Cancer Of The Vulva
• What Is Vulva Cancer?
|What Is Vulva Cancer?
The vulva is the fleshy tissue which surrounds and protects the opening of the vagina. Cancer of this area is very rare and accounts for 1 percent of all cancers (and 4 percent of gynecologic cancers) in American women. This amounts to about 4,000 new cases being diagnosed every year. Although vulva cancer can occur in women in their 30's and 40's, 85 percent of cases are reported in postmenopause women after the age of 50. In most Western countries, nearly half of all incidences are found when they are very small and highly curable. A routine self-examination of the vulva can aid early detection.
In 2011 there were 4,340 cases of vulva cancer and 940 related deaths in North America. The 10 year survival rate for the most common type of vulva cancer (squamous cell carcinoma) is 87 percent for stage 1. This declines to 69 percent for stage 2, 46 percent for stage 3 and 16 percent for stage 4.
Signs and symptoms of vulva cancer include:
1. Change in color or texture of the vulva skin.
If cancer does develop it is usually because the woman has ignored some of these symptoms. Fortunately because vulva cancer grows very slowly it does not spread to other parts of the body until the disease is quite advanced (picture of advanced stage).
Squamous Cell Carcinomas
There are several non-cancerous conditions which can cause vulva problems. These include squamous cell hyperplasia (used to be called hyperplastic dystrophy), lichen sclerosis and vulvar intraepithelial neoplasia (VIN). VIN, also known as carcinoma in situ, is generally considered the precancerous condition for vulva cancer. Formerly known as Bowen's disease, VIN is similar to VAIN, the precancerous condition related to cancer of the vagina and cervical intraepithelial neoplasia (CIN), the precancerous condition related to cervical cancer. VIN usually causes itching and burning although the woman may mistake it for vaginitis. They may self-diagnose it as a yeast infection and use anti-fungal medications or other yeast infection treatments with little effect. It is easy to detect during an examination by the presence of raised white patches. A biopsy will confirm the diagnosis.
Little is known for certain about the causes of vulvar cancer, however several risk factors have been identified:
Previous Gynecologic Cancers
A vulva cancer diagnosis is made after taking a medical history and carrying out a physical examination and biopsy of suspicious tissue. This can usually be completed in a doctor's office. If the biopsied sample comes back positive, the woman will be referred to a specialist, such as a gynecologist for further testing and staging purposes. A specialist might use a cystoscopy, proctoscopy or intravenous urography. This will help determine type, location and size of the cancer. Imaging tests such as an X-ray, CT scan or MRI scan may be used to check for staging and metastasis (i.e. to see if cancerous cells have spread - see vulva cancer staging). This information is important for determining a treatment plan. It also helps determine the chances of survival for a patient (see vulva cancer survival rates).
The three main types of vulva cancer treatment are surgery, radiation therapy and chemotherapy. The precancerous stage VIN is usually treated by local excision, laser therapy or vulvectomy. The cure rate is practically 100 percent. The topical chemotherapy cream fluorouracil is sometimes used but results are not reliable. Stage 1 cancer is also treated with surgery, but the incision may be wider and require removing lymph nodes. Stages 2 and 3 may involve removing parts of the vulva and lymph nodes in addition to radiation therapy. Patients who are too old to undergo surgery may be given radiation combined with chemo (see chemotherapy guide). Stage 4 vulvar cancer can involve radical vulvectomy combined with pelvic exenteration. This is a radical procedure and only considered as a treatment of last resort.
Recurrent vulva cancer: Regular follow-up tests after treatment will be scheduled by the doctor. This means any signs of a recurrence will be spotted immediately. One study showed that about 10 percent of patients who were treated for vulvar cancers had recurrences within 5 years, another indicated 24 percent. As about 80 percent of all recurrences occur within 2 years of original treatment this emphasizes the importance of follow up. Cancer can return to the vulva or other areas. If the recurrence is small it may be treated with radiation. If it is aggressive surgical options such as a radical vulvectomy or pelvic exenteration combined with external radiation will be considered.
Vulva cancer prevention: As the cause has not been clearly identified preventative care must focus on reducing exposure to possible risk factors. This includes:
1. Limiting your number of sexual partners to avoid HPV exposure.
Also do be sure to report any vulva itching, rashes, lumps or mole changes to your doctor. The sooner VIN is diagnosed the faster it can be cured and the less likely cancer is to develop. If you have any questions on this or any other topics, see womens health questions.
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