Vulvar cancer

Vulvar cancer is a relatively rare gynaecologic cancer affecting the external female genital organs, particularly the labia, clitoris, and vaginal opening. Most cases are squamous cell carcinomas, which originate in the thin, flat cells lining the vulva. Vulvar cancer primarily affects older women but can occur at any age.

Timely diagnosis and treatment can significantly improve outcomes. However, due to limited awareness, the condition is often diagnosed at a later stage. Understanding the signs, risk factors, and modern treatment methods can empower women to seek medical advice early.

Vulvar cancer occurs when abnormal cells grow uncontrollably in the tissues of the vulva. The vulva includes the outer lips of the vagina (labia majora and labia minora), clitoris, and vaginal opening. It often starts as precancerous changes called vulvar intraepithelial neoplasia (VIN), which can develop into invasive cancer over time.

There are several histological types of vulvar cancer:

• Squamous Cell Carcinoma: The most common type, accounting for over 90% of cases.
• Adenocarcinoma: Originates from glandular cells.
• Melanoma: Starts in pigment-producing cells.
• Basal Cell Carcinoma: Rare and less aggressive.

India

Vulvar cancer is rare in India but not negligible. According to the National Cancer Registry Programme, vulvar cancer accounts for approximately 3-5% of all gynaecological cancers. It is more frequently diagnosed in women aged 60 and above.

Worldwide

Globally, vulvar cancer represents about 4% of all gynaecologic cancers. The American Cancer Society estimates around 6,000 new cases are diagnosed annually in the United States alone. Higher rates are observed in older women and in regions with better access to screening.

• Squamous Cell Carcinoma: Begins in the skin cells and is often linked to HPV infection or lichen sclerosus.
• Adenocarcinoma: Arises from sweat glands or Bartholin glands.
• Melanoma: Affects pigment cells; more aggressive and prone to spreading.
• Basal Cell Carcinoma: Slow-growing and usually not life-threatening.

Vulvar cancer is usually caused by changes (mutations) in the DNA of vulvar cells. These mutations can be influenced by:

• Human Papillomavirus (HPV): Particularly types 16 and 18.
• Lichen Sclerosus: A chronic skin condition causing thin, white patches.
• Ageing: Risk increases with age, especially after menopause.
• Smoking: Tobacco use weakens the immune system and affects cell health.
• HIV or Immunosuppression: Increases vulnerability to HPV infections.
• Precancerous Conditions: VIN or Paget’s disease of the vulva.

Early symptoms may mimic other less serious conditions, making it difficult to diagnose. Common symptoms include:

• Persistent itching, burning, or pain in the vulva
• A lump, ulcer, or growth on the vulva
• Bleeding not related to menstruation
• Changes in vulvar skin colour or texture
• Pain during urination or intercourse
• Swelling or enlarged lymph nodes in the groin

• Physical Examination: Inspection of the vulva for abnormalities.
• Biopsy: A small tissue sample is examined for cancer cells.
• Colposcopy: Magnified visual examination of the vulva.
• Imaging Tests: CT scan, MRI, or PET scan to check for metastasis.
• Blood Tests: To evaluate overall health and identify markers.

Surgical Options

• Local Excision: Removal of cancerous tissue with a margin of healthy tissue.
• Vulvectomy: Partial or complete removal of the vulva.
• Lymphadenectomy: Removal of lymph nodes to check for spread.

Radiation Therapy

• Used pre- or post-surgery to shrink tumours or kill remaining cancer cells.

Chemotherapy

• Administered in advanced or recurrent cases. Drugs like cisplatin are commonly used. (Celplat 50mg Injection and Cismax 50mg Injection)

Targeted Therapy and Immunotherapy

• Emerging treatments focus on specific genetic mutations or immune responses, especially in HPV-linked cancers.

While not a replacement for medical treatment, alternative therapies may provide symptom relief and emotional support:

• Acupuncture: Helps reduce pain and anxiety.
• Herbal Supplements: Should only be used under professional guidance.
• Yoga and Meditation: Promote mental well-being.
• Nutritional Therapy: A balanced diet supports recovery.

• Age over 60
• HPV infection
• Lichen sclerosus
• Smoking
• Weak immune system
• History of cervical or vaginal cancer
• Chronic vulvar inflammation

• Lymph node metastasis
• Recurrence of cancer
• Sexual dysfunction
• Urinary or bowel issues due to surgery or radiation
• Emotional and psychological distress

• Follow-up regularly with your oncologist.
• Use prescribed creams or medications to manage symptoms.
• Attend support groups for emotional strength.
• Seek sexual counselling if experiencing intimacy issues.
• Maintain open communication with your healthcare team.
• Practice good hygiene to prevent infections.

• "Only sexually active women get it" – Non-sexually active women can also develop vulvar cancer.
• "It’s caused by poor hygiene" – Hygiene is important but not a direct cause.
• "It’s always fatal" – Early diagnosis significantly increases survival rates.
• "Young women aren’t at risk" – Though less common, it can occur in younger women

• Persistent vulvar itching or burning
• Unusual lumps or sores
• Vaginal bleeding outside of menstrual cycles
• Pain during urination or sex
• Any changes in vulvar appearance or skin

Early consultation leads to timely diagnosis and treatment.

• What stage is my cancer?
• What treatment options do I have?
• Will I need a vulvectomy?
• Are there fertility or sexual health concerns?
• How will treatment affect my daily life?
• Are there any clinical trials available?

• Offer emotional and practical support.
• Encourage adherence to treatment.
• Be patient with mood changes.
• Help with transportation or daily chores.
• Join them during medical appointments if needed.
   

Vulvar cancer, though rare, is a serious condition that warrants awareness and timely intervention. With advancements in medical science, early-stage vulvar cancer is highly treatable. Women should be encouraged to speak openly about symptoms and undergo regular gynaecological examinations. Education, emotional support, and early treatment can make a world of difference in improving outcomes and quality of life.