Vulvar Cancer

Vulvar cancer is a rare cancer that affects the outside part of a woman’s genital area, called the vulva. It happens when abnormal cells grow too much in the vulva’s tissues. Even though it’s not common, knowing its signs and risks is key.

This guide covers everything about vulvar cancer. We’ll talk about what it is, its types, and how HPV plays a part. We’ll also look at precancerous conditions like VIN, how doctors diagnose it, and treatment choices. Knowing more about vulvar cancer helps women prevent and catch it early.

What Is Vulvar Cancer?

Vulvar cancer is a rare cancer that affects the outside of a woman’s genital area. This area includes the labia, clitoris, and the vagina opening. It’s important to know about its symptoms and risk factors, even though it’s not common.

Defining Vulvar Cancer

Vulvar cancer starts in the outer skin layers and can grow deeper if not treated. Most cases are squamous cell carcinomas, which affect the skin-like cells. Other types include adenocarcinoma and melanoma, which are less common.

Types of Vulvar Cancer

The main types of vulvar cancer are:

It’s key to watch for any changes in the vulvar area. Early detection and treatment can greatly improve outcomes. Regular check-ups and self-exams can help catch issues early.

Risk Factors for Developing Vulvar Cancer

Many factors can raise a woman’s chance of getting vulvar cancer. Knowing these risks is key for catching it early and preventing it. Having one or more risk factors doesn’t mean a woman will definitely get vulvar cancer. But, it’s important to talk about any worries with a doctor.

Human Papillomavirus (HPV) Infection

HPV infection is a big risk for vulvar cancer. HPV is a common virus spread through sex that can change vulvar cells. This can lead to precancerous lesions or cancer. Women with HPV, like strains 16 and 18, are at higher risk.

Age and Menopause

Age is a big risk factor for vulvar cancer. Most cases happen in women over 50, with risk going up with age. Menopause, between 45 and 55, also raises the risk. Hormonal changes in menopause might harm vulvar tissues.

Smoking and Tobacco Use

Smoking and tobacco use increase vulvar cancer risk. Smoking women face a higher risk than non-smokers. Tobacco’s harmful chemicals can damage DNA, leading to cancer. Quitting smoking can lower this risk and other health problems.

Weakened Immune System

Women with weak immune systems face higher vulvar cancer risk. This includes those with HIV/AIDS, organ transplant recipients, and those on immune-suppressing meds. A weak immune system makes it hard to fight off HPV and other cancer causes.

Signs and Symptoms of Vulvar Cancer

It’s important to know the early signs and symptoms of vulvar cancer. This helps in getting the right treatment on time. Some women might not notice anything different, but others might feel constant discomfort or see changes in their vulvar area.

Vulvar itching that doesn’t go away with common treatments is a common symptom. This itching might feel like burning or stinging. Women might also feel pain or tenderness in the vulva, which gets worse during sex or when pressed.

Lumps or sores on the vulva could be a sign of cancer. These growths might look like warts or be flat and change color. If sores don’t heal in a few weeks, even with good care, see a doctor.

Other signs that might mean vulvar cancer include:

Remember, these symptoms can also mean other, less serious issues. But if they last more than a few weeks or bother you a lot, see a doctor. They can check and figure out what’s going on.

Precancerous Lesions and Vulvar Intraepithelial Neoplasia (VIN)

Before vulvar cancer can develop, precancerous lesions may show up on the vulva. These changes are called vulvar intraepithelial neoplasia (VIN). It’s important to find and treat these lesions early to stop vulvar cancer from getting worse.

Identifying Precancerous Lesions

Precancerous lesions on the vulva can look like:

• Patches of skin that are thicker, lighter, or darker than the rest
• Persistent itching, burning, or discomfort in the vulvar area
• Rough, scaly, or wart-like growths on the vulva

Regular check-ups and self-exams can spot these lesions early. This allows for quick treatment and management.

Vulvar Intraepithelial Neoplasia (VIN) Classification

VIN is divided into levels based on how severe the changes are:

• Low-grade VIN (VIN 1): Mild changes in the lower third of the skin
• High-grade VIN (VIN 2/3): More severe changes in the upper layers, with a higher risk of cancer

Knowing the exact type of VIN is key. It helps doctors choose the right treatment and keep an eye on the lesions.

Treatment Options for Precancerous Lesions and VIN

Treatment for precancerous lesions and VIN aims to get rid of the abnormal cells. This helps prevent cancer from developing. Treatment options include:

• Topical medications: Using creams or ointments on the affected area
• Laser therapy: Destroying abnormal cells with a focused light beam
• Surgical excision: Removing the lesion and some healthy tissue around it
• Immunotherapy: Boosting the immune system to fight off abnormal cells

The best treatment depends on the size, location, and type of lesion. It also depends on the patient’s health and what they prefer. After treatment, it’s important to keep an eye on things to catch any signs of trouble early.

