Vulvar Cancer


Vulvar cancer is a rare form of malignancy that accounts for 0.6% of all cancer types for women. The prognosis and treatment options for this condition depends on several factors [1, 2].

Anatomy and Pathophysiology

The vulva is the exterior of the female genitalia and includes the external opening of the vagina, the labia minora and majora and the clitoris. Malignancy of the vulva affects this part of the female genitalia. It is usually the outer lips of the vagina that is affected but the cancer may also affect inner vaginal lips, vaginal glands and clitoris.

The condition starts with the development of precancerous cells on the skin of the vulva. This event is known as vulvar intraepithelial neoplasia (VIN) or dysplasia. Although not all VIN progresses into vulvar cancer, it is necessary to get appropriate treatment immediately [1, 3, 4]. Figure 1 shows an example of vulvar cancer.

Figure 1- Vulvar Cancer

Vulvar Cancer


Vulvar Cancer Staging

Vulvar cancers are staged according to the classification of the tumor, node and metastasis. Physicians use the results from diagnostic tests to identify the stage of the cancer [5].


  • Stage 0- There is no evidence of cancer spread and is located superficially on the vulva
  • Stage IA- Tumor is less than 2cm and is still confined in its original location
  • Stage IB-  The mass that was identified is smaller than 2cm in diameter, has not yet spread but its location is deeper than 1mm in the vulva
  • Stage II- Tumor mass is greater than 2cm in size, involved the perineal area, vulva or both but has not metastasized
  • Stage III- Cancer mass have starter to spread to nearby organs such as urethra, vagina and anus. The lymph nodes on one side of the body may be affected but it has not spread to distant parts of the body.
  • Stage IVA- Lymph nodes located in both sides of the body have been affected or it has already metastasized in the pelvic bone, bladder, urethra or rectum.
  • Stage IVB- This stage means that the malignancy have already spread to distant body parts.
  • Recurrent- If the cancer have recurred after completing the treatment. Diagnostic tests have to be done to assess the extent of the recurrence.

vulvar cancer stage 1 and 2

Stage iii vulvar cancer


ICD10

According to the 2016 ICD-10-CM list, the code that is assigned for the diagnosis of vulvar cancer is C51.9. This is for a primary or metastatic cancer involving the vulva [6].

Risk Factors

The exact cause of vulvar cancer but there are certain factors that may increase the possibility of acquiring this condition. Females who have a history of human papillomavirus (HPV) because of the cell changes that are associated with the infection caused by this organism. Conditions that compromises the immune system such as the acquired immunodeficiency syndrome caused by human immunodeficiency virus (HIV) makes an individual to be more susceptible to HPV infections. Other conditions of the vulva which increases the likelihood of vulvar cancer are VIN and Lichen sclerosus. This skin condition makes the vulvar skin thin and itchy [1, 2, 4].

Signs and Symptoms

Aside from the formation of a lump or sore in the vulva, other symptoms that may be present include [1, 4, 7]:


  1. Bleeding or vaginal discharge in between periods
  2. Skin color changes in the vulva
  3. Appearance of warts or rashes
  4. Itching or burning sensation in the vulva
  5. Pain felt in the urethra while urinating

Vulvar Cancer advanced stage

Diagnosis

Health history and physical examination

The health history will focus on the date when the symptoms have started appearing. Physician will also identify any risk factors such as HPV infection or VIN in the past. The physical examination will include an assessment of the vulva to identify the symptoms that are present. The physician may use a special instrument called a colposcope in order to examine the vulva more closely [1, 2, 4].

Biopsy

A sample of the vulvar skin will be obtained for analysis. This test will be able to confirm the diagnosis of vulvar cancer [1, 4].

Staging the cancer

After the diagnosis is confirmed, the physician will have to provide the stage of the malignancy to identify the appropriate treatment modality. Staging is done through the aid of other laboratory tests such as X-rays, CT scans and MRI scans. It will be able to show if the cancer have spread to other parts of the body [1, 2, 4].

Treatment

There are several treatment options that are available but it depends on the progression of the patient’s condition [1, 4].

Surgery

If the cancer have not spread, a surgery may be advised to the patient. This procedure may involve removing the tumor with a margin of healthy tissues, removing a part of the vulva or removing the vulva. A margin of healthy cells is excised along with the tumor to ensure that all the cancer cells have been removed. After surgically excising a portion or the whole vulva, the patient may also undergo a reconstructive surgery to minimize the damage to the vulva [4].

Radiation therapy

This treatment modality uses energy beams to destroy cells. This technique may be done in combination with a surgical procedure wherein the tumor is shrunk before it is excised [4].

Chemotherapy

Chemotherapy uses drugs that are infused intravenously to eliminate cancer cells. This treatment is the method of choice for advanced types of vulvar cancer where it has already metastasized to other parts of the body [4].

Follow-up

Follow-up with a physician after completing the treatment is important to monitor the possible recurrence of the tumor. A follow-up of 2-4 times a year may be recommended during the 1st 2 years following the cancer treatment [4].
References

  • National Institutes of Health. (2015, July 30). Vulvar Cancer Treatment–Patient Version (PDQ®). Retrieved from National Cancer Institute: http://www.cancer.gov/types/vulvar/patient/vulvar-treatment-pdq
  • Creasman, W. T. (2016, April 4). Malignant Vulvar Lesions. Retrieved from Medscape: http://emedicine.medscape.com/article/264898-overview
  • Health Wise Staff. (2014, March 12). Female External Genitalia (Vulva). Retrieved from Web MD: http://www.webmd.com/women/female-external-genitalia-vulva
  • Mayo Clinic. (October, 7 2015). Vulvar cancer. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/vulvar-cancer/basics/definition/con-20043483
  • Cancer.net. (2015, August). Vulvar Cancer: Stages. Retrieved from Cancer.net: http://www.cancer.net/cancer-types/vulvar-cancer/stages
  • ICD10 Data. (2015). Malignant neoplasm of vulva, unspecified. Retrieved from ICD10 Data: http://www.icd10data.com/ICD10CM/Codes/C00-D49/C51-C58/C51-/C51.9
  • Centers for Disease Control and Prevention. (2014, March 13). Gynecologic Cancer. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/cancer/vagvulv/basic_info/symptoms.htm

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