Cancer of the Vulva
The vulva refers to the area that contains the external female reproductive organs. Cancer of the vulva (vulvar carcinoma) is the fourth most common gynecologic cancer, accounting for only 3 to 4% of these cancers. Vulvar cancer usually occurs after menopause. The average age at diagnosis is 70 years. As more women live longer, this cancer is likely to become more common.
The risk of developing vulvar cancer is increased for women who have persistent itching of the vulva, have genital warts due to human papillomavirus (HPV), or have had cancer of the vagina or cervix.
Most vulvar cancers are skin cancers that develop near or at the opening of the vagina. About 90% of vulvar cancers are squamous cell carcinomas, and 5% are melanomas. The remaining 5% include basal cell carcinomas and rare cancers such as Paget's disease and cancer of Bartholin's gland.
Vulvar cancer begins on the surface of the vulva. Most of these cancers grow slowly, remaining on the surface for years. However, some grow quickly. Untreated, vulvar cancer can eventually invade the vagina, the urethra, or the anus and spread into lymph nodes in the area.
Symptoms and Diagnosis
White, brown, or red patches on the vulva are precancerous; that is, they may indicate that cancer is likely to eventually develop. Vulvar cancer is usually seen and felt as unusual lumps or flat, red sores that do not heal. Sometimes scaly patches develop or the area becomes discolored. The surrounding tissue may contract and pucker. Usually, vulvar cancer causes little discomfort, but itching is common. Eventually, the lump or sore may bleed or produce a watery discharge (weep). These symptoms should be evaluated promptly by a doctor. About one fifth of women have no symptoms, at least at first.
Doctors diagnose vulvar cancer by performing a biopsy of the abnormal skin. The biopsy can identify whether the abnormal skin is cancerous or just infected or irritated. It also identifies the type of cancer, if present, so that doctors can develop a treatment plan. Sometimes doctors apply stains to the sores to help determine where to take a sample of tissue for a biopsy. Sometimes an instrument with a binocular magnifying lens (colposcope) is used to examine the surface of the vulva.
Prognosis and Treatment
If vulvar cancer is detected early, about 3 of 4 women have no sign of cancer 5 years after diagnosis. If the lymph nodes are involved, less than one third of women survive for 5 years.
Because most vulvar cancers can spread quickly, surgical removal of the vulva (vulvectomy) is usually necessary. Depending on the extent of the cancer, all or part of the vulva is removed. Sometimes nearby lymph nodes are also removed. Treatment with radiation therapy, chemotherapy, or both may be used to shrink very large cancers so that they can be surgically removed. Sometimes the clitoris must be removed. Doctors work closely with the woman to develop a treatment plan that is best suited to her and takes into account her age, sexual lifestyle, and any other medical problems. Sexual intercourse is usually possible after vulvectomy.
For some small vulvar cancers that do not extend below the skin, treatment consists of removal with a highly focused beam of light (laser surgery), surgical removal of only the skin, or use of an ointment containing a chemotherapy drug (such as fluorouracil). Some small cancers are treated with radiation therapy alone.
Because basal cell carcinoma of the vulva does not tend to spread (metastasize) to distant sites, surgery usually involves removing only the cancer. The whole vulva is removed only if the cancer is extensive.
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