Vulvar Cancer Symptoms, Causes, Tests/screening/Diagnosis and Treatment

Vulvar Cancer Symptoms

Signs and symptoms of vulvar cancer may include:

• Itching that doesn't go away
• Pain and tenderness
• Bleeding that isn't from menstruation
• Skin changes, such as color changes or thickening
• A lump, wart-like bumps or an open sore (ulcer)

When to see a doctor
Make an appointment with your primary care doctor or gynecologist if you experience any vulvar signs or symptoms that worry you, such as:

• Abnormal bleeding
• Burning
• Itching
• Pain

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• Vaginal discharge or bleeding that is not normal for you. The bleeding may be abnormal because of how heavy it is, or when it happens, such as bleeding after you have gone through menopause; bleeding between periods; or any other bleeding that is longer or heavier than is normal for you.
• A change in bathroom habits, such as having blood in the stool or urine; going to the bathroom more often than usual; or feeling constipated.
• Pain in your pelvis, the area below your stomach and in between your hip bones, especially when you pass urine or have sex.

Many women who have vulvar cancer have signs and symptoms. They may include—

• Itching, burning, or bleeding on the vulva that does not go away.
• Changes in the color of the skin of the vulva, so that it looks redder or whiter than is normal for you.
• Skin changes in the vulva, including what looks like a rash or warts.
• Sores, lumps, or ulcers on the vulva that do not go away.
• Pain in your pelvis, especially when you urinate or have sex.

It is important for you to pay attention to your body and know what is normal for you. If you have vaginal bleeding that is not normal for you, see a doctor right away. Also see a doctor if you have any of the other symptoms for two weeks or longer and they are not normal for you. Symptoms may be caused by something other than cancer, but the only way to know is to see your doctor.

Causes of vulvar cancer

Cancer is a class of diseases characterized by out-of-control cell growth. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with and alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign, dangerous cancer that spreads is malignant.

More dangerous, or malignant, tumors form when two things occur: 1. a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion. 2. that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis. 

If the patient with malignant cancer receives no treatment, it can grow and spread to other parts of the body (metastasis). As soon as the cancer gets into the lymphatic system it can more effectively reach other parts of the body, including vital organs. 

Experts do not know exactly why the runaway growth of cancer cells starts. We do know, however, that certain risk factors increase the probability of developing the disease. These include:

• Human papilloma virus (HPV) - women infected with HPV have a higher risk of developing vulval cancer.
• Vulvar intraepithelial neoplasia (VIN) - this is a general term for a precancerous state in which certain cells within the vulvar epithelium have a range of low-grade carcinoma. Women with VIN have a significantly higher risk of developing vulval cancer.
• Sexually transmitted infections - women with antibodies to the herpes simplex virus type 2 have been linked to a higher increase of vulval cancer.
• Systemic lupus erythematosus- one study showed a three-fold increase in vulval cancer risk.
• Smoking- studies have revealed an association between regular smoking and vulval cancer, ranging from a three-fold to six-fold increase. If the regular smoker also has HPV infection, the risk is much higher still.
• Kidney transplant - women who have had a kidney transplant have a much higher risk of developing vulval cancer. Doctors believe it is due to the immunosuppressant drugs (to stop organ rejection by the body) the patient has to take for life.
• Human immunodeficiency virus (HIV)- People with HIV/AIDS are more susceptible to HPV infection.
• Psoriasis - women with psoriasis have a significantly higher risk of developing vulval cancer.

Stages of vulvar cancer

If a biopsy confirms the presence of vulval cancer, the doctor will stage it with the help of imaging (CT or MRI). Staging guidelines used in the UK:

• Stage 0 - known as carcinoma in situ; the cancer only exists on the surface of the skin.
• Stage 1 - the cancer is limited to the vulva or perineum and is up to 2cm in size.
• Stage 2 - same as 1, but the tumor is at least 2cm in size.
• Stage 3 - the cancer has reached nearby tissue, such as the anus or vagina. It may also have reached the lymph nodes.
• Stage 4 - the cancer has reached lymph nodes on both sides (of the groin). It may also have reached the urethra (where urine comes out of), the bowel or the bladder.

Diagnosing vulvar cancer 
Tests and procedures used to diagnose vulvar cancer include:

• Examining your vulva. Your doctor may conduct a physical exam of your vulva to look for abnormalities.
• Using a special lens to examine your vulva. During a colposcopy exam, your doctor uses a device that works like a magnifying glass to closely inspect your vulva for abnormal areas.
• Removing a sample of tissue for testing (biopsy). To determine whether an area of suspicious skin on your vulva is cancer, your doctor may recommend removing a sample of skin for testing. During a biopsy procedure, the area is numbed with a local anesthetic and a scalpel or other special cutting tool is used to remove all or part of the suspicious area. Depending on how much skin is removed, you may need stitches.

