Vulvar cancer most commonly affects elderly women in the post menopausal years. the vulva includes the inner and outer lips of the vagina (labia minora and majora), the clitoris and the opening of the vagina. Vulvar cancer most often affects the labia majora and less often, the labia minora or the clitoris.
Vulvar cancer starts in the external genitalia and can affect the vagina, urethra, bladder, and rectum in advanced. This only occurs with direct extension.Vulvar cancer is a very slow growing tumor and usually develops slowly over a period of years. Precancerous cells can grow on the surface of the vulvar skin for a long time. This precancerous condition is called vulvar intraepithelial neoplasia (VIN) or dysplasia. Because it is possible for VIN or dysplasia to develop into vulvar cancer, treatment of this condition is very important.
SIGNS AND SYMPTOMS
Vulvar cancer often does not cause early symptoms. When symptoms occur, they may be caused by vulvar cancer or by other conditions. A gynecologic oncologist should be consulted if any of the following problems occur:
- A lump in the vulva.
- Itching that does not go away in the vulvar area.
- Bleeding not related to menstruation (periods).
- Tenderness in the vulvar area.
TREATMENT
1. Laser Therapy
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
2. Surgery
Surgery is the most common treatment for cancer of the vulva. The goal of surgery is to remove all the cancer while restoring normal female anatomy 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 (margins).
- Radical local excision: A surgical procedure to remove the cancer and a large amount of normal tissue around it (margins). 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 vulva containing cancer and some of the normal tissue around it is removed.
- Radical vulvectomy: The entire vulva, including the clitoris, and nearby tissue is removed. Nearby lymph nodes may also be removed.
- Pelvic exenteration: This type of surgery is reserved for patients with advanced stage vaginal cancer (stage 4) or patients who have a recurrence of their vaginal cancer despite the conventional treatments. Our lead doctor is a world expert in exenterative procedure and the reconstruction that is required. Pelvic exenteration surgery removes the lower colon, rectum, and bladder. In women, 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 your doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given 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.
3. Radiation Therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to focus the radiation in the direction of the cancer. Internal radiation therapy or brachytherapy 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.
4. Chemotherapy
Chemotherapy is a cancer treatment that uses medicines to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect cancer cells throughout the body The way the chemotherapy is given depends on the type and stage of the cancer being treated.Topical chemotherapy for squamous cell vaginal cancer may be applied to the vagina in a cream or lotion.
