ladies Cancer of the Vulva

 

     The vulva is the part of the female genital reproductive organs that can be seen from outside of the body. Vulvar cancer is cancer that occurs on the vulva Anatomy The vulva is the external portion of the female genital organs. It includes the mons pubis is the soft mound in front of their pubic bones that becomes covered with hair Labia majora: two large, fleshy lips, or folds, of skin, Labia minora: small lips just inside the labia majora surrounding the openings to the urethra and vagina, Vestibule: space where the vagina opens, Prepuce: a fold of skin formed by the labia minora that covers the clitoris, Clitoris: a small protrusion of nerve tissue sensitive to stimulation, Fourchette: area beneath the vaginal opening where the labia minora meet, Bartholin glands are found just inside the vulva. They produce a thick fluid, which acts as a lubricant during sexual intercourse. Perineum: area between the vagina and the anus,  Anus: opening at the end of the anal canal, Urethra: connecting tube to the bladder

    

      Vulvar cancer is a type of cancer that occurs on the outer surface area of the female genitalia Labia Majora. The vulva is the area of skin that surrounds the urethra and vagina, including the clitoris and labia.  Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching. Though it can occur at any age, vulvar cancer is most commonly diagnosed in older adults.

     Cells in the vulva sometimes change and no longer grow or behave normally. These changes may lead to many non-cancerous (benign) conditions such as lichen sclerosus or genital warts. They can also lead to non-cancerous tumours such as Bartholin cysts and Skene’s cysts.

     Changes to cells of the vulva can also cause precancerous conditions. This means that the abnormal cells are not yet cancer, but there is a chance that they may become cancer if they aren’t treated for many months. The most common precancerous condition of the vulva is vulvar intraepithelial neoplasia (VIN).

 

Statistics

     Vulvar cancer makes up about 6% of cancers diagnosed in the female reproductive organs and less than 1% of all cancers in women. Worldwide, an estimated 45,240 people were diagnosed with vulvar cancer in 2020.

It is estimated that In 2020, an estimated 17,427 people worldwide died from vulvar cancer.

     The 5-year survival rate for people with vulvar cancer is 71%. However, survival rates depend on several factors, including the type of vulvar cancer and the stage of disease at the time it is diagnosed.  The 5-year survival rate for vulvar cancer that has not spread beyond the vulva is almost 87%. An estimated 60% of vulvar cancers are diagnosed at this local stage. For cancer that has spread to surrounding tissues or organs and/or to the regional lymph nodes, the 5-year survival rate is 49%. The survival rate is almost 22% if the cancer has spread to a distant part of the body.

 

Other types of vulvar cancer include:  Adenocarcinoma, Paget disease, Sarcomas,  Basal cell carcinoma

 

 

 

Risks

The following factors may increase a woman’s risk of developing vulvar cancer:

Age: over 80 percent are over 50, and half are over 70. The average age at diagnosis is 65.

Being exposed to human papillomavirus (HPV).* HPV is a sexually transmitted infection that increases the risk of several cancers, including vulvar cancer and cervical cancer. Many young, sexually active people are exposed to HPV, but for most the infection goes away on its own. For some, the infection causes cell changes and increases the risk of cancer in the future. Recombinant HPV Quadrivalent Vaccine (Gardasil®). This vaccine is approved for individuals nine to 26 years of age.    Recombinant HPV Nonavalent Vaccine (Gardasil 9®). This vaccine is approved for adults through 26 years of age. It may be given to adults up to 45 years of age if appropriate after discussing risk for new HPV infection.

Lichen sclerosus: This can cause the vulvar skin to become very itchy and may slightly increase the possibility of vulvar cancer.

Melanoma or atypical moles on nonvulvar skin: A family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer.

Vulvar intraepithelial neoplasia (VIN): VIN occurs when there are abnormal cells on the surface layer of vulvar skin. These cell changes are a precancerous condition, so there is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer.

Having a weakened immune system.* People who take medications to suppress the immune system, such as those who've undergone organ transplant, and those with conditions that weaken the immune system,  such as human immunodeficiency virus (HIV), have an increased risk  of vulvar cancer.

Other genital cancers

Smoking

 

Vulvar Cancer Symptoms

You might not notice any symptoms early on. Over time, you might have:

  * A change in the colour of your vulva

  * Unusual growths or bumps that may be red, pink, or white and feel rough or thick

  * A change in how a mole looks

  * Thickened skin on your vulva

  * An open sore or other sore that doesn’t heal.

  * Itching that doesn’t go away

  * Pain soreness, or burning

  * Unusual vaginal bleeding or discharge not related to menstruation

  * Pain when you pee

  * Tenderness in the vulvar area.

  * Pelvic pain while having sex or peeing.

 

Vulvar Cancer Diagnosis and Treatment

     The main tests used to diagnose vulvar cancer are a physical examination, a procedure called a colposcopy and, most importantly, the removal of a tissue sample (biopsy). Because vulvar cancer is sometimes associated with cervical and vaginal cancers, the doctor may also check for abnormal cells in the cervix and vagina.