Determining the extent of the cancer
Once your diagnosis is confirmed, your doctor works to determine the size and extent (stage) of your cancer. Staging tests can include:

• Examining your pelvic area for cancer spread. Your doctor may do a more thorough examination of your pelvis for signs that the cancer has spread.
• Imaging tests. Images of your chest or abdomen may show whether the cancer has spread to those areas. Imaging tests may include X-ray, computerized tomography (CT) and magnetic resonance imaging (MRI).

Treatments  for vulvar cancer

Treatment options for vulvar cancer depend on the type and stage of your cancer, your overall health and your preferences.

Surgery to remove vulvar cancer
Operations used to treat vulvar cancer include:

• Removing the cancer and a margin of healthy tissue (excision). This procedure, which may also be called a wide local excision or radical excision, involves cutting out the cancer and at least 3/4 inch (2 centimeters) of the normal tissue all the way around it. Cutting out what doctors refer to as a margin of normal-looking tissue helps ensure that all of the cancerous cells have been removed.
• Removing a portion of the vulva (partial vulvectomy). During a partial vulvectomy, a portion of the vulva is removed, along with its underlying tissues.
• Removing the entire vulva (radical vulvectomy). Radical vulvectomy involves removal of the entire vulva, including the clitoris and underlying tissues.
• Extensive surgery for advanced cancer. If cancer has spread beyond the vulva and involves nearby organs, your doctor may recommend removing all of the vulva and the involved organs in a procedure called pelvic exenteration. Depending on where your cancer has spread, your surgeon may remove the lower colon, rectum, bladder, cervix, uterus, vagina, ovaries and nearby lymph nodes. If your bladder, rectum or colon is removed, your doctor will create an artificial opening in your body (stoma) for your waste to be removed in a bag (ostomy).
• Reconstructive surgery. Treatment of vulvar cancer often involves removal of some skin from your vulva. The wound or area left behind can usually be closed without grafting skin from another area of your body. However, depending on how widespread the cancer is and how much tissue your doctor needs to remove, your doctor may perform reconstructive surgery — grafting skin from another part of your body to cover this area.

Surgery to remove the entire vulva carries a risk of complications, such as infection and problems with healing around the incision. In addition, with part or all of the vulvar padding gone, it can be uncomfortable to sit for long periods. Your genital area may feel numb, and it may be difficult to achieve orgasm during sexual intercourse.

Surgery to remove nearby lymph nodes
Vulvar cancer often spreads to the lymph nodes in the groin, so your doctor may remove these lymph nodes at the time you undergo surgery to remove the cancer. Depending on your situation, your doctor may remove only a few lymph nodes or many lymph nodes.

Removing lymph nodes can cause fluid retention and leg swelling, a condition called lymphedema. If you develop this complication, your doctor may give you compression devices or support stockings to help ease the symptoms. You'll also be advised to avoid scratches and other injuries to your legs because you're more susceptible to infection.

Doctors are studying a technique that may allow surgeons to remove fewer lymph nodes. Called sentinel lymph node biopsy, this procedure involves identifying the lymph node where the cancer is most likely to spread first. The surgeon then removes that lymph node for testing. If cancer cells aren't found in that lymph node, then it's unlikely that cancer cells have spread to other lymph nodes.

Radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy for vulvar cancer is usually administered by a machine that moves around your body and directs radiation to precise points on your skin (external beam radiation).

Radiation therapy is sometimes used to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Radiation is sometimes combined with chemotherapy, which can make cancer cells more vulnerable to radiation therapy.

If cancer cells are discovered in your lymph nodes, your doctor may recommend radiation to the area around your lymph nodes to kill any cancer cells that might remain after surgery.

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically administered through a vein in your arm or by mouth.

For women with advanced vulvar cancer that has spread to other areas of the body, chemotherapy may be an option. Sometimes chemotherapy is combined with radiation therapy to shrink large vulvar cancers in order to make it more likely that surgery will be successful.

Follow-up tests after treatment
After completing vulvar cancer treatment, your doctor may recommend periodic follow-up exams to look for a cancer recurrence. Even after successful treatment, vulvar cancer can return. Your doctor will determine the schedule of follow-up exams that's right for you, but doctors generally recommend exams twice each year for the first five years after vulvar cancer treatment.

Source : http://www.mayoclinic.com