Vulvar Cancer Treatment in Mumbai, India

Vulvar cancer is defined as cancer or tumorous growth of the female genital or reproductive organs, mainly around the outer lips of the vagina.

Associated Anatomy

Vulvar or vulva is a part of the female vagina that consists of outer lips, labia, clitoris, perineum and mons pubis.

Alternate Name

Vulval cancer

Pathophysiology

Vulvar cancer can cause mutations in healthy tissues and cause the spread of cancer. The lungs, kidneys, rectum, anus and the urinary system may get affected, thus causing loss of function in the affected organs.

Vulvar Cancer Symptoms

• Itching, pain, swelling or lump formation around the vagina.
• Skin discolouration and tenderness.
• Painful sexual intercourse.
• Thickened skin and ulceration.
• Painful urination.
• Bleeding.
• Painful vaginal discharge.
• Physicians or health professionals may notice tenderness, thick skin and swelling on palpation. Warts may be seen around the affected area.

Vulvar Cancer Causes

There is no definite cause, but some females may be predisposed to cancerous growths due to genetic mutations.

Stages of Vulvar Cancer

• Stage 0: or carcinoma in situ: Cancer is only on the surface of the skin.
• Stage 1: Cancer is limited to the vulva or perineum and is up to 2 cm in size.
• Stage 2: Similar to stage 1, the tumor is at least 2 cm in size.
• Stage 3: Cancer has reached nearby tissue, like the anus or vagina, and may have reached the lymph nodes.
• Stage 4: Cancer has spread to the lymph nodes on both sides of the groin, and bowel, the bladder, or the urethra.

Additional Types of Vulvar Cancer

Vulvar cancer can be of various types depending on the type of tissue affected in the vulvar area of the female genital organs.

• Squamous cell carcinoma: Most common with fish-like scales of cancerous tissue.
• Adenocarcinoma: Looks like a cyst and forms in the Bartholin's glands in the vaginal area.
• Melanoma:Melanoma is related to skin. Sometimes the skin of the vulva is the source of cancer.
• Sarcoma: This type occurs in bones surrounding the vulva and related tissues and the occurrence is extremely rare.
• Basal cell carcinoma: It also occurs in skin tissue exposed to sun and other forms of radiation but is rare in vulvar cancer.

Vulvar Cancer Treatment

• Surgery: Vulvectomy is aimed at removing the cancerous growth and leaving urination and sexual function intact. Other surgical options include the use of laser-assisted ablation of cancerous tissue (removal of cancer and surrounding healthy tissue).
• Radiation: The surgical area is exposed to radiation therapy to shrink deep-seated cancerous cells. This makes it easier to remove them during surgery.
• Chemotherapy: Drugs are used as palliative care to maintain a symptom-free state and prevent a recurrence.
• Rehabilitation: Some individuals may require compensatory rehabilitative therapies to improve their quality of life and independence in daily activities.
• Counselling: Patient and caregiver counselling are necessary to prevent further growth and spread of cancer as well as good hygienic practices.

Vulvar Cancer Diagnostic Tests

• A thorough gynaecology assessment is performed by a physician or gynaecologist. A detailed history is also obtained for symptoms and risk factors.
• Diagnostic tests involve doing a biopsy for lesions or mass seen or felt around the vagina to confirm the presence of cancer. It also checks for any infectious source and staging of cancer.
• Additional tests are conducted depending upon the initial examination, such as cystoscopy (scanning of bladder walls and ureter), proctoscopy (examination of the rectal walls and tissue) and an MRI or X-ray to confirm migration of cancer to other body parts.

Vulvar Cancer Prevention

Primary Prevention

To reduce the risk of developing vulvar cancer, women of all ages are recommended the following:

• Regular health screening: Pap smears or pelvic examination from a certified health professional may prove beneficial in diagnosing cancer at an early stage.
• Self-examination: One must check for abnormal swelling or unusual discharge from the vagina.
• Use of protection during sexual intercourse: This prevents sexually transmitted diseases and eventually reduces the risk of vulvar cancer.

Secondary Prevention

• After one is diagnosed with vulvar cancer, the use of protection during sexual intercourse is a must, and it also calls for good hygiene practices.
• Regular follow-up with a doctor for recurrent lesions and rehabilitation.

Epidemiology

• Age: Occurs in females above the age of 70 but may occur secondary to other cancers in the body due to metastasis.
• Race and religion: It usually has no significant racial and religious barriers.
• Genetic predisposition: Plays an important role in such cancers.

Prognosis

Expected Prognosis

The life expectancy of treatable vulvar cancer is more than 90% when diagnosed at an early stage. The percentage reduces when there is significant metastasis to other organs and the presence of comorbidities. Quality of life is fairly good.

Natural Progression

When neglected or undiagnosed, vulvar cancer may spread to other organs and can also lead to loss of sexual and urinating function. Life expectancy goes down to 16% in this stage.

Vulvar Cancer Risk Factors

Modifiable risk factors are reasons that cause vulvar cancer and can be changed or prevented.

• Unprotected sex: It may expose an individual to fungal and viral infections.
• Multiple sexual partners: There is an increased risk of contracting sexually transmitted diseases, particularly HIV and AIDS.
• Smoking: It reduces the ability of the body to defend itself and makes an individual prone to abnormal tissue growths.
• Cervical cancer: Women with cervical cancer are prone to develop vulvar cancer due to metastasis and therefore need to take extra precautions.
• Human Papillomavirus (HPV) infection: A viral infection that affects the female reproductive system may also cause vulvar cancer.

Non-modifiable risk factors are reasons that cannot be changed or modified.

• Age: Vulvar cancer usually occurs in women above 70 years of age.
• Genetic predisposition: Some females may acquire it from their parents or have genetic mutations within their cells.

Vulvar Cancer Complications

Complications include multiple organ failure, loss of sexual function, damage or loss of bladder and bowel function, and side effects of chemotherapy and radiation exposure. Vulvar cancer may also prove to be fatal in long-standing cases.

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