Cancer of the vulva is a rare type of cancer that occurs on the outer part of the female genitalia, including the labia majora and minora, the clitoris and the foreskin of the vagina. It usually appears as a lump, sore or wart on the vulva and can cause symptoms such as itching, burning, pain and bleeding. The exact cause of vulvar cancer is unknown, but it is thought to be related to the human papillomavirus (HPV), which is a sexually transmitted virus that can cause changes in the cells of the vulva. Other risk factors for vulvar cancer include age, smoking, a weakened immune system and a history of genital warts or skin conditions such as scleroderma and atrophic lichen. Vulvar cancer is usually diagnosed through a physical examination and biopsy, in which a small piece of tissue is removed and examined under a microscope. Treatment for vulvar cancer may include surgery to remove the cancerous tissue, radiotherapy, chemotherapy or a combination of these approaches, depending on the stage and location of the cancer. The prognosis for vulvar cancer depends on many factors, including the size and location of the tumor, the stage of the cancer, and the overall health of the patient. Early diagnosis and treatment can improve the chances of successful treatment and long-term survival.

What are the types of vulvar cancer?

There are different types of vulvar cancer, such as:

→ Squamous cell carcinoma: This is the most common type of vulvar cancer, accounting for about 90% of cases. It grows from the thin, flat cells that cover the surface of the vulva.

→ Adenocarcinoma: This is a less common type of vulvar cancer that develops from the glandular cells of the vulva.

→ Melanoma: This is a rare but aggressive type of skin cancer that can grow anywhere in the body, including the vulva.

→ Basal cell carcinoma: This is another type of skin cancer that can develop in the vulva, although it is less common than squamous cell carcinoma.

→ Sarcoma: This is a rare type of vulvar cancer that develops in the connective tissues of the vulva.

What are the most common symptoms caused by vulvar cancer;

The most common symptoms of vulvar cancer include:

• A lump in the vulva that may cause itching, pain or bleeding.
• A persistent sore or ulcer in the vulva that does not heal.
• Changes in the colour or texture of the skin of the vulva, such as thickening or crusting.
• Pain or burning during urination.
• Pain during sexual intercourse.
• Swollen lymph nodes in the groin.

These symptoms may also be caused by other conditions, so it is important to consult a healthcare provider if you experience any of these symptoms. Early detection and treatment of vulvar cancer can improve the chances of successful treatment and long-term survival.

What are the causes and risk factors for developing vulvar cancer?

The exact causes of vulvar cancer are not fully understood, but several factors may increase the risk of this type of cancer. These include:

• Age: Vulvar cancer is more common in older women, with most cases occurring after menopause.
• Human papillomavirus (HPV) infection: Certain strains of HPV can increase the risk of developing vulvar cancer, although not all cases of vulvar cancer are linked to HPV.
• Smoking: Smoking can increase the risk of developing vulvar cancer.
• Intraepithelial neoplasia of the vulva (VIN): It is a precancerous condition in which abnormal cells grow on the surface of the vulva. VIN increases the risk of developing vulvar cancer.
• Chronic skin diseases: Certain skin conditions, such as sclerotrophic lichen, can increase the risk of developing vulvar cancer.
• Weakened immune system: Women with weakened immune systems, such as those who have had an organ transplant or are taking immunosuppressive drugs, may be at higher risk of developing vulvar cancer.
• History of genital warts: Women who have had genital warts caused by HPV may be at higher risk of developing vulvar cancer.

It is important to note that having one or more of these risk factors does not mean that a woman will definitely develop vulvar cancer. Many women with vulvar cancer have no known risk factors and many women with risk factors never develop the disease.

How is vulvar cancer diagnosed?

Vulvar cancer is usually diagnosed through a combination of physical examination, biopsy and imaging tests. The diagnostic process may include:

Physical examination: Your doctor may perform a physical examination of the vulva, looking for any abnormal changes and nodules.

Biopsy: If an abnormal area or lesion is found, a biopsy may be performed. During a biopsy, a small section of tissue is removed from the vulva and examined under a microscope for signs of cancer.

Imaging tests: Additional tests may be done to determine the extent of the cancer and whether it has spread to other parts of the body. These may include imaging tests such as CT scans, MRIs or PET scans.

Lymph node biopsy: If cancer is suspected to have spread to nearby lymph nodes, a lymph node biopsy may be performed to determine if cancer cells are present. It is important to get an early and accurate diagnosis in order to start treatment as soon as possible. Treatment options and prognosis will depend on the type, stage and location of the cancer, as well as the patient's general health and preferences.

How is vulvar cancer treated?

Treatment for vulvar cancer depends on the type, stage and location of the cancer, as well as the patient's overall health and preferences. The main treatment options for vulvar cancer include:

→ Surgery: Surgery is the main treatment for most cases of vulvar cancer. The type of surgery will depend on the extent and location of the cancer. Surgery may involve removing the cancerous tissue along with some surrounding healthy tissue, or it may involve removing the entire vulva or nearby lymph nodes.

→ Radiotherapy: Radiotherapy can be used in combination with surgery or as the main treatment for some cases of vulvar cancer. Radiotherapy uses high-energy rays to kill cancer cells.

→ Chemotherapy: Chemotherapy is a type of drug treatment that can be used in combination with surgery or radiotherapy for some cases of vulvar cancer. Chemotherapy drugs circulate throughout the body and kill cancer cells.

→ Immunotherapy: Immunotherapy is a type of treatment that uses the body's immune system to fight cancer cells. It may be used in combination with other treatments for some cases of vulvar cancer. The aim of the treatment is to remove or destroy all the cancer cells, while minimising damage to healthy tissue. Treatment can be complex and may require a team of healthcare providers, including gynecologic oncologists, radiation oncologists, and medical oncologists. It is important to discuss the potential benefits and risks of each treatment option with a healthcare provider to make an informed decision about treatment.

What does surgical treatment for vulvar cancer involve?

The type of surgery for vulvar cancer depends on the extent and location of the cancer, as well as the overall health and preferences of the patient. The following are some of the surgical procedures that may be used to treat vulvar cancer:

Local tumour resection: If the cancer is small and has not spread, a healthcare provider may perform a resection biopsy to remove the cancerous tissue and a small margin of healthy tissue around it.

Wide local excision: If the cancer has spread further, your doctor may perform a wider resection to remove the cancerous tissue along with a larger healthy tissue.

Radical vulvectomy: If the cancer has spread extensively or invaded the deeper tissues of the vulva, your doctor may perform a radical vulvar resection, which involves removing the entire vulva along with the nearby lymph nodes.

Guardian lymph node biopsy: In some cases, your doctor may perform a sentinel lymph node biopsy, which involves first removing the lymph node that is most likely to be affected by cancer cells. If no cancer cells are found in this lymph node, it may be possible to avoid more extensive lymph node removal.

Recovery from vulvar cancer surgery can vary depending on the extent and type of surgery performed. Patients may experience pain, swelling and discomfort in the surgical area and may require medication to manage pain. Physical therapy may also be recommended to aid in recovery and rehabilitation. It is important to discuss the potential risks and benefits of surgery with a healthcare provider in order to make an informed decision about treatment.