Vulvar cancer occurs on the outer surface of the female genital organs, which includes the vulva, labia majora, labia minora, clitoris, and the vaginal opening. Although it can develop at any age, it is most commonly diagnosed in older adults.
• Persistent burning and itching of the vulva.
• Changes in vulvar skin texture, such as redness, whiteness, or thickening.
• Unresolved swollen bumps or ulcers on the vulva.
• Abnormal bleeding not related to menstruation.
The precise cause of vulvar cancer is not well understood. Generally, cancer starts when cells undergo mutations in their DNA. These mutations prompt the cells to grow and divide uncontrollably, forming tumors that can invade surrounding tissues and spread to other body parts.
The treatment approach depends on the type of cell where the cancer originates. The main types include:
• Vulvar Squamous Cell Carcinoma: Originates in the vulva’s inner and outer folds. It constitutes about 90% of vulvar cancers.
• Adenocarcinoma: Typically begins in the Bartholin glands and accounts for around 8% of vulvar cancers. This category also includes melanoma, basal cell carcinoma, and sarcomas.
Several factors may increase the risk of developing vulvar cancer:
• Age: The risk rises with age, with an average diagnosis age of 65.
• HPV Exposure: Human papillomavirus infection, transmitted through sexual contact, can increase cancer risk.
• Smoking: Smoking is associated with a higher risk of vulvar cancer.
• Weakened Immune System: Conditions like HIV or medications that suppress the immune system can raise the risk.
• Skin Conditions: Diseases like lichen sclerosus can elevate the risk.
• Chest X-ray: Checks if cancer has spread to the lungs.
• CT Scan: Provides detailed images of the body to detect large tumors or enlarged lymph nodes.
• MRI: Examines pelvic tumors and lymph nodes using magnetic fields and radio waves.
• PET Scan: Uses radioactive drugs to highlight active cancer cells and assess spread, often combined with CT scans (PET-CT).
• Stage 1: Cancer is confined to the vulva or perineum.
o 1A: Tumor is 2 cm or smaller and not deeper than 1 mm.
o 1B: Tumor is larger than 2 cm or deeper than 1 mm.
• Stage 2: Cancer has spread to nearby structures like the lower urethra, vagina, or anus.
• Stage 3: Cancer has spread to nearby tissues and groin lymph nodes.
o 3A: 1-2 metastases to lymph nodes, smaller than 5 mm, or one metastasis 5 mm.
o 3B: 3 or more lymph node metastases, or 2 or more metastases larger than 5 mm.
o 3C: Cancer has spread to lymph nodes and their surrounding capsules.
• Stage 4: Cancer has metastasized to distant parts of the body or involves the upper vagina or urethra.
o 4A: Cancer has ulcerated or attached to nearby lymph nodes.
o 4B: Cancer has spread to distant organs.
• Stage 1: Treatments include surgery (partial or radical vulvectomy) and possibly radiation or chemotherapy if lymph nodes are affected.
• Stage 2: Treatment options include partial radical vulvectomy, lymph node removal, and radiation therapy, potentially combined with chemotherapy.
• Stage 3: Includes surgery to remove tumors and lymph nodes, followed by radiation and possibly chemotherapy. Radiation may precede surgery to preserve normal structures.
• Stage 4A: Treatment may involve extensive surgery, radiation, and chemotherapy, with pelvic exenteration as a rare option.
• Stage 4B: Treatment focuses on symptom relief through surgery, radiation, and chemotherapy to manage cancer spread.
Treatment usually involves surgical options like local excision or vulvectomy, which can be performed during or after pregnancy.
The five-year survival rate for stage 1 vulvar cancer is approximately 86%. For stage 4 vulvar cancer, this rate drops to around 16%.
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