Vulvar cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 31, 2016
StartDiseasesVulvar cancer

Vulvar cancer is a form of squamous-cell carcinoma originating in skin cells. It is a rare form of cancer of the female reproductive system. Vulvar cancer affects the skin of the outer female genitalia or vulva. The cancer most often appears on the labia majora or labia minora.

Contents

Definition & Facts

Vulvar cancer in the United States contributes to about 0.6 percent of cancers found in all women. In the US, women's chances of developing this form of cancer are 1 in 333 at some time in their lives.

Vulvar cancer is more prevalent in woman over the age of 60, and more white women are diagnosed with the condition than other races of women. The National Cancer Institute reports a rise in vulvar cancer at about 1.5 percent per year from 2003-2012.

Symptoms & Complaints

Vulvar cancer develops very slowly. Precancerous cells can grow unnoticed on the skin of the vulva for a long time. This precondition is called VIN or vulvar intraepithelial neoplasia. It is important to get treatment for vulvar intraepithelial neoplasia because it is known that VIN can become cancerous in time.

Vulvar cancer does not give early warning symptoms. Some of the occasional symptoms may be confused with other conditions, so it is important to check with a physician for any of the following indicators:

Causes

Various conditions, or risk factors, can be causes of vulvar cancer, and aging is one of the most identifiable risks for women over 60. Human papilloma virus infection (HPV) contributes to risk for vulvar cancer. This is a very common infection.

A high percentage of sexually active adults will become infected with HPV at least once, but most HPV infections are self-limiting. Persistent HPV infection is a liability for development of VIN and vulvar cancer. An abnormal pap smear may indicate human papilloma virus, dysplasia (abnormal cervical cells) or cervical cancer. Cervical cancer increases the risk for vulvar cancer.

Having many sexual partners is another risk factor for vulvar cancer, as is beginning sexual activity at a young age. Human immunodeficiency virus (HIV) is linked to many cancerous conditions, including vulvar cancer.

Smoking increases the possibility of vulvar cancer, especially when combined with ongoing HPV infection. A condition called lichen sclerosus, characterized by thinning vulvar skin and itching, increases vulvar cancer risks, and the itching can disguise the need to check for a cancerous lesion.

Diagnosis & Tests

In order to diagnose vulvar cancer, a physician will need a complete medical history. A thorough physical examination will be ordered to check the ovaries, uterus, vagina, and cervix for unusual indicators, and a pap test will be performed. If abnormal skin lesions are suspected, the doctor will treat the vulva with a solution that will enable precise viewing through an instrument called a colposcope. The instrument has a magnifying lens for close examination of any suspicious lesions. The examination is called a vulvoscopy.

Sometimes a physician will coat the vulva with a dye (toluidine blue). The dye will cause suspicious lesions of VIN or vulvar cancer to turn blue. If abnormal areas are detected, an anesthetic will be injected into the skin as a numbing agent. If the abnormality is small, it can be completely removed, or excised, with a scalpel. This procedure is called an excision biopsy. Stitches may be necessary.

If the lesion is larger, a small sample called a punch biopsy will be taken with an instrument that removes a small, round piece of skin. The samples of skin will be sent to a lab for biopsy. If cancer cells are detected, further tests will be done.

Diagnostic tests will decide the size of the tumor, how deeply it has embedded itself into the original site, whether it has spread into nearby organs, and whether it has metastasized (spread to lymph nodes or distant organs). Determining how far the cancer has spread is called cancer staging. Selecting the right treatment plan hinges on staging of the cancer. Staging vulvar cancer is a system based on the extent of the cancerous tumor. Vulvar cancer staging is listed as follows:

  • Stage 0: A very early cancer found only on the skin of the vulva.
  • Stage I: The cancer is in the vulva or perineum but has not spread to any other organs.
  • Stage II: Cancer is in both previous sites and has spread to anus, urethra, and vagina. It has not spread to any distant sites or lymph nodes.
  • Stage III: The cancer has spread to one or two lymph nodes but no distant organs.
  • Stage IV: Advanced vulvar cancer, involving lymph nodes, distant organs and causing open sores.

Treatment & Therapy

Treatment of vulvar cancer is directly related to the stage of the cancer. Stage 0 cancer is treated routinely with wide local incision or a topical medication such as fluorouracil ointment applied to the lesions. This cancer may return after treatment, so persistent followup is imperative. The five-year survival rate is almost 100 percent, which is typical of other stage 0 skin cancers.

Stage I cancer treatment will hinge upon the size and depth of the cancer and whether the patient also has VIN. Surgical removal of the tissue is performed, along with a small amount of normal tissue. Stage II cancers are treated with excision and radiation. Sometimes chemotherapy is included.

Stage III cancers are treated with radiation and chemotherapy. Attempts are made to excise tissue but preserve the structures of the vulva. Stage IV cancer treatments combine a vulvectomy with chemotherapy and radiation.

Prevention & Prophylaxis

Prevention of vulvar cancer includes routine pap smears and examination of reproductive organs, especially for women over the age of 60. Cessation of smoking is advised, and, if diagnosed, the modification of lichen sclerosus symptoms is addressed with topical steroids. This will bring the condition under control and reduce risk of vulvar cancer.