Vulvar cancer – Symptoms, Treatments, Diagnosis , and more

Dr. Anusha Raaj, MBBS,MD,DNB

Telemedicine Department

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  Urinary Tract Infection

Vulvar cancer is the cancer of the skin covering the female external genitalia and the urinary passage, namely the urethra. It mostly affects older women over 60 years of age after the cessation of their periods.

 The common symptoms of vulvar cancer include,

• Itching pain
• soreness or pain
• Raised and thickened patches of skin that can be red, white or dark
• lump/sore: ulcer
• bleeding from the vulva or blood-stained vaginal discharge between periods
• mole/sudden change of colour of vulval skin.

The exact cause of vulval cancer is not clear, but there are a few risk factors that increase the chance of acquiring the same:

• Increasing age
• Vulval intraepithelial neoplasia (VIN) – abnormal cells in the vulval skin that progress to cancer if left untreated.
• Persistent infection with particular types of the human papillomavirus (HPV)
• Skin conditions affecting the vulva, such as lichen sclerosus.
• Smoking
• Untreated skin lesions of the vulva like lichen sclerosis and lichen planus.

Diagnosis

Vulval cancer is diagnosed by

• clinical appearance of the lesion.
• biopsy
• colposcopy: viewing the cells of the vulva, vagina and neck of the womb with a camera that has a special green filter.
• CT scan to get for Lymph node.
• MRI: to check for adjacent tissue spread.
• Special blue dye installation and biopsy of the lymph node that is central to spread: Sentinal node biopsy: when this node is involved, all the adjacent nodes in the pelvis are removed.
• Chest X-ray to check for lungs.
• PET scan in selected cases.

Treatment of vulvar cancer

• For any cancer, it is essential to remove the cancer tissue or, in other words, reduce the bunch of abnormal/cancer tissues by surgery or anti-cancer drugs or radiotherapy.
• In vulval cancer, the primary modality, in other words, the first line of management, is
• Removal of the lesions when they are small and localised to one side: excision biopsy
• Removal of part of the vulva: partial vulvectomy
• Removal of vulva completely: total vulvectomy
• Removal of the vulva, adjacent tissues of the urinary passage (urethra) and other tissues: radical vulvectomy
• Removal of lymph nodes in the groin and thigh: lymphadenectomy
• Chemotherapy and radiotherapy: in advanced cases

Recovery from vulvar cancer 

Vulval cancer, when diagnosed early and promptly treated, 7 out of 10 women survive at least for 5 yrs which is close to 90% recovery.

Recovery also depends on the age of the patient, how far the cancer has spread and the general health of the patient.

The younger the patient better the chances of successful treatment and survival.

Follow up 

• Even after successful treatment, cancer can come back
• Long-term follow-up is essential.

Conclusion 

Women should be more aware of the different carcinoma that can affect them.

Especially sexually active women across all age groups should undergo yearly check-ups with their consulting gynaecologist. This helps in a timely intervention during an incidental screening. Hence, lowering the incidences can be done by increasing awareness.

FAQ

How do I know if I have vulvar cancer?

Symptoms like itching, soreness, ulcers, lump, redness, pain and dryness indicate it. It can also be detected during routine screening.

How do I check myself for vulvar cancer?

If any of the above symptoms are present, approach the gynaecologist as soon as possible for a proper medical examination.

 What age can you get vulvar cancer?

Chances of getting vulvar cancer increase with age. And also if any comorbidities or above-mentioned underlying conditions are present.

 Can PAP test detect vulvar cancer?

PAP – Does not screen for vulvar carcinoma.

 Do you lose weight with vulvar cancer?

If there is a loss of appetite, then losing weight may occur.

 Is vulvar cancer lump painful?

Yes, if left untreated, it is painful.

What cancers cause itching?

Itching is caused by the release of chemical messengers. It can be a symptom in many carcinomas.