(LifeWire) - Vulvar cancer is a relatively rare disease that usually begins as a precancerous skin condition and progresses slowly. Because of its slow growth and often prominent symptoms, vulvar cancer is frequently diagnosed in its early stages -- a time when it is highly curable.
"Vulva" refers to the external female genitalia, and it includes the internal and external labia, vaginal opening, clitoris and perineum (space between the vagina and anus). Vulvar cancer is most often diagnosed in women over 60, and it may occur on any part of the vulva, but typically affects the labia.
Symptoms of Vulvar Cancer
Itching lasting more than 1 month is the most common sign of vulvar cancer. But several other symptoms may also signal the disease, including:
- A vulvar sore that fails to heal
- A growth on the vulva
- Vulvar pain
- Painful urination
- Bleeding other than menstruation
- Burning that persists in an area already treated for burning
- Any change in a birthmark or mole in the vulvar area
If you have any of these symptoms, see a doctor right away to rule out vulvar cancer or get the earliest possible diagnosis.
Causes and Risk Factors
Vulvar cancer accounts for only 1% of all cancers in women. Several conditions and habits increase a woman's risk, along with stage in life, such as the following:
- Older age is a factor. The average age of diagnosis is 69 years.
- Human papilloma virus (HPV) is a virus that is transmitted by sexual contact. The HPV virus can cause condyloma of the vulva, otherwise known as genital warts. HPV can also cause the skin cells of the vulva to become cancerous. HPV associated vulvar cancer is more common in younger women. In fact, some doctors believe vulvar cancers caused by HPV should be treated as a different disease from the cancer generally found in older women.
- Human immunodeficiency virus (HIV) is the virus that causes AIDS. HIV compromises the immune system, rendering women more vulnerable to HPV. A damaged immune system may also allow cancer cells to grow and spread more rapidly.
- Vulvar intraepithelial neoplasia (VIN) is the name for the abnormal cells that often precede vulvar cancer.
- Lichen sclerosus is a condition that thins the vulva and causes itching. Lichen sclerosus increases your chances of vulvar cancer by 4%.
- Cervical cancers are a risk factor for vulvar cancer, if one has a prior history.
- Melanoma is a type of skin cancer. Women who've had this type of cancer or any atypical mole anywhere on their body are at a higher risk for vulvar cancer.
- Smoking is a known risk factor for vulvar cancer. Smokers with HPV infection have a greater chance of developing vulvar cancer than infected non-smokers.
- Multiple sex partners and sexually transmitted diseases (STDs) in addition to HPV and HIV are also associated with vulvar cancer.
Diagnosing vulvar cancer is a two-step process: A physical examination of the vulva, and a biopsy of suspicious areas, which involves the removal of these suspicious cells for examination under a microscope.
The physical exam may include painting the area with a special dye that causes VIN and vulvar cancer to turn blue. If the area to be biopsied is small, a doctor may remove the whole area during the biopsy, a procedure which may require stitches.
Further examination of the biopsied cells will establish their grade (appearance of cells) and stage (size and extent of tumor). Grades are assigned in numerals 1 through 3, with grade 1 cells being near normal in appearance and grade 3 being the most abnormal. Lower grade cells grow more slowly and are less apt to spread.
The different stages of progression help doctors determine how to best treat the cancer. All vulvar cancers can be described by one of the following four stages:
- Stage I: Tumor is 2 cm or less, contained in the vulva or perineum and has not spread to the lymph nodes.
- Stage II: Tumor is larger than 2 cm, confined to the vulva and/or perineum and has no obvious presence in the lymph nodes.
- Stage III: Cancer extends into the vagina, anus, lymph nodes and groin, and/or lower urethra (tube extending from the bladder that empties urine from the body).
- Stage IV: Malignancy has spread to the upper urethra, bladder, bowels or bones, or it has reached the lymph nodes, groin and other parts of the body.
More than 60% of vulvar cancers are diagnosed in stage I or II, when the 5-year survival rate is greater than 90%.
Treating vulvar cancer almost always involves surgery, the extent of which depends on the severity of the cancer. When the tumor is large, radiation may be used to shrink it before surgery.
Small cancers may be removed by a laser and larger ones by a scalpel. The removal of a large area is called a "vulvectomy," and after this procedure, a woman may undergo reconstructive surgery.
Chemotherapy or radiation may follow surgery if the cancer has spread to the lymph nodes.
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