Vulvar Cancer

When cancer arises from the vulvar area is known as vulvar cancer. Like any other cancer vulvar cancer when detected at an early stage are highly curable. Vulvar cancer is seen in older women generally after menopause. Most of the time women ignore the common symptom of vulvar cancer that is vulval itching and pain as these symptoms can also happen with a vulval or vaginal infection.

Where is vulva situated?

The vulva is the external part of the female genital area which includes the inner and outer lips of the vagina, the clitoris, the opening of the vagina, and its glands.

What are the causes?
  • Risk increases with age

  • Human Papilloma Virus

  • Pre-cancerous conditions of vulvar such as lichen sclerosis, vulval intraepithelial neoplasia

  • Smoking increases the risk

What are the symptom?
  • Persistent itching, itching that doesn’t go away even after treatment

  • Pain and tenderness of the vulva or pelvic area especially while passing urine or during sexual intercourse

  • Vaginal bleeding not related to menstruation

  • Change in the color or thickening of the vulval skin

  • A lump, small bumps or an ulcer on to the vulva

What test will be required for diagnosis?

1.  To confirm the diagnosis

The doctor will usually do a vaginal examination (internal examination) if you have symptoms that may possibly be like cancer.

2.  Assessing the extent and spread

Further tests may be advised to assess if cancer has spread to other organs such as an ultrasound scan, a CT scan, PET CT an MRI scan, a chest X-ray, and blood tests.

What are the treatment options?
  • 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 Therapy: 
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: Radiation is given 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 go for follow-up with your doctor as per their advice.

  • In addition to receiving treatment for vaginal cancer, your success in treatment will depend only on when you have a regular follow-up.

Prevention of vulvar cancer

Since vulval cancer is also caused by Human Papillomavirus (HPV) protection from this infection is important, including HPV vaccination, to reduce the risk of vulvar cancer. During your annual visit, an examination of the vulva for any changes can lead to the detection of preinvasive disease or early vulvar cancer.

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