Also called as Vulvar Cancer, Vulval Cancer is a rare occurrence in women and usually occurs in and around the vulva, the region on the external surface of a woman’s genitals (including the skin in and around the vagina, urethra, labia and the clitoris).
In most cases, vulval cancer is not immediate but develops over a period of several years. The cancer is usually preceded by a condition called dysplasia or Vulvar Intraepithelial Neoplasia (VIN) which is characterized by the growth of precancerous cells in and around the vulva.
Initial symptoms include the formation of lumps or sores in and around the vulva followed by an itching or burning sensation in the area. In certain cases, mild bleeding or spotting can be seen before or after regular menstrual cycles.
Common Causes and Risk Factors of Vulval Cancer in Women
Like any form of cancer, there are no specific reasons for vulval cancer to affect a woman. Like most cases, vulval cancer is caused when DNA mutations in the cell cause it to multiply rapidly and kill healthy cells in the process. In the case of vulval cancer, these cancerous cells start occurring in the vulva. With time, the cancerous cells would accumulate to form a cancerous growth and start invading adjacent tissues and eventually spread to other parts of the body.
Vulval cancer in women is associated with certain risk factors. These include age (more prevalent in women above 50 years of age), smoking, skin conditions related to the vulva (like lichen sclerosus), HIV (reduced immunity levels can increase the risks of HPV infections and subsequent vulval cancer), exposure to human papillomavirus (HPV) infections (that can cause cell changes and increase risks of vulval and cervical cancer in women) and VIN (precancerous condition that can increase the risks of vulval cancer).
Different Symptoms of Vulval Cancer in women
The initial symptoms of vulval cancer would include the formation of ulcers, lumps or bumps on the skin, vulval pain, tenderness, skin discoloration, burning or itching sensation in the region and bleeding/spotting (apart from regular menstruation).
Vulval cancer may also cause other symptoms like increased sensitivity (in and around the affected area), painful urination (also called ‘Dysuria’) and painful intercourse (also called ‘Dyspareunia’). Symptoms like abnormal bleeding and extreme pain in and around the vulval region would most likely warrant an immediate visit to the doctor.
Different Types of Vulval Cancer in Women
Vulval cancer has many different variations that can either be benign or malignant. The general variations of the condition include:
Squamous Cell Carcinoma
which accounts for more than 90% of all cases of vulval cancer and usually occurs as flat cells (resembling fish scales) on the outer skin layers.
which resembles squamous cell carcinoma and appears as a wart which grows slowly.
usually forms in the glandular tissue that lines the vulva and accounts for a miniscule proportion of the condition.
which accounts for nearly 6% of all cases of vulval cancer and resembles the characteristics of melanoma that occurs in other areas of the body. Vulval melanoma has high chances of spreading to other parts of the body.
which is usually malignant and occurs in and around the connective tissues. Sarcoma is extremely rare and accounts for less than 1% of all cases of vulval cancer.
General Prognosis – The Stages involved
The general prognosis for vulval cancer depends on the particular stage of the disease. Vulval cancer is categorized into 5 different stages that would help describe the complexity of the disease and aid the doctor in choosing the best possible treatment for the individual in question.
The different stages of vulval cancer in women include Stage I (a localized tumor that is small and has not yet spread to other parts of the body), Stage II (multiple tumors that have reached out to neighboring areas like the vagina, urethra and anus), Stage III (tumors have spread to the lymph nodes), Stage IV A (tumors have spread to the lymph nodes, urethra, vagina, bladder, rectum and pelvic bone etc.) and Stage IV B (metastasized cancer cells have spread to other distant areas of the body)
Diagnosis of Vulval Cancer
Diagnosis of vulval cancer involves a preliminary evaluation which would include a thorough examination of the vulva (including the urethra, vagina, clitoris, anus and the glands) to spot possible lumps, lesions, ulcerations or suspicious masses. A biopsy is recommended in case a suspicious lump or mass is detected.
Once the biopsy results are in, the doctor may recommend a few more tests to diagnose the condition. These include a Proctoscopy (checking the rectum for the presence of cancer cells), Cystoscopy (checking the bladder for the presence of cancer cells) and Imaging Scans (like X -Rays, MRI scans or CT scans to determine the location of the cancerous growth and how far it has spread.
Treatment Options available for Vulval Cancer
The earlier vulval cancer is detected and diagnosed, the better. The best treatment option for vulval cancer is surgery which would be simple in case of localized cancer and more extensive in case of metastasized cancer (which has spread to neighboring areas like the vagina, urethra and rectum). The different surgical options available for vulval cancer in women include:
This procedure is usually opted for during the early stages of the disease and can effectively eradicate localized cancer cells that have not yet spread to the adjacent regions or other areas of the body.
This procedure involves surgically removing the cancerous growth from the vulva. Usually, a bit of healthy tissue is removed along with the growth in order to prevent the cancer cells from spreading to nearby areas.
This procedure involves surgically removing the upper layer of the skin (in and around the vulva) which houses the cancerous growth. Using skin grafting techniques, the doctor would then replace the skin in the vulva with healthy skin taken from another part of the body.
If the cancer has spread extensively to the areas around the vulva, the doctor would recommend a radical vulvectomy which would involve surgically removing the entire vulva (including the vaginal lips, vaginal opening and the clitoris) along with a few lymph nodes attached to the vulva.
Radiation Therapy and Chemotherapy
In case the tumors are either too deep or too extensive (spread to other parts of the body) to be treated by the other options mentioned above, radiation therapy or chemotherapy would be used to first shrink the cancer cells before removing them from the body.
This form of treatment can also be used for the lymph nodes that are attached to the cancerous growth.
Follow Up Care
After a surgery for vulval cancer, the individual in question would need to opt for regular follow up visits to the doctor to check for recurrences. In case the surgery involved the removal of excess skin or tissue from the region, the doctor would recommend reconstructive surgery via skin grafts or skin flaps to restore both the appearance and function in the area.
After undergoing treatment for vulval cancer, an individual would need to take preventive measures to make sure the disease does not recur. Some of the preventive measures that need to be adopted to stay safe from recurrent vulval cancer include safe sex, routine cervical smear examinations, routine HPV vaccinations and certain lifestyle changes (for example, not smoking).