What is Vulvar Cancer?
Vulvar cancer occurs when cancerous cells form and rapidly multiply on the outer area of the female genitalia. This part of the human body is known as the vulva. It consists of the vestibule (opening of the vagina), the labia (inner and outer skin folds), the clitoris (sensitive tissue between the lavia), and the perineum (the area between the vagina and the anus).
Not to be confused with its cousin vaginal cancer (which occurs inside the vagina), vulvar cancer is very rare around the world. It is estimated to have about 50 new cases annually in Malaysia alone. Nevertheless, this cancer occurs mostly in older women of ages 65-75 and can be fatal.
Symptoms of Vulvar Cancer
The 10 most common symptoms of vulvar cancer are:
- Persistent itching that doesn’t go away
- An open cut or sore on the vulva that won’t heal
- A lump or mass on the vulva
- Pelvic pain during sex or when peeing
- Bleeding or unusual discharge from the vulva that is unrelated to menstrual bleeding
- A lasting soreness or a burning sensation in the genital area
- Colour changes of the vulva area (red, pink, or white)
- Texture changes of the vulva area (feeling rough or thick)
- Size changes of a mole or mark on the vulva
- Vulvar tenderness
Every woman experiences these symptoms differently. Since it may take several years for noticeable symptoms to develop, it is fundamental for every woman to go for regular screenings to ensure a healthy vulva.
If you experience one or more of the warning signs above, speak to a doctor or your gynaecologist immediately.
Causes & Risk Factors of Vulvar Cancer
Because this type of cancer is so rare, little is known about the exact cause of vulvar cancer. In general, researchers continue to study how gene mutation can turn normal cells into cancerous cells. Others found that human papillomavirus (HPV) and HIV (human immunodeficiency virus) infections could play a key role in vulvar cancers as you would read more of below.
Vulvar cancers involve modifiable and non-modifiable risk factors. These include but are not limited to:
- Age: Age-related changes make one more susceptible to this and many other cancers. Although, some cases of vulvar cancers can begin as early as 40 years of age.
- Lichen sclerosus: A skin condition that typically occurs around the genital or anal areas, making the skin patchy, white, and unusually thin.
- Exposure to cancer-causing agents: Cancer-causing chemicals found in carcinogens can increase the risk of cancer, including vulvar cancer.
- Exposure to HPV infection: HPV is a group of viruses that is sexually transmitted via skin-to-skin contact. It is also a common risk factor of vulvar cancer and cervical cancer.
- Exposure to HIV infection: Also contracted during sexual activity, HIV is another group of viruses that damages the immune system. It can also raise the risk of HPV or lengthen their infection.
- Other risk factors also include precancerous conditions or a family history of melanoma.
It is important to note that while some risk factors may increase your risk of developing vulvar cancers, most people are in the clear. That’s why it’s difficult to pinpoint which risk factor is the actual cause when a person is diagnosed with vulvar cancer.
Types & Stages of Vulvar Cancer
There are 5 main types of vulvar cancer, namely:
- Squamous cell carcinomas: A large, fungating mass that develops in the skin cells, resulting in an abnormal growth on the surface of the vulva. It is the most common of the five (making up 90% of vulvar cancers).
- Melanoma: Forms as dark pigmentation (black or dark brown, but can sometimes appear red or white) throughout the vulva, but mostly on the clitoris or labia. It is the second most common (making up 5% of vulvar cancers).
- Adenocarcinoma: Develops in the cells in the Bartholin’s glands right at the opening of the vagina.
- Sarcoma: A visible mass that occurs in the cells of bones, muscles, or connective tissues. Considered very rare.
- Basal cell carcinoma: Develops as lesions. While it is the most common type of skin cancer, it occurs very rarely on the vulva (less than 1%).
Vulvar Cancer Stages
Due to the complexity of stage grouping, we’ll cover only the four main stages by International Federation of Gynecology and Obstetrics (FIGO) to give you a general sense:
|Stage I||The cancer is present but confined to the vulva or the perineum.|
|Stage II||The cancer grows in size and extends into the lower third of the vagina or urethra, or the lower-third of the anus.|
|Stage III||The cancer continues to grow in size and spreads to one or more nearby lymph nodes. It does not spread to distant sites.|
|Stage IV||The cancer further spreads into other parts of the genitals. It may progress to form an ulcer and has fixed to nearby or distant lymph nodes, or pelvic bone.|
Cancer Care At Every Stage
Getting A Diagnosis for Vulvar Cancer
Can Vulvar Cancer Be Detected Early?
There is no standard screening for vulvar cancer, but getting regular screening can improve the chances of early detection and successful treatment. In other words, don’t wait around for any symptoms to show.
Your doctor will run one or more tests that are similar to that of ovarian screening:
The doctor will ask about family history and as well as your overall health, including symptoms, habits or medical conditions.
Physical & Pelvic Examination
Then, the doctor will perform blood tests and examine your physical body for any irregularities. This includes a pelvic exam where the doctor will feel your uterus, ovaries, cervix, and vagina.
In the case of any abnormalities, you may be referred to a gynaecologist (a physician or surgeon skilled in the female genital system) for further testing.
Colposcopy & Biopsy
In a colposcopy (also known as vulvoscopy), the doctor uses a magnifying instrument called a colposcope to zoom into the problem areas of the vulvar surface.
Next, the doctor will perform a biopsy. A biopsy is the removal of tissue or fluid to see if cancer or pre-cancer cells are present.
Imaging tests are used to create detailed cross-sectional images of the inside of your body. They’re extremely useful in detecting tumours and the spread. You would know them as X-rays, computed tomography (CT) scan, positron emission tomography (PET) scan, and magnetic resonance imaging (MRI).
