An Overview of Vulvar Cancer

Vulvar cancer is a rare type of cancer that affects vulva of women. Not to be confused with the vagina, the vulva encompasses the labia majora and labia minora, folds of skin that protect the vaginal and urethral openings.
There are several types of vulvar cancer, but squamous cell vulvar carcinoma is most common. It accounts for more than 90% of diagnosed cases. Melanoma of the vulva is the second most common and represents about 5% of women with vulvar cancer. Other types include Paget's Disease of the vulva, vulvar adenocarcinoma, and basal cell carcinoma, but these are much less common.

Causes and Risk Factors

Although researchers have yet to pinpoint the exact causes of vulvar cancer, they have identified known risk factors for the disease. Vulvar cancer risk factors include:

• being infected with the human papillomavirus (HPV)
• being infected with HIV
• having lichen sclerosis, a skin condition that affects the vulva
• smoking
• family history of melanoma
• being 70 or over (vulvar cancer, however, can be diagnosed in younger women)

Symptoms

In the early stages, vulvar cancer rarely has any symptoms. As the disease progresses, vulvar cancer symptoms include:

• lump or bump on the vulva
• vulvar itching, burning, or sensitivity
• pain during urination
• change in the texture of the vulva
• mole on the vulva or change on existing mole
• bleeding not related to your menstrual cycle

These vulvar cancer symptoms are not exclusive to vulvar cancer and can be related to another, less serious condition. Reporting symptoms early to your healthcare provider may aid in early detection.

Diagnosis

The first step in diagnosing vulvar cancer is for your healthcare provider to be aware of any symptoms you may be experiencing. Symptoms may be what prompt women to see their healthcare provider, but signs of vulvar cancer can be detected through routine pelvic exams, even if a woman is not experiencing any noticeable symptoms.
Women can also monitor their vulvar health by regularly doing vulvar self-exams at home. Doing these exams regularly helps a woman to understand her anatomy, learn what is normal for her vulva, and over time, possible abnormal changes that could indicate an abnormality.

A biopsy is needed to confirm the presence or absence of cancer. During a vulvar biopsy, the healthcare provider removes a small sample of vulvar tissue to be sent to a pathology lab for screening. If a biopsy reveals cancer, the disease is then staged. Staging refers to how far cancer has spread to nearby tissues or organs. Other tests used in diagnosing vulvar cancer may include:

• cystoscopy
• proctoscopy
• X-ray examination of the lungs
• intravenous urography (as needed)

Treatment

Vulvar cancer treatment plans heavily depend on the stage of cancer and general health. Three methods are used to treat vulvar cancer: surgery, chemotherapy, and radiation therapy.

Surgery

Surgery is the most common type of vulvar cancer treatment. One type of surgery, local excision, involves the removal of cancerous tissue along with a margin of healthy tissue surrounding it. Lymph nodes may be removed.

Another surgical procedure, a vulvectomy, is another option for some women. A vulvectomy is the removal of all or part of the vulva and is reserved for more advanced cases of vulvar cancer. For women who have undergone aggressive vulvectomy surgeries, vaginal reconstruction surgery may be available using plastic surgery techniques and skin grafts.

Chemotherapy

Chemotherapy may be an option for some women with vulvar cancer. It is often prescribed along with radiation therapy to either increase the effectiveness of radiation therapy or to help shrink a large tumor prior to surgery. It may also be given as adjuvant therapy to prevent recurrence.

Radiation Therapy

Radiation therapy is also an option for treating vulvar cancer. This type of treatment uses certain types of high-energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.

Prevention

While there are no guaranteed prevention methods for vulvar cancer, there are several things we can do to reduce our risk of developing the disease. Ways to reduce our risk include the following.

Reduce Your HPV Risk

Limiting your exposure to the human papillomavirus (HPV) may also decrease the risk of vulvar cancer. HPV is a common sexually transmitted virus that in some cases when left undetected or untreated may progress into cervical cancer. Its role in the development of many other cancers, including vulvar cancer, is being investigated.

Avoid Smoking

Since we know that tobacco use is linked to some types of gynecologic cancer, avoiding smoking is a good risk reduction strategy. Quitting smoking may reduce your risk of not only gynecologic cancers like vulvar cancer but many other types of diseases and conditions as well.

Getting Regular Pelvic Exams

Having a regular pelvic exam is extremely important, even if you are not experiencing any symptoms. A pelvic exam allows your healthcare provider to look for abnormalities that may require further evaluation.

If you are experiencing symptoms, report them to your healthcare provider right away. Do not wait until your next pelvic exam to do so. A precancerous vulvar condition called vulvar intraepithelial neoplasia (VIN) may be able to be detected and treated prior to progressing to vulvar cancer, but only if screened by a healthcare provider.