vulvar cancer

overview

Vulvar cancer starts in the vulva, the outer part of a woman’s genitals. The vulva includes the vaginal opening, the vaginal lips (labia) and the clitoris. There are several types of vulvar cancer, including:

  • Squamous cell carcinoma: A form of skin cancer. The vast majority of vulvar cancers are squamous cell carcinomas.
  • Melanoma: Less frequently, vulvar cancer may develop as this more serious type of skin cancer.
  • Adenocarcinoma (including Paget’s disease): This is a type of cancer that begins in glandular cells of the vulva.
  • Sarcoma: This type of vulvar cancer develops in the connective tissue under your skin.

symptoms

Often there are no signs of vulvar cancer. But you might experience symptoms such as:

  • Itching around the vulva that doesn’t go away
  • Change in skin color around the vulva
  • Change in skin texture around the vulva
  • Pain when urinating
  • Enlarged glands or lumps in your groin
  • Bumps, growths, ulcers or sores around your vulva or clitoris
  • Abnormal vaginal discharge
  • A change in an existing mole around your vulva

diagnosis

Regular pelvic exams are essential to finding vulvar cancer early, when it’s most treatable. If an abnormality is found, your doctor may perform additional tests, such as a colposcopy (a special magnifying scope is used to examine the vulva and vagina) or a biopsy (a small sample of tissue is removed and examined under a microscope).

To determine whether your cancer has spread, your doctor may also perform the following:

Pelvic exam: A more thorough pelvic exam may be performed while you’re under anesthesia.

Cystoscopy or proctoscopy: Your doctor will insert a thin, lighted tube (called a cytoscope) to check whether cancer has spread to your urethra or bladder. He or she may also insert a tube (called a proctoscope) into your rectum to check for cancer there.

CT (computed tomography): This scan can show the tumor’s precise location, size and involvement with adjacent tissue.

MRI (magnetic resonance imaging): This scan can show biochemical changes that can signal cancerous tumors, particularly those that have spread.

PET (positron emission tomography): In this procedure, a dye is injected that highlights cancer cells growing in your body, which can then be detected by a special camera.

treatment options

There are many options for treating vulvar cancer. Your doctor will discuss the approach that is best for you. Treatment options may include: 

Laser surgery: A focused beam of energy is used to remove the layer of skin containing precancerous cells (known as vulvar intraepithelial neoplasia).

Traditional surgery:
 
  • Excision: Your surgeon will use a scalpel to remove the cancer and a border of healthy tissue around it. Skin grafting or reconstructive surgery may be necessary afterwards.
  • Vulvectomy: Part (or all) of your vulva is surgically removed. A skinning vulvectomy removes the complete top layer of skin; a simple vulvectomy removes the entire vulva; a partial vulvectomy removes part of the vulva and some deep tissue; and a complete (or radical) vulvectomy removes the entire vulva, clitoris and deep tissues.
  • Lymph node dissection: Your surgeon will remove the lymph nodes in your groin or on one or both sides of your vulva.
  • Pelvic exenteration: Very rarely, you may require surgery to remove your vulva and lymph nodes, along with other organs, such as your bladder, rectum, part of your colon, uterus, vagina and cervix. You may then need additional procedures to allow your body to function without the organs that have been removed.
In some cases, your doctor may recommend using chemotherapy or radiation before surgery to shrink the tumor or after surgery to kill any remaining cancer cells. 

Chemotherapy: These drugs help prevent the cancer from spreading to other parts of your body. Systemic chemotherapy is usually given intravenously, although sometimes you can take the drugs in pill form. Topical chemotherapy is delivered via a cream or ointment, such as fluorouracil (5-FU).

Radiation: External beam radiation uses a special machine to send beams of high-energy X-rays through your skin to target and kill cancer cells. It’s sometimes combined with low-dose chemotherapy. 

Treatments for more advanced vulvar cancer, such as  removing your ovaries or uterus, will make you unable to have children. Talk to your doctor preserving your fertility is important to you. He or she will discuss available options.

treating your cancer, caring for you.

Our musculoskeletal oncology program is located at Aurora St. Luke's Medical Center in Milwaukee. We treat all kinds of musculoskeletal cancer, including adult and pediatric bone and soft-tissue tumors and metastatic bone disease.

Team members include an orthopedic surgical oncologist, radiologist, radiation oncologist, medical oncologist, plastic surgeons and a physical therapist.

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