Vulvar cancer is cancer that attacks the outer surface of the vagina. This cancer is more common in women over 65 years of age or who have experienced menopause.
Vulvar cancer is usually characterized by a lump or open sore on the vulva which is often accompanied by itching. The vulva itself is the outermost part of the female sexual organs which includes the vaginal lips (vaginal labia), clitoris, and Bartholin 's glands .
There are two types of vulvar cancer that occur most often, namely:
- Vulva melanoma, which is a cancer of the vulva that starts in the pigment-producing cells found in the skin of the vulva
- Vulva squamous cell carcinoma ( vulvar squamous cell carcinoma ), which is cancer of the vulva that begins in the thin cells that line the surface of the vulva
Most cases of vulvar cancer that occur are vulvar squamous cell carcinoma.
Causes of Vulvar Cancer
Vulvar cancer begins when the gene in the vulva cells changes (mutation). These mutations cause vulvar cells to grow out of control and become cancer cells. These cancer cells can continue to grow and spread to other organs of the body.
The exact cause of the mutations in these cells is not yet known, but there are factors that can increase a person's risk of developing vulvar cancer, including:
- Suffer from infection with HPV ( human papilloma virus )
- Have a weak immune system, for example due to suffering from HIV
- Have a history of precancer of the vulva, eg vulvar intraepithelial neoplasia
- Suffering from skin diseases in the vulva area, such as lichen sclerosus and lichen planus
- Have a history of disease, such as melanoma , vaginal cancer, or cervical cancer
- Age over 65 years
- Have a smoking habit
Vulvar Cancer Symptoms
In the early stages (stages), vulvar cancer may not cause any symptoms at all. However, as the disease progresses, sufferers may experience the following symptoms:
- Disturbing itching in the vulva
- Open sores on the vulva
- Pain and burning in the vulva
- Bleeding outside of menstruation or after menopause
- The skin in the vulva area thickens and turns darker in color
- Lumps that resemble warts on the vulva
- Pain when urinating
When to see a doctor
Check with your doctor if you experience the above symptoms, especially if you have a high risk of developing vulvar cancer. The sooner vulvar cancer is detected, the more likely you are to recover.
If you have been diagnosed, are undergoing treatment, or have recovered from vulvar cancer, check with your doctor regularly. This is important because vulvar cancer can recur in patients who have been declared cured.
Diagnosis of Vulvar Cancer
The doctor will ask about the patient's symptoms, medical history, and history of sexual relations. After that, the doctor will do a pelvic examination to see abnormalities in the vulva.
To confirm a diagnosis of vulvar cancer, the doctor will carry out supporting examinations, such as:
- Colposcopy , to see the presence of abnormal cells in the vagina, vulva, and cervix
- Skin biopsy , to ensure the spread of cancer cells in the lymph nodes by taking tissue samples
If the cancer is suspected to have spread to other organs, the doctor will carry out tests to detect the spread of cancer to other organs. This examination is done with X-rays, CT scans , PET scans, or MRI.
Vulvar Cancer Stage
After the results of the examination are obtained, the doctor can determine the stage of development (stage) of vulvar cancer. The determination of the stage of this cancer will be used by the doctor to determine the right method of treatment. The stages of vulvar cancer include:
There is a small tumor on the vulva or the area between the vagina and anus (perineum). This cancer has not spread to the lymph nodes or other organs in the body.
The tumor has grown and spread to nearby organs, such as the lower part of the urethra, vagina and anus.
At this stage, the spread of cancer is increasingly widespread, starting from the urethra, vagina, bladder, to the lymph nodes.
Cancer has spread to many lymph nodes, the upper part of the urethra or vagina, bladder, and pelvic bones. At stage 4, it is possible that the cancer has spread to other organs far from the vulva.
Vulvar Cancer Treatment
Treatment of vulvar cancer depends on the patient's condition, type of vulvar cancer, and its severity. Treatment methods that can be performed by doctors include surgery, chemotherapy, and radiotherapy. The following is an explanation:
There are several types of surgery that doctors can perform to treat vulvar cancer, namely:
- Removal of cancerous tissue in the vulva and a small portion of healthy tissue around the cancer ( radical wide local excision )
- Removal of most of the vulva, including one or both vaginal lips and clitoris ( radical partial vulvectomy )
- Removal of all parts of the vulva, including the outside and inside of the vaginal lips, as well as the clitoris ( radical vulvetomy )
- Removal of a small portion ( sentinel node biopsy ) or the entire lymph node in the groin ( groin lymphadenectomy ) if vulvar cancer has spread to nearby lymph nodes
Chemotherapy is the administration of drugs to kill cancer cells. Drugs used can be injected or taken by mouth.
Chemotherapy can be combined with radiotherapy if vulvar cancer has spread to the lymph nodes. Chemotherapy and radiotherapy can also be combined to shrink cancer cells before surgery, increasing the chances of successful surgery.
Radiotherapy is a treatment method using X-rays or proton beams to kill cancer cells. Besides being useful for shrinking cancer cells before surgery, radiotherapy is also used to kill cancer cells in lymph nodes that were not successfully removed during surgery.
The process of treating vulvar cancer with radiotherapy is carried out in stages. Radiotherapy is generally done 5 times a week for several weeks.
Vulvar Cancer Complications
Vulvar cancer can cause complications in the form of the spread of cancer cells to other organs ( metastasis ). In addition, vulvar cancer that has been successfully removed can still attack again. Therefore, patients need to check themselves periodically so that the progress of the disease can be known.
The recommended examinations are pelvic exams every 3 or 6 months for the first 2 years, and every 6 or 12 months for the next 3–5 years. The doctor will also recommend that the patient undergo cancer screening .
Prevention of Vulvar Cancer
Like other cancers, vulvar cancer cannot always be prevented. However, avoiding risk factors, for example by quitting smoking, can help reduce the risk of developing vulvar cancer.
Vulvar cancer prevention can also be done by reducing the risk of infection with HPV. The method, among others, is by adopting healthy sexual behavior and undergoing the HPV vaccination .
In addition, have regular pelvic exams to detect diseases of the vulva and uterus that can develop into vulvar cancer. If you have certain conditions or diseases, talk to your doctor about your risk of developing vulvar cancer.