The HPV test is done when your doctor will take cell samples from your cervix or vagina. This is to detect the presence of cancer-causing types of HPVs.
HPV testing is recommended once every 5 years in women aged 30 and above who have already had sexual intercourse. Women often schedule the test 14 days after the first day of their menstrual period.
Getting Treatment for Vulvar Cancer
Vulvar cancer can be treated, depending on factors like your age, cancer stage, and overall health condition. Your doctor will discuss some treatment options and how this might change your lifestyle. In several cases, they may suggest a combination of treatments. It’s a good idea to get a second opinion before you lock down your decision.
Similar to most other cancers, there are three main types of treatment for vulvar cancer:
Surgery is the most common treatment for vulvar cancer, especially when the cancer hasn’t spread beyond the vulva.
The surgeon performs a simple excision to remove the tumour and surrounding tissues. If the cancer has spread to the lymph nodes, the surgeon would also remove the affected lymph nodes to prevent further spreading into other parts of the body.
It isn’t uncommon that some doctors recommend radiation therapy and chemotherapy to shrink the tumour to ease the operation and minimise complications such as slow healing or infection.
Radiotherapy is a therapy that directs beam radiation from an X-ray machine to the vulva area to kill or shrink the cancer. It is considered the primary form of treatment when the tumour extends into the urethra or anus.
It is sometimes the only treatment needed. In other times, it will be used before surgery to make the operation less extensive or after surgery to kill any remaining cancer cells. Or it will be combined with other types of therapy, for instance, chemotherapy.
Chemotherapy uses drugs to kill rapidly-growing cancer cells and prevent them from growing and spreading in your body.
It effectively eliminates cancer in areas that cannot be successfully treated with surgery or radiation alone. Hence why it is widely used in advanced stages. It is also said to be the primary or sole treatment in many cancer cases.
The downside, however, is that it is commonly known to damage your healthy cells in the process. The side effects are namely hair loss, rashes, dryness of skin, nausea, vomiting, and diarrhoea.
Can We Prevent Vulvar Cancer?
It is possible to lower your risk of vulvar cancer. Below are five things you can practise to prevent cancer or reduce the chances:
- Make positive life changes like quit smoking and practise a healthy lifestyle overall.
- Avoid having multiple sexual partners to prevent HPV and HIV infections.
- Get HPV-vaccinated to protect from certain types of HPVs. Routine vaccination is necessary to reduce your risk of vulvar and cervical cancer.
- Schedule regular screenings to ensure your body is healthy. Remember, the earlier you get your diagnosis, the better your treatment outcomes will be.
- Limit your exposure to sunlight and cancer-causing substances.
What Happens After Treatment?
After treatment, you’re most likely going to have to do another round of tests periodically. This allows you to check for any signs if the cancer returns. Generally, it is recommended testing two to four times every year for the first two years after vulvar cancer treatment.
Besides that, you can turn to support groups and resources for assistance.
Support Group and Resources
A cancer diagnosis is truly a tough pill to swallow. Support groups are available for patients and their caregivers who are struggling in their battle with cancer. They provide you or your loved ones a place to share and find comfort in a community that understands best.
We recommend three active support groups in Malaysia:
Not only will you get to be part of a larger community of cancer survivors, you can also be sure to receive useful resources and aid ranging from wellness classes to counselling to financial assistance.
Interested to know more about these groups? Find more information about them here.
Care tips, straight to your inbox!
Like this article so far? Subscribe to us to get a weekly digest of the latest Homage happenings, caregiving tips and health guides.
Cancer care can take a toll on one’s physical and mental wellbeing. You don’t have to go it alone.
Have you considered engaging caregiving services? Whether you’re looking for cancer care support for yourself or for your loved one, our team of Care Professionals are available 24/7 to support you in your journey.
Quality care from our finest caregivers, nurses, therapists and doctors at your doorstep. They will take good care of you or your loved ones at home, with companionship, meal preparation, medication reminders, and more.
For more information, fill this form and receive free consultation.
- American Cancer Society, Inc. (February 4, 2019). Survival Rates for Vulvar Cancer. Retrieved from https://www.cancer.org/cancer/vulvar-cancer/detection-diagnosis-staging/survival-rates.html
- American Cancer Society, Inc. (November 22, 2019). How Is Chemotherapy Used to Treat Cancer?. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/how-is-chemotherapy-used-to-treat-cancer.html
- Borhan, N. F. (2020). Cervical Cancer. Retrieved from http://www.myhealth.gov.my/en/cervical-cancer/
- Bruni L., Albero G., Serrano B., Mena M., Collado J. J., Gómez D., Muñoz J., Bosch F. X., de Sanjosé S. (2021). Human Papillomavirus and Related Diseases in Malaysia. ICO/IARC Information Centre. Retrieved from http://www.hpvcentre.net
- Cancer Research UK. (2019). Screening – Vulvar Cancer. Retrieved from https://www.cancerresearchuk.org/about-cancer/vulval-cancer/getting-diagnosed/screening
- Kumar, K. (2021). Can Vulvar Cancer Be Cured?. Medicine.net. Retrieved from https://www.medicinenet.com/can_vulvar_cancer_be_cured/article.htm
- Mayo Clinic. (October 10, 2021). Lichen sclerosus. Retrieved from https://www.mayoclinic.org/diseases-conditions/lichen-sclerosus/symptoms-causes/syc-20374448
- Olawaiye, A. B., Cuello, M. A., & Rogers L. J. (2021). Cancer of the vulva: 2021 update. International Journal of Gynecology & Obstetrics. Retrieved from https://doi.org/10.1002/ijgo.13881
- World Health Organization. (November 30, 2021). HIV/AIDS. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hiv-aids