Vulvar Cancer

What is the vulva?

The vulva is the external portion of the female genital organs. It includes:

• labia majora - two large, fleshy lips, or folds of skin.
  
  
• labia minora - small lips that lie inside the labia majora and surround the openings to the urethra and vagina.
  
  
• vestibule - space where the vagina opens.
  
  
• prepuce - a fold of skin formed by the labia minora.
  
  
• clitoris - a small protrusion sensitive to stimulation.
  
  
• fourchette - area beneath the vaginal opening where the labia minora meet.
  
  
• perineum - area between the vagina and the anus.
  
  
• anus - opening at the end of the anal canal.
  
  
• urethra - connecting tube to the bladder.

What is vulvar cancer?

Vulvar cancer is a malignancy that can occur on any part of the external organs, but most often affects the labia majora or labia minora. According the American Cancer Society, about 3,870 cases of cancer of the vulva will be diagnosed in the US in 2005. Cancer of the vulva is a rare disease, which accounts for 0.6 percent of all cancers in women, and may form slowly over many years. Nearly 90 percent of vulvar cancers are squamous cell carcinomas. Melanoma is the second most common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include:

• adenocarcinoma
• Paget's disease
• sarcomas
• verrucous carcinoma
• basal cell carcinoma

What are risk factors for vulvar cancer?

The following have been suggested as risk factors for vulvar cancer:

• age - of the women who develop vulvar cancer, three-fourths are over age 50, and two-thirds are over age 70
  
  
• chronic vulvar inflammation
  
  
• infection with the human papillomavirus (HPV)
  
  
• human immunodeficiency virus (HIV) infection
  
  
• lichen sclerosus - can cause the vulval skin to become very itchy and may slightly increase the possibility of vulvar cancer
  
  
• melanoma or atypical moles on non-vulvar skin - a family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer
  
  
• vulvar intraepithelial neoplasia (VIN) - there is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer
  
  
• other genital cancers
  
  
• smoking

What are the symptoms of vulvar cancer?

• constant itching
• changes in the color and the way the vulva looks
• bleeding or discharge not related to menstruation
• severe burning, itching, or pain
• skin of the vulva looks white and feels rough

The symptoms of vulvar cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How can vulvar cancer be prevented?

The cause of vulvar cancer is not known at this time, however, certain risk factors are suspected as contributors to the development of the disease. Suggestions for prevention include:

• Avoid known risk factors when possible.
• Delay onset of sexual activity.
• Use condoms. Research shows that condoms may protect against HIV/AIDS and other sexually transmitted diseases that are transmitted through body fluids. However, condoms will not protect against infection with HPV since this infection is transmitted by skin-to-skin contact.
• Do not smoke.
• Have regular physical checkups.
• Have routine Pap tests and pelvic examinations.
• Routinely check entire body for irregular growth of moles.

How is vulvar cancer diagnosed?

The diagnosis of vulvar cancer is confirmed only by a biopsy. A biopsy is a procedure in which tissue samples are removed from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

Treatment for vulvar cancer:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• surgery, including:
  
  
  • laser surgery - use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells.
    
    
  • excision - the cancer cells and a margin of normal appearing skin around the cancer is removed.
    
    
  • vulvectomy - surgical removal of part of all of the tissues of the vulvar.
    
    
• external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  
  
• chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.

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