Colposcopy  The doctor uses a magnifying instrument called a colposcope to look at the vulva, vagina and cervix in detail. The colposcope is placed near your vulva but does not enter your body. A colposcopy that examines the vulva is sometimes called a vulvoscopy, and one that examines the vagina may be called a vaginoscopy.     The doctor will use a speculum to spread the walls of the vagina apart, and then apply a vinegar-like liquid or iodine to your vulva and vagina. This makes it easier to see abnormal cells through the colposcope. The liquid may sting or burn, and you may have a brown discharge afterwards. During a colposcopy, the doctor will usually take a biopsy from the vulva and/or the vagina.

Biopsy  During a colposcopy, your doctor will usually take a small tissue sample (biopsy) from the vulvar area and possibly also the vaginal area. A biopsy is the best way to diagnose vulvar cancer. The doctor will usually put a local anesthetic into the affected area of your vulva to numb it before the biopsy. There should not be any pain when the sample is taken, but you may feel a little discomfort.  If large areas of the vulva look suspicious, you may have several biopsies taken under general anesthetic. This is known as vulvar mapping and it helps the doctor plan the best treatment for you.

After the biopsy, your vulva may bleed a little. Sometimes stitches are needed to close up the wound. Your doctor will explain how much bleeding to expect afterwards and how to care for the wound. You may have some soreness, which can be relieved by taking painkillers. You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours after the biopsy.

The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will look at the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of vulvar cancer it is.

Cervical screening test   This test has replaced the Pap test.

The cervical screening test looks for cancer-causing types of HPV in a sample of cells taken from the cervix or vagina. While the speculum is in place for the physical examination, the doctor will use a small brush or swab to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two.

The sample is sent to a laboratory to check for HPV. If HPV is found, the pathologist will do an additional test on the sample to check for cell changes.

Further tests

 

Once the cancer is confirmed, you may have some of the following tests to determine the size of cancer and find out whether it has spread.

Blood tests: These checks your general health, and how well your kidneys and liver are working.

CT scan: A CT (computerized tomography) scan uses x-ray beams to create detailed pictures of the inside of your body. Before the scan, you may be given a drink or injection of a dye called contrast that makes the pictures clearer.

MRI scan:  An MRI (magnetic resonance imaging) scan uses a magnet and radio waves to create detailed pictures of the inside of your body. Sometimes dye is injected before the scan to make the pictures clearer. You will lie on a treatment table that slides into a metal cylinder that is open at both ends.

Ultrasound:  Uses sound waves to create a picture of an area of your body. It may be used to check the lymph nodes in your groin.

PET–CT scan:  A PET (positron emission tomography) scan combined with a CT provides more detailed information about cancer.

Proctoscopy: The doctor uses a slender tube with a camera and light (proctoscope) to look inside the rectum and anus. This can be done under local or general anesthetic.

Cystoscopy: The doctor uses a slender, flexible tube with a camera and light (cystoscope) to look inside the urethra and bladder. This can be done under local or general anesthetic.

 

Treatment for Vulvar Cancer

 

Specific treatment for vulvar cancer will be determined by your doctor(s) based on:

 

  *    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

 

Treatment for cancer of the vulva may include:

 

  * aser surgery: This surgery uses a powerful beam of light to destroy abnormal cells. The beam can be directed to specific parts of the body without making a large incision (cut). This type of therapy is only used for premalignant (non-invasive) disease of the vulva.

  * Excision: The cancer cells and a margin of normal tissue around the cancer are removed.        *Vulvectomy: All tissues of the vulvar are surgically removed.  The extent of the tissue removed is based on the size and location of the lesion.

  * Radiation therapy:   X-rays, gamma rays and charged particles are used to fight cancer.

  * Chemotherapy:   Anticancer drugs are used to treat cancerous cells.

 

Different stages of vulvar cancer

Stage 1   The tumour is only in the vulva or is only in the vulva and the perineum (the area between the vagina and anus). Stage 1 can be divided into stages 1A and 1B depending on the size of the tumour and how much the tumour has grown into surrounding tissues, such as connective tissue, blood vessels and nerves.

Stage 2     The tumour has grown into nearby areas, such as the lower part of the urethra, the lower part of the vagina or the anus.

Stage 3 cancer has spread to nearby lymph nodes in the groin. Stage 3 can be divided into stages 3A, 3B and 3C depending on how many of the lymph nodes contain cancer and the size of the lymph nodes.

Stage 4 cancer has spread to nearby lymph nodes in the groin. These lymph nodes are firmly attached to surrounding tissues (fixed) or have broken open (ulcerated) (stage 4A).

    The tumour has grown into nearby areas, such as the upper part of the urethra, the upper part of the vagina, the inner lining of the bladder or the inner lining of the rectum. Or the tumour has attached to the pelvic bone (stage 4A).

    Cancer has spread to other parts of the body, such as to the lungs or lymph nodes in the pelvis (stage 4B). This is also called metastatic vulvar cancer.

Prevention

      Reduce your risk of sexually transmitted infections To reduce your risk of vulvar cancer, reduce your risk of the sexually transmitted infection HPV:

      Use a condom every time you have sex. Condoms may reduce your risk of contracting HPV but can't fully protect against it.

     Get the HPV vaccine.  Children and young adults may consider the HPV vaccine, which protects against the strains of the virus that are thought to cause most cases of vulvar cancer.

Ask your doctor how often you should undergo pelvic exams. These exams allow your doctor to visually examine your vulva and manually examine your internal reproductive organs to check for abnormalities.

Talk to your doctor about your risk factors for vulvar cancer and other pelvic cancers in order to determine the most appropriate screening exam schedule for you.

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