Vulvar Cancer

The vulva is the region of skin that surrounds the female genitalia like the vagina, clitoris, labia and urethra. Vulvar cancer occurs on the outer surface of these parts. This is seen in older women generally after menopause.

What are the causes?
  • Human papilloma virus
  • Pre-cancerous conditions of vulvar such as lichen sclerosus, vulval intraepithelaial neoplasia
  • Smoking
What are the symptoms?
  • Persistent itching, itching that doesn’t go away even after treatment
  • Pain and tenderness of the vulva
  • Vaginal bleeding not related to menstruation
  • Change in the colour or thickening of the skin
  • A lump, small bumps or an ulcer on to the vulva
What test will be required for diagnosis?
  • 1. To confirm the diagnosis
    • Doctor will usually do a vaginal examination (internal examination) if you have symptoms that may possibly be like cancer.
    • If she sees an abnormal area on the vulva a small biopsy will be taken to confirm the diagnosis.
  • 2. Assessing the extent and spread
    • Further tests may be advised to assess if the cancer has spread to other organs such as, an ultrasound scan, a CT scan, PET CT an MRI scan, a chest X-ray, blood tests or other tests.
    • This assessment is called staging of the cancer, done to asses the extent of the spread and to know the stage.
What are the treatment options available?

Following are the surgical options available depending on the spread of the cancer and other considerations:

  • Wide Local Excision: In this procedure, only the cancerous part of the vulva is removed, sparing the healthy tissue.
  • Partial vulvectomy: Removing part of the vulva
  • Radical Vulvectomy: removing entire vulva. The vulva can be recreated with reconstructive surgery and may involve plastic surgeons.
  • Sentinel Lymph Gland Excision: This entails identifying and examining the nearest lymph glands the cancer is most likely to metastasise. If the cancer has not spread till here, it is likely that other glands are also cancer-free.
  • Inguinal Groin Gland Dissection: Depending on the location of the cancer and its extent, the surgeon may remove the lymph glands from one or both the sides of the groin. This procedure is often conducted at the same time as vulvar surgery.

In some cases radiation and or chemotherapy may be required, depending on your stage.

Radiation

  • Radiation is a machine, which uses high-energy X-rays to kill cancer cells and stop their growth.
  • There are two ways of having radiation treatments:
    • Brachytherapy:   You get radiation through your vagina.
    • External beam radiation therapy: radiation is given from above your tummy.

Chemotherapy

  • In chemotherapy treatment drugs are used to kill or slow the growth of cancerous cells. It’s usually given through an IV injection.
  • You will be told that you need chemo with radiation; this type of treatment is called chemoradiation.
  • Adding chemo during radiation makes the radiation to be more effective. You might also get only chemotherapy treatment if your cancer has spread to other organs.
Follow-up after treatment
  • You should strictly follow-up with your doctor as per their advice.
  • In addition to receiving treatment for cervical cancer your success of treatment will depend only when you have regular follow-up.