Vulvar cancer (patient information)

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 * Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Vulva is a woman's external genitals. Vulvar cancer is a rare type of cancer. It develops slowly over several years. Vulvar cancer doesn't have any early symptoms. With the development of the cancer, frequent symptoms include a lump in the vulva, vulvar itching or tenderness, and bleeding that is not your period. Being older and having a human papillomavirus infection are risk factors for vulvar cancer. Treatment includes laser therapy, surgery, radiation therapy or chemotherapy.

What are the symptoms of Vulvar cancer?
Early vulvar cancer does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:


 * A lump in the vulva


 * Vulvar itching or tenderness


 * Bleeding that is not your period

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at highest risk?
Clinical data has suggested that the development of vulvar cancer is related to several factors.


 * Human papilloma virus (HPV): Clinical survey shows HPV infection is thought to be responsible for up to half of vulvar cancers overall, and most of the cases that occur in younger women.
 * Human immunodeficiency virus (HIV): Scientists found that HIV can damage the body's immune system and make women more susceptible to persistent HPV infections.
 * Vulvar intraepithelial neoplasia (VIN): Clinical data suggest that women with VIN have an increased risk of developing invasive vulvar cancer.
 * Lichen sclerosus (LS): Epidemiological data show about 4% of women with LS develope vulvar cancer later.
 * Melanoma or atypical moles: Epidemiological data have verified that melanoma or atypical moles increase the risk of developing vulvar cancer.
 * Smoking: Smoking can further increases the risk of developing vulvar cancer.
 * Age: The risk of vulvar cancer goes up with age and the average age of women diagnosed with invasive vulvar cancer is 70.

When to seek urgent medical care?
Call your health care provider if symptoms of vulvar cancer develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * A large amount of bleeding in vulva

Diagnosis
To diagnose vulval cancer, the physician may decide to do the following:
 * Biopsy: This is the most important test for vulvar cancer. In this procedure, your gynecologist remove a small piece of tissue from the suspicious area and then it will be examined under the microscope.
 * Computed tomography (CT) scan: CT scans are often used to diagnose kidney cancer. It can confirm the location of the cancer and show the organs nearby, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful for determining the stage of the cancer and in determining whether surgery is a good treatment option.
 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.

Treatment options
Patients with vulvar cancer have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.


 * Surgery: The goal of surgery is to remove all the cancer and maintain the sexual function of the patient. It includes laser surgery, excision and vulvectomy.
 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.
 * Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Drugs often used include cisplatin, mitomycin, and fluorouracil (5-FU).

Where to find medical care for Vulvar cancer?
Directions to Hospitals Treating Vulvar cancer

What to expect (Outlook/Prognosis)?
The prognosis depends on:


 * The stage of the cancer
 * Whether or not the tumor can be removed by surgery
 * The patient’s general health
 * Whether the cancer has just been diagnosed or has recurred

How will vulvar cancer affect my sex life?
Impact of the cancer on sex life vary greatly among people with some people having no or little change based on the physical and emotional stress they are experiencing. Some people feel even closer to their partners and have increased desire for sex during this time. Though pregnancy may be possible during the treatment, it is not recommended as some drugs could cause birth defects.

Radiotherapy for vulvar cancer can cause an early menopause as well as scarring, dryness and vaginal narrowing and may be associated with pain when having sex. Your doctor may advice you to use dilators to stop the vagina shrinking and narrowing and some gels and creams to moisturise the vagina and vulva and prevent soreness.

Prevention

 * Avoidance infection of HPV: Keeping a healthy sex behavior, using condom, injecting HPV vaccine.
 * Detecting pre-cancerous conditions: A Pap test and pelvic examination need to be done for adult women. Other tests recommended include HPV DNA test and vulva self-examination.
 * Quitting smoking