Signs and Symptoms of Vulva Cancer
Dr. Murali Subramanyam
Malleswaram, Bengaluru Feb 11, 2017
What is vulva?
The vulva is a woman’s external genitalia. It is made up of the skin and fatty tissue that surround the clitoris and the openings of a vagina and urethra. The fatty tissue makes up 2 folds on each side of the vaginal opening, called the labia majora and labia minora. Cancer of the vulva occurs most often in or on the labia. Less often, it can occur on the clitoris or in glands on the sides of the vaginal opening, called the Bartholin’s glands, which produce a mucus-like lubricating fluid.
It is a relatively rare type of cancer that affects the vulva. It is more likely to appear on the outer vaginal lips. Cancer usually grows slowly over the several years. First, precancerous cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer.
Types of Vulva Cancer
- Squamous cell carcinoma: It accounts for about 90% of vulvar cancers, most of which are found on the labia.
- Adenocarcinoma: It starts in the Bartholin’s glands or vulvar sweat glands.
- Melanoma: It type of skin cancer that accounts for about 2% to 4% of vulvar cancer. It occurs most often on the clitoris or the labia minora.
- Sarcoma: It is a tumor of the connective tissue beneath the skin.
- Verrucous carcinoma: This is a slow-growing subtype of squamous cell carcinoma that looks like a wart.
Causes and Risk Factors
Cancer happens when cell growth is out of control. Most cancers harm the body when damaged cells divide uncontrollably to form lumps or masses of tissue, or tumors.
Malignancy occurs when two things happen:
• A cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue via a process called an invasion.
• The cell divides and grows through a process called angiogenesis, making new blood vessels to feed itself.
- Age: It usually occurs above the age of 55.
- Human papillomavirus (HPV)
- Vulvar intraepithelial neoplasia (VIN)
- Lichen sclerosus et atrophicus (LSA)
- Sexually transmitted infections (STIs)
- Human immunodeficiency virus (HIV)
- painful sexual intercourse
- pain and burning
- dark discoloration in cases of melanoma
- painful urination
- persistent itching
- rawness and sensitivity
- wart-like growths
- thickened skin
The doctor will perform a physical exam and closely examine vulva. If there is an ulceration, lump, or a mass that looks suspicious, a biopsy is required. The doctor should also palpate the Bartholin's glands.
Depending on the results of the biopsy, there may be further tests:
• Cystoscopy: the bladder is examined to determine whether the cancer has spread to that area.
• Proctoscopy: the rectum is examined to check whether the cancer has spread to the rectal wall.
• Imaging scans: these can help the doctor determine whether the cancer has spread.
If a biopsy confirms the presence of vulvar cancer, the doctor will stage it with the help of imaging scans.
There are different ways of staging cancer.
The four-stage system is as follows:
• Stage 0, or carcinoma in situ: The cancer is only on the surface of the skin.
• Stage 1: The cancer is limited to the vulva or perineum and is up to 2 cms in size.
• Stage 2: The same as stage 1, but the tumor is at least 2 cms in size.
• Stage 3: cancer has reached nearby tissue, such as the anus or vagina, and it may have reached the lymph nodes.
• Stage 4: The cancer has reached the lymph nodes on both sides of the groin, and it may have reached the bowel, the bladder, or the urethra, the passage through which urine leaves the body.
The types of treatment normally used for vulvar cancer are surgery, chemotherapy, radiation therapy, and biologic therapy.