Cancer of the vulva is a rare female cancer affecting the external genitals. Based on U.S. cancer rates between 2006-2008, it is estimated it will affect 1 in 372 women. The death rate is 0.5 per 100,000. It is a cancer that affects mainly elderly women, although it can occur at any age.
Who is at Risk of Cancer of the Vulva?
Certain groups of women may be more likely to get cancer of the vulva than others. These are the elderly, women who smoke, women with Paget’s disease, and HPV infection.
HPV is often present in the body but may not cause any problems. However, for women whose have impaired immune systems it can cause changes to the vulva and sometimes cancer). About half of all cancers of the vulva are linked to infection with the high-risk HPV types.
Women with pre-existing conditions of the vulva can also be more prone to getting cancer of the vulva, for instance, those with lichen sclerosus or lichen planus of the vulva.
Symptoms are:
• Persistent itching of the vulva
• Burning pain in the vulva
• Soreness and patches on the skin (red, raised or darkened patches)
• Pain when touching the vulva
• Sores or ulcers on the vulva
• Bleeding in between periods
• Burning pain when you urinate
• A lump or swelling on the vulva, possinbly resembling a wart)
If you have any of these symptoms, don’t panic as they may be due to other causes (for instance, sexually transmitted infections, thrush, vulvodynia, etc.) but it is a good idea to get checked by a doctor just in case.
Diagnosis
Your doctor will take a full medical history and examine you. This will include an examination of the vulva and a vaginal examination. You may also be given a smear test.
If you are embarrassed or upset you can ask to be examined by a female doctor. If you tell the doctors how you feel they can do things to help you feel less self-conscious, such as putting a sheet over your abdomen.
If you have any lumps, a biopsy will be taken (a small sample of tissue). A local anaesthetic cream will be put on your skin first, followed by an injection so you don’t feel the pain.
If you are in too much pain or you have a pre-existing vulval condition that makes examination and/or biopsy very painful, it can be done under a general anaesthetic.
If the sample is cancerous, further tests can be done to determine how far the cancer has spread (for instance, CT scans and MRI scans).
Treatment
Medical treatment for cancer of the vulva varies from patient to patient but usually involves surgery, radiotherapy or chemotherapy.
For a small cancer that hasn’t spread, the cancerous tissue can be removed from your vulva (with a tiny amount of healthy tissue as a precaution). The area is then stitched.
For a bigger cancer, a vulvectomy can be done. This involves removing the external genitals including the vulva, labia (one or both) and the clitoris. It may be possible to reconstruct the vulva. The choice whether to have this type of radical surgery will always be yours.
Radiotherapy
This is using X-rays to destroy cancerous cells and may be done after surgery to kill off any remaining cancer cells that may have been left behind. A machine either fires radioactive waves at the affected area or, in some cases, it will be done internally. In internal radiotherapy, an radioactive implant is placed into the cancerous tissue.
Side Effects of Radiotherapy to the Vulva
Side effects include:
• Loss of pubic hair
• Swelling of the vulva
• Sore skin around the vulva
• Narrowing of the vagina and difficulties with sexual intercourse
• Cystitis
• Infertility
• Extreme tiredness
These are only a few of the side effects that can occur after having radiotherapy.
Chemotherapy
Chemotherapy is using chemicals to destroy cancer, and it is sometimes used in conjunction with radiotherapy. Chemotherapy is given by injection, through a pump or through intravenous infusion (IV).
Side Effects of Chemotherapy include:
• Nausea and vomiting
• Nerve damage
• Sore throat and mouth
• Mouth ulcers
• Hair loss
• Fatigue
• Diarrhea
• Memory loss
• Pain
• Cracked nails, dry skin
• Swelling
• Trouble urinating or the need to go more often
• Lack of sex drive
• Hot flashes
• Itchy vagina
• Lack of period
• Vaginal and bladder infections and other opportunistic infections
• Weakened immune system
These are only a few examples of the side effects that can occur after chemotherapy.
Prevention
There is no way to prevent cancer of the vulva, but you can minimize your risk by quitting smoking or not taking it up, and using condoms. If you have a skin condition of the vulva, you should also see the gynecologist regularly to ensure you are not developing cancer.
Sources:
SEER Stat Fact Sheets: Vulva, National Cancer Institute. Web. 5 March 2012. http://seer.cancer.gov/statfacts/html/vulva.html#incidence-mortality
Diagnosis of vulval cancer, Macmillan Cancer Support. Web. 5 March 2012. http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Symptomsdiagnosis/Diagnosis.aspx
Vulvar Cancer. American Cancer Society. Web. 5 March 2012.
http://www.cancer.org/Cancer/VulvarCancer/DetailedGuide/vulvar-cancer-risk-factors
Treating vulval cancer, NHS Choices. Web. 5 March 2012. http://www.nhs.uk/Conditions/Cancer-of-the-vulva/Pages/Treatment.aspx
Intravenous (IV) chemotherapy, Cancer Research UK. Web. 5 March 2012. http://cancerhelp.cancerresearchuk.org/about-cancer/treatment/chemotherapy/having/iv-chemotherapy
Chemotherapy Side Effects Fact Sheets, National Cancer Institute. Web. 5 March 2012.
http://www.cancer.gov/cancertopics/coping/chemo-side-effects
Reviewed March 5, 2012
by Michele Blacksberg RN
Edited by Jody Smith