Vulvar Cancer

What it is:

Vulvar cancer is a rare type of cancer. It forms in a woman's external genitals, called the vulva. The cancer usually develops slowly over several years. First, precancerous cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer, but it is best to treat it early.

How we find it:

Often, vulvar cancer doesn't cause early symptoms. However, see your doctor for testing if you notice

  • A lump in the vulva
  • Vulvar itching or tenderness
  • Bleeding that is not your period

The following tests and procedures may be used:

  • Physical exam and history — An exam of the body to check general signs of health, including checking the vulva for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Biopsy — The removal of cells or tissues from the vulva so they can be viewed under a microscope by a pathologist to check for signs of cancer.

How we treat it:

Four types of standard treatment are used:

  • Laser therapy — Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
  • Surgery — Surgery is the most common treatment for cancer of the vulva. The goal of surgery is to remove all the cancer without any loss of the woman's sexual function. One of the following types of surgery may be done:

    • Wide local excision — A surgical procedure to remove the cancer and some of the normal tissue around the cancer.
       
    • Radical local excision — A surgical procedure to remove the cancer and a large amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.
       
    • Vulvectomy — A surgical procedure to remove part or all of the vulva:

      • Skinning vulvectomy — The top layer of vulvar skin where the cancer is found is removed. Skin grafts from other parts of the body may be needed to cover the area.

      • Simple vulvectomy — The entire vulva is removed.

      • Modified radical vulvectomy — The part of the vulva that contains cancer and some of the normal tissue around it are removed.

      • Radical vulvectomy — The entire vulva, including the clitoris, and nearby tissue are removed. Nearby lymph nodes may also be removed. 

    • Pelvic exenteration — A surgical procedure to remove the lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

  • Radiation therapy — Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

  • Chemotherapy — Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, a body cavity such as the abdomen, or onto the skin, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Topical chemotherapy for vulvar cancer may be applied to the skin in a cream or lotion.

 

Source: National Cancer Institute