Vulvar cancer is a rare cancer that occurs in elderly women.
The vulva is the skin in between a woman’s legs which consists of the outer and inner lips, the clitoris between the inner lips, the opening of the urinary passage called urethra and the vaginal opening. Behind the vagina, the area between the vagina and the anus is termed as the perineum.
Causes of vulvar cancer
- Vulvar cancer occurs in women in their sixties although it can occur earlier as well.
- The cause of this particular cancer is unknown. One theory states that if precancerous cells are present in the vulva, chances of acquiring vulvar cancer are higher.
- Women exposed to the human papilloma virus (HPV) and those affected with HIV are more likely to get this cancer.
Symptoms and signs of vulvar cancer
- Abnormal bleeding from the vagina or vulva: different from menstruation
- Itching in the private areas
- A sore in the vulva which does not go away
- Inflammation of the vulva which does not subside even after treatment.
- Pain during urination
Diagnosis of vulvar cancer
Vulvar cancer may be diagnosed during a routine visit to the gynaecologist or if any of the above symptoms or signs are present. The doctor will ask for a detailed medical history, family history of vulvar cancer, sexual habits and partners and related topics. It is important not to withhold any information as it will be confidential and only between you and the doctor.
A thorough local examination is done to check for sores, bleeding, infection or an abnormal growth. With a magnifying device, an examination is done in the vulva. A manual pelvic examination is also done to identify spread to the pelvis.
The doctor may perform a biopsy (taking a small sample of tissue from the affected region) and send it for laboratory analysis. If cancerous cells are found, further consultation with an oncologist is required.
Routine blood tests as well as those to determine HIV and HPV are done.
Imaging tests like CT scan or MRI of the abdomen or chest are done to rule out spread of the cancer.
A cancer has to be staged to identify and pursue a further course of treatment.
Stage 1: The cancer is limited to the vulva
Stage 2: The cancer has spread to nearby structures like the urethra or vagina
Stage 3: Cancer spread to the nearest lymph nodes (located at the skin crease between the pelvis and legs)
Stage 4 A: Cancer that spread to the upper part of the urethra or vagina or urinary bladder or rectum or to all the local lymph nodes
Stage 4B: Cancer that has spread to other distant parts of the body (called metastasis)
Treatment of vulvar cancer
Most stage 1 & 2 cancers can be completely cured by surgery. The surgeon removes the cancerous growth as well as a rim of healthy tissue around it. This is to make sure that the surgeon has removed all the possible cancer cells so that the cancer does not recur.
A big tumour can be shrunk using radiotherapy or chemotherapy and then is surgically removed. This procedure ensures a better success rate than surgery alone.
During surgery, the clitoris (the sensitive tissue that is responsible for female orgasms) may have to be removed so discuss the possibility of not being able to reach orgasm with your partner.
If extensive surgery is done, the urethral opening and the anus will be removed. So an opening called a stoma is created to pass out urine and another for faeces.
What you can do as a patient
Ask your doctor for reading material pertaining to vulvar cancer and read up about the condition on the internet. Being informed can help you discuss your treatment plan better with your doctor.
Join a cancer support group in your area. Also seek support of close family or friends, a counsellor or a spiritual guide.
Photograph via sxc.hu
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