Vulvar Cancer

Cancer of the vulva forms in the vulva, the area around the external genital organs on a woman. The vulva includes the following parts:

• Labia - The lips around the opening of the vagina
• Clitoris - A small mass of tissue at the opening of the vagina
• Bartholin's Glands - The small mucus-producing glands on either side of the vaginal opening

Women should be aware of their risk of vulvar cancer. It is important for women to be alert to changes in their bodies and to discuss them with a doctor.

Vulvar cancer is a malignancy that can occur on any part of the external organs, but most often affects the labia majora or labia minora. Cancer of the vulva is a rare disease, which accounts for 0.6 percent of all cancers in women, and may form slowly over many years. Nearly 90 percent of vulvar cancers are squamous cell carcinomas. Melanoma is the second most common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include:

• Adenocarcinoma
• Paget's disease
• Sarcomas
• Verrucous carcinoma
• Basal cell carcinoma

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

The following have been suggested as risk factors for vulvar cancer:

• Age (of the women who develop vulvar cancer, 75% are over age 50, and 50% are over age 70)
• Chronic vulvar inflammation
• Infection with the human papillomavirus (HPV)
• Human immunodeficiency virus (HIV) infection
• Lichen sclerosus - This condition can cause the vulval skin to become very itchy and may slightly increase the possibility of vulvar cancer
• Melanoma or atypical moles on non-vulvar skin - a family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer
• Low socioeconomic status
• Vulvar intraepithelial neoplasia (VIN) - this is a pre-cancer lesion, although most cases do not progress to cancer
• Other genital cancers
• Smoking

The following are the most common symptoms of vulvar cancer. However, each individual may experience symptoms differently. Symptoms may include:

• Constant itching
• Changes in the colour and the way the vulva looks
• Bleeding or discharge not related to menstruation
• Severe burning g/ itching or pain
• Skin of the vulva looks white and feels rough

The symptoms of vulvar cancer may resemble other conditions or medical problems. Please consult your doctor when in doubt.

Vulvar cancer is diagnosed by biopsy, removing a section of tissue for examination by a pathologist.

Treatment options for vulvar cancer may include any or all of the following:

• Surgery, including:
  • Oexcision (the cancer cells and a margin of normal appearing skin around the cancer is removed)
  • Vulvectomy (surgical removal of part or all of the tissues of the vulva)
  • Lymph node removal (removal of the glandular tissue in the groins)
• Radiation therapy
• Chemotherapy

After treatment, women with vulvar cancer will need to have regular check-ups. During these visits, the doctor may perform a pelvic examination. Other tests, including ultrasound, chest X-ray, or computed tomography, will be done only when needed.