Diagnosing Vulvar Cancer

Early diagnosis is key to treating vulvar cancer well. If you have ongoing symptoms or see changes in your vulvar area, see a doctor right away. They will check you thoroughly to see if more tests are needed.

Physical Examination

The first step is a detailed physical examination. Your doctor will look at your vulva and nearby areas for any unusual spots or lumps. They might also do a pelvic exam to see how big the problem is and if it has spread.

Biopsy and Pathology

If your doctor finds something odd, they might suggest a biopsy. This means taking a small piece of tissue from the area for lab tests. A pathologist will then look at it under a microscope to see if there are cancer cells and what kind they are.

There are a few ways to do a biopsy, depending on the size and where the lesion is:

Imaging Tests for Staging

If the biopsy shows you have vulvar cancer, your doctor might want to do more imaging tests. These help figure out how far the cancer has spread. Tests might include:

• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

These tests help your healthcare team plan the best treatment for you, based on how far the cancer has spread.

Staging of Vulvar Cancer

Staging is key in diagnosing and treating vulvar cancer. The TNM system, short for Tumor, Node, and Metastasis, is the main method used. It helps doctors figure out how far the cancer has spread and plan the best treatment.

The TNM system looks at three main things:

• T (Tumor): How big the main tumor is
• N (Node): If cancer is in nearby lymph nodes
• M (Metastasis): If cancer has spread to other parts of the body

After checking these, vulvar cancer gets a stage from 0 to IV. Here’s a quick look at the stages:

Getting the cancer stage right is very important. It helps decide the best treatment. For early-stage cancers, surgery might be enough. But for more advanced cases, treatments like radiation and chemotherapy might be needed too. The TNM system helps doctors tailor treatments for each patient’s cancer.

Treatment Options for Vulvar Cancer

The treatment for vulvar cancer varies based on several factors. These include the cancer’s stage, the patient’s health, and personal choices. A team of experts works together to create a treatment plan tailored for each patient. The main treatments are surgery, radiation therapy, chemotherapy, and immunotherapy.

Surgery

Surgery is often the first choice for treating vulvar cancer, mainly in early stages. The goal is to remove the cancer while keeping healthy tissue. There are different types of surgery for vulvar cancer, including:

• Wide local excision: This involves removing the tumor and some healthy tissue around it.
• Radical vulvectomy: This surgery removes the entire vulva, including the clitoris and labia.
• Sentinel lymph node biopsy: This involves removing and checking the first lymph nodes where cancer might spread.
• Inguinofemoral lymphadenectomy: This surgery removes lymph nodes in the groin if cancer has spread or is suspected to have spread.

Radiation Therapy

Radiation therapy uses beams to kill cancer cells. It can be used before surgery to shrink the tumor or after surgery to get rid of any remaining cancer cells. It can also be the main treatment for those who can’t have surgery. Radiation therapy can be given from outside the body or placed inside (brachytherapy).

Chemotherapy

Chemotherapy uses drugs to kill cancer cells all over the body. It’s often used in advanced vulvar cancer or when cancer has spread. Chemotherapy can be used alone or with other treatments like radiation therapy or surgery.

Immunotherapy

Immunotherapy uses the body’s immune system to fight cancer. It’s a newer treatment that has shown promise in treating advanced vulvar cancer. Immune checkpoint inhibitors, like pembrolizumab, work by blocking proteins that stop immune cells from attacking cancer.

Choosing the right treatment for vulvar cancer depends on many factors. It requires teamwork between the patient and their healthcare team. Regular check-ups are key to catch any signs of cancer coming back and to ensure the best outcome.

Prognosis and Survival Rates for Vulvar Cancer

Knowing about the prognosis and survival rates for vulvar cancer is key. It helps patients and their families plan for the future. The prognosis depends on several factors, like the cancer’s stage, the patient’s health, and how well they respond to treatment.

Factors Influencing Prognosis

The stage of the cancer at diagnosis is a big factor. Early-stage cancers, like those only in the vulva or with little spread to nearby lymph nodes, usually have a better outlook. Other important factors include the patient’s age, overall health, and the type of vulvar cancer.

Five-Year Survival Rates by Stage

The five-year survival rate is a common way to measure prognosis. It shows the percentage of patients who live at least five years after diagnosis. The American Cancer Society reports the following five-year survival rates for vulvar cancer by stage:

• Stage 1: 86%
• Stage 2: 57%
• Stage 3: 43%
• Stage 4: 16%

These rates are based on a large number of patients. But, they may not exactly predict what will happen to any one patient. Many factors, like the patient’s health, the cancer’s specific characteristics, and treatment response, can affect their prognosis.