What is vulvar cancer?

Vulvar cancer is a cancer of the female reproductive system that affects the vulva. The vulva is a structure that surrounds the urethra (opening through which urine flows out of the body) and the vaginal opening. It includes the labia and the clitoris. Its function is to protect the internal structures of the female reproductive system. The vulva also plays an important role in sexual arousal, providing lubrication and cushioning.

The prevalence of vulvar cancer is less compared to other gynaecological cancers such as endometrial, ovarian and cervical cancer. It is associated with human papillomavirus (HPV) infection. HPV is a sexually transmitted infection which can also lead to other forms of cancer such as cervical cancer. Each year, in the United States, there is about 6100 new cases of and 1500 deaths from vulvar cancer. It is a cancer that is more common among white people. The average age at which the diagnosis of vulvar cancer is made is around 68 years.

Most women with the disease are diagnosed at an early stage and various treatment options are available.

What are the causes and risk factors of vulvar cancer?

The exact cause of vulvar cancer is still not clear. A cancer generally develops when mutations occur in certain cells causing them to develop and divide uncontrollably, producing an accumulation of abnormal cells. These cells become cancerous and spreads to nearby tissues or other organs in the body.

HPV infection may be the trigger for vulvar cancer. In some cases, it is believed to be autoimmune, that is, caused by your own body’s reaction toward your cells. Another proposed pathway is through a long-standing inflammation of the vulva.

Furthermore, there are some factors that may increase your risk of developing vulvar cancer. These include:

• Increasing age: Vulvar cancer is most commonly diagnosed in older women.
• HPV infection: This infection is associated with an increased risk of developing several gynaecological cancers including vulvar and cervical cancer. It is a sexually transmitted infection, therefore, you are at risk if you are sexually active. The risk is higher if you have multiple sexual partners or having unprotected sex.
• Skin disorder on vulva: Lichen sclerosus is a skin condition that can involve the vulva increasing your risk of having vulvar cancer.
• Immunosuppression: Having a weak immune system can put you more at risk of having vulvar cancer.
• Smoking: As for many cancers, smoking increases your risk of having vulvar cancers.

What are the symptoms of vulvar cancer?

At the time of diagnosis, many women may not be experiencing any symptoms. However, some women may notice the following:

• Lesion on the vulva: Majority of women will notice having a plaque, ulcer or growth on the vulva. The growth may be fleshy, nodular or appear as a wart.

• Itchiness of vulva: This is a common symptom in vulvar cancer. However, it can be present in many other genital disorders which should be ruled out.
• Pain: Pain may also be present in cases of vulvar cancer.
• Vulvar bleeding

How is the diagnosis of vulvar cancer made?

To make the diagnosis of vulvar cancer, your doctor will first take a complete history from you to know more about your symptoms. He/she will then proceed with a general and pelvic examination. This will involve having a look at your external genitalia as well as palpation for any lesions or masses. Other tests may be requested to confirm the diagnosis including:

• Biopsy: A biopsy of the vulva may be needed to confirm the diagnosis of vulvar cancer. This involves taking a sample of the lesions present using a special apparatus. This samples is then sent to a laboratory for further analysis under a microscope.
• Colposcopy: This procedure may be done to look for lesions that may not be visible to naked eye. In this procedure, a special device known as a colposcope is used to closely examine the vulva, vagina and cervix. A speculum is inserted in your vagina to keep it open. A special solution is applied on your skin, vagina and cervix which will help your doctor to identify abnormal cells with the colposcope.

If your doctor suspects that the cancer may have spread to other structures, he/she may request further imaging tests such as X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography (PET).

How is vulvar cancer treated?

The choice of treatment for vulvar cancer depends on the type and extend of the disease. Treatment options include the following:

• Excision of the cancer: In this procedure, the lesion is excised along with a margin of healthy skin tissue. This is to make sure that the whole cancer has been removed. This is usually indicated in early stages of vulvar cancer.
• Vulvectomy: In this procedure, part of or the entire vulva may be removes depending on the extent of the disease. The underlying tissue is also removed. This procedure may be carried out along with radiation or chemotherapy for larger forms of cancers as they can help in shrinking the cancer growth.
• Removal of lymph nodes: This might be done to determine if the cancer has spread further from the original site. Sentinel lymph node biopsy is a procedure in which the closest lymph node is removed for analysis. If the cancer is not present in that node, it is unlikely that it has spread beyond the node.
• Radiation therapy: In this treatment modality, high-powered energy beams are used to target cancer cells and destroy them. It can also be used prior to surgery as it can be helpful in shrinking the cancer growth. In some cases, it can even be used in combination with chemotherapy.

• Chemotherapy: In this treatment modality, medications are administered through your veins or mouth to kill cancer cells. It is usually used in cases where the cancer may have spread to other areas of the body.

How can vulvar cancer be prevented?

Since vulvar cancer is known to be associated with HPV infection, it is recommended to use a condom each time you have sexual intercourse. However, it does not completely eliminate the risk of having the infection. It is also recommended to get the HPV vaccine. This is usually done in children and young women as it protects against the strains that may be causing vulvar cancer.

Merlo, S., 2020. Modern treatment of vulvar cancer. Radiology and Oncology, 0(0).

Mahajan, N., 2008. Sentinel lymph node in vulvar cancer. Cancer, 112(8), pp.1869-1869.

Berek, J., n.d. Vulvar cancer: Epidemiology, diagnosis, histopathology, and treatment

Creasman, W., 2016. Malignant Vulvar Lesions