The vulva is the external female genitals, seen on the outside of the female reproductive tract. The vulva consists of the vaginal opening (also known as the vestibule), the labia majora (also known as the outer lips) & the labia minora (also known as the inner lips), and the clitoris, as well. The vagina connects the vulva on the outside of the body to the uterine cervix in the inside of the body.
What are vulvar cancers ?
Vulvar cancers are basically tumours of the VULVA. Cancer of the vulva (or vulvar cancer) most often starts in the inner lips of the labia majora or the labia minora. But, cancer may also occur on the clitoris or Bartholin glands, albeit less frequently.
How is a vulvar cancer caused ?
- High- risk human papilloma virus (HPV) Infection : As in many lower-tract gynaecological tumours, Human Papilloma Virus (HPV-16, 18 & 31) infection plays a role in the aetiology of cancer of the vulva. HPV can be spread from one person to another through either skin-to-skin contact or through unprotected sex. Being immunocompromised (such as having AIDS or HIV infection) also can predispose to HPV infection and thus, vulvar cancer.
- Smoking : Women smokers are more likely to get vulvar cancer as women non-smokers.
- Cervical cancer : Having either cervical cancer or cervical pre-cancer ups the risk of vulvar squamous cell cancer. It could be more so as vulvar and cervical cancers have comparable risk factors, like smoking & HIV infection.
- Lichen sclerosus : Lichen Sclerosus is a condition that results in vulvar skin becoming thin, itchy and atrophic. The risk of vulvar cancer appears to be slightly elevated in Lichen sclerosus.
What are the types of vulvar cancers ?
There are several types of cancer that can initiate in the vulva. However, the chief types of vulvar cancers include squamous cell carcinomas and adenocarcinomas.
- Squamous cell carcinoma: The changes in the squamous cells are first precancerous. Then the precancerous lesions may progress to become squamous cell carcinomas or invasive cancers, over a period of time.
The medical term coined for this pre-cancerous change is vulvar intraepithelial neoplasia (VIN). “Intraepithelial” implies that atypical squamous cells are merely found in the superficial surface layer of the vulva or in its epithelium. There are 3 described types of VIN, that is VIN1, VIN2, and VIN3, with 3 being maximum progression to a true cancer. - Adenocarcinoma: Most of the other vulvar cancers, apart from squamous cell carcinomas are adenocarcinomas. Adenocarcinomas are cancers that arise from glandular cells of the vulva. These are also invasive, as well.
- Melanoma: Other types of cancer are also known to develop in the vulva. These other types of cancers, such as melanoma are quite rare.
What are the clinical features of vulvar cancers ?
Symptoms of vulvar cancers include an area or vulvar patch that looks somewhat changed from normal. This could be a lighter or darker colour change, or it could be reddish/ pinkish. The area could also be in the form of a bump or a lump. The vulvar skin could be thickened. Itching, pain, burning, abnormal bleeding or discharge, or an open ulcer may also be noted.
How are vulvar cancers diagnosed ?
- A complete Physical Examination of the body is mandatory.
- The Pap Smear Test : The gynaecologist will examine your vulva and take smears from the surface for a microscopic cellular examination. A suspicious Pap smear shows the need for a biopsy, i.e. the surgical resection of part or whole of a tissue containing all the layers. This allows visualisation not only of individual cells, as in a smear, but of the whole tissue structure.
- Colposcopy : In case of abnormal or atypical results, of the Pap smear, colposcopy will be performed in the clinical examination. Colposcopy is a practice in which the patient lies down on the examination table and a speculum is put in the vagina to help good visualization of cervix. The doctor then utilizes a colposcope to thoroughly examine the cervix and the surrounding areas like the vagina and vulva. The colposcope is an instrument endowed with magnifying lenses that can be compared to binoculars. An acetic acid wash or toluidine blue stain can also be utilized to assess the cervix clearly.
- Biopsy : Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a vulvar cancer diagnosis.
- Imaging Tests : To determine the exact extent of disease, additional radiographic and imaging tests may need to be performed so doctors can view, assess and judge the cancer. These imaging tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans.
How are vulvar cancers staged ?
The stage is the exact spread of the disease in the human body. Staging is used to assess the risks and prognosis associated with the cancer extent to determine the appropriate treatment. The less advanced the stage, the better the prognosis.
How are vulvar cancers treated ?
The standard treatment is basically surgical. A surgical intervention has to be done on the vulva and the removal of lymph nodes, as well within the pelvis. Laser surgery utilizes a focused laser beam, that removes the top layer of vulvar skin containing abnormal or precancerous cells in vulvar pre-cancer. It cannot be used to treat invasive cancer. In a surgery called vulvectomy, complete excision of the whole cancer, all or part of the vulva and an adjacent margin of normal tissue are excised. It could be of two types, that is either simple partial vulvectomy or radical vulvectomy. For more advanced stages, radiotherapy and chemotherapy should be given together. In this external radiotherapy, radiation is produced by an external source and targeted to the tumour as well as lymph nodes & vessels. The chemotherapy has an arsenal drugs to kill the remnant cancer cells in the body.
What is the care to be taken after the treatment of vulvar cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans.
Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
Are vulvar cancers preventable ?
Either we can prevent the pre-cancer from occurring or we can prevent the progression of pre-cancer into full blown cancers.
Avoiding exposure to the Human Papilloma Virus (HPV) by practising safe sex and taking the HPV vaccine help in preventing vulvar cancer.
The best way to find vulvar cancer early on is to have routine & regular screening with a smear test called the PAP test (which can be combined with a test for human papilloma virus or HPV).
How to find and reach cancer specialists for vulvar cancer treatment ?
Now you can find and reach cancer specialists for vulvar cancer treatment from different cancer hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple cancer specialists, cost estimates for vulvar cancer treatment from different cancer hospitals, compare things and then choose a cancer specialist or a cancer hospital for vulvar cancer treatment.
Find, reach and choose a cancer specialist for vulvar cancer treatment on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
