is important.

What is Vulva Cancer?

Vulvar cancer is a rare type of cancer that can occur in the tissues of a woman’s vulva area. It most commonly develops on the inner or outer vaginal lips, but can occur in any part of the vulva. This type of cancer, which generally develops slowly, appears after a period of several years. Precancerous lesions, characterized by abnormal cell growth in the outermost layer of the skin, often develop before cancer. These precursor lesions are called vulvar intraepithelial neoplasia (VIN).

What Causes Vulva Cancer?

In general, cancers occur when mutations develop in a cell’s DNA. Cell DNA contains instructions for what cells should do. As a result of cancer-causing mutations, cells are given instructions to grow and divide rapidly. While other normal cells die, the cancerous cell and its offspring continue to live. As a result, the cells that accumulate because they do not die form a tumoral tissue that invades the surrounding tissues and can spread to other parts of the body. Although the exact cause of vulvar cancer is not yet clear, some factors that increase the risk of developing it have been identified. Related risk factors may include:

• Age: The risk of vulvar cancer increases with age. However, it is possible to be seen in women of all ages. The average age of diagnosis for the disease is 65 years old.
• HPV: HPV, or human papillomavirus, is a microorganism that is sexually transmitted from person to person. HPV infection is a virus that causes an increase in the risk of various cancers such as cervix and vulva. Although most sexually active women or men are exposed to HPV, the infection often clears up on its own. In some cases, it causes cell changes and increases the risk of cancer.
• Smoking: Smoking has been associated with an increased risk of vulvar cancer.
• Weak immune system: The risk increases in people who use immune-suppressing drugs due to organ transplant or have a condition that weakens the immune system, such as HIV.
• History of precancerous lesions in the vulva: VIN or vulvar intraepithelial neoplasia is a precancerous condition that increases the risk of cancer in the vulva. However, the majority of vulvar intraepithelial neoplasia cases do not turn into cancer. A small number of them carry the risk of turning into invasive vulvar cancer. Therefore, your doctor may recommend treatment or regular follow-up for the area where the abnormal cells are found.
• Presence of a triggering skin condition in the vulva: A condition called lichen sclerosus, which causes thinning and itching on the vulva skin, increases the risk of vulvar cancer.

What are the Symptoms of Vulva Cancer?

Although vulvar cancer symptoms vary from woman to woman, there are some common symptoms. Some of the common symptoms can be listed as follows:

• Persistent itching, burning and bleeding in the vulva
• Change in the color of the vulvar skin, for example appearing redder or whiter-paler than usual
• Changes to the skin of the vulva, such as redness, wart-like appearance
• Non-healing sores, masses, or ulcers on the vulva
• Pain in the groin, especially during urination or during sex
• tenderness in the vulva

Types of Vulva Cancer

Determining the cell type from which vulvar cancer originates helps plan the most effective treatment. Vulvar cancers are classified according to the cell of origin. The most common types of vulvar cancer are:

1. Vulvar Squamous Cell Carcinoma: This subtype begins in the cells lining the surface of the vulva. The majority of vulvar cancers consist of squamous cell carcinomas.
2. Vulvar Melanoma: This type of cancer begins in cells called melanocytes, which are found in the skin of the vulva and produce pigment.

Vulva Cancer Diagnosis Methods

To diagnose vulvar cancer, your doctor will first ask questions about your health, such as your current and past diseases, medical and family history, medications you take, and current diseases. Then, your general health condition is evaluated with a detailed physical examination. Other examination methods that can be performed in case of suspicion of vulvar cancer may include:

1. Vulvar and pelvic examination: At this stage, your doctor examines the vulva in detail. It looks for the presence of any unusual lesions such as masses, discoloration, or wounds. If necessary, a biopsy may be taken for examination in the laboratory. Your doctor then performs a pelvic exam by placing one or two fingers on the vagina and the other hand on the lower abdomen. Parameters such as the shape and size of the uterus and ovaries are evaluated through pelvic examination; The presence of any unusual condition such as a mass or lump is investigated. Additionally, the vagina and cervix are examined with the help of a speculum, and at this stage, a sample is often taken from the service for pap smear. The cell sample taken can then be checked for HPV during a pap smear in the laboratory. In addition to all these examinations, rectal examination is also frequently performed.
2. Colposcopic examination: Colposcopic is an illuminated, magnifying medical device designed to examine the vulva, vagina and cervix in more detail. A colposcope can be used during vulvar and pelvic examination to examine the tissues in the area in more detail. In order to highlight abnormal cells that cannot be seen with the naked eye during examination with the help of a colposcope, a dilute acetic acid solution or a brown dye is applied to the examined tissues. Biopsies, or tissue samples, can be taken from areas with an abnormal appearance.

Vulva Cancer Treatment

The methods to be used in the treatment of vulvar cancer are determined according to the type, stage, location of the cancer, and the general health status and preferences of the patient. The methods used in the treatment are detailed below.

Surgical

The most common treatment option for vulvar cancer is surgery. The goal of surgery is to remove all cancerous tissue without losing sexual function. Types of surgery used in treatment include:

1. Laser surgery: Laser beam is used to remove cancerous surface lesions.
2. Local excision: This surgery is a surgical procedure that removes the cancer and some healthy tissue around it. Sometimes neighboring lymph nodes are also removed.
3. Vulvectomy: This surgical procedure is the removal of part or all of the vulva and adjacent lymph nodes. Skin grafts can be used to replace the removed skin.
4. Pelvic exenteration: This surgery is an extensive surgical procedure that may be necessary in the presence of advanced cancer. It is performed by removing the lower part of the large intestine, rectum, bladder, cervix, vagina, ovaries and adjacent lymph nodes. Artificial openings are created in the body to collect urine and feces in a collection bag.

Chemotherapy or radiotherapy treatment may be required after surgery to eliminate any remaining cancerous cells. Sometimes only radiotherapy or chemotherapy may be given before or without surgery.

Radiotherapy

Radiotherapy often aims to kill cancer cells using high-energy x-rays.

Chemotherapy

Chemotherapy is a cancer-killing drug that can be used orally, intravenously or by intramuscular injection.

If you notice symptoms suggestive of vulvar cancer, you should consult a healthcare provider without delay for early diagnosis and treatment.