Vulvar Cancer

Terms will open new windows for definitions

January 19th, 2008 by admin

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Vulvar cancer

January 19th, 2008 by admin

Vulvar cancer is a type of cancer that affects the vulval region. It accounts for about three per cent of all gynaecological cancers and is most commonly diagnosed in older women aged around 70 years or over. However, an increasing number of women aged 35-45 are being diagnosed with this form of cancer.

The most common site for vulvar cancer is the labia majora, while just one in 10 cases originates in the clitoris. The vulva has lots of blood and lymphatic vessels, which means that vulval cancer cells can easily spread to nearby body parts such as the bladder, vagina and anus. Without treatment, the patient can suffer from severe infection and pain.

The vulva is a general term that describes the external female genitals. The vulva is made of three main parts: the labia majora (outer lips), the labia minora (smaller inner lips) and the clitoris.

Symptoms

In its early stages, vulvar cancer often has no symptoms. This is because the cancer is so tiny. The progression of symptoms can include:

— An unusual lump or bump can be felt somewhere on the vulva.

— The lump becomes itchy and painful.

— The lump progresses to an ulcerated sore that refuses to heal.

— The raw-looking sore can be white, red or pink. The sore gets bigger with time.

— There could be unusual bleeding or discharge from the vagina.

— The lymph glands in the groin may swell.

— Problems with bowel motions and passing urine may indicate the cancer has spread into these structures.

— Secondary cancers may cause a range of symptoms, such as aching bones.

Risk factors

Some of the risk factors for vulvar cancer include:

— Age - vulvar cancer usually occurs in postmenopausal women, but there appears to be an increasing number of young women diagnosed

— Other sexually transmitted infections

— Multiple sex partners

— Never having children (nulliparity)

— Chronic vulval itching (pruritis)

— Genital warts (human papillomaviral infection)

— Vulvar intraepithelial neoplasia (a pre-cancerous condition)

— Prior incidence of squamous cell cancer of the cervix

— Prior incidence of squamous cell cancer of the vagina.

The progression of vulvar cancer

Vulvar intraepithelial neoplasia (VIN) is a pre-cancerous condition of the vulva. It is uncommon but appears to have a high risk of becoming cancerous if untreated. Of those women who are treated, 5-10 per cent may still develop vulvar cancer. If cancer cells reach the pelvic lymph nodes, secondary cancers can spread to almost anywhere in the body.

Different types

Vulvar cancer is classified according to its cell of origin. This can include:

— Squamous cell carcinoma - originating in the skin cells. This type accounts for about 90 per cent of cases.

— Melanoma - originating in the pigment cells deeper in the skin. This type accounts for about five per cent of cases.

— Adenocarcinoma - originating from the Bartholin’s glands, the structures that supply lubricant. This type accounts for less than one per cent of cases.

— Sarcoma - originating from fat cells. This type is quite rare.

— Lymphoma - originating from the immune cells. This type is quite rare.

— Basal carcinoma - a form of skin cancer. This type is quite rare.

Diagnosis methods

Vulvar cancer is diagnosed after:

— Taking a medical history.

— Doing a physical examination.

— Doing a colposcopy examination of the vulva, which makes the lesions of certain diseases (including VIN and vulvar cancer) more obvious.

— Taking a biopsy of the sore or lump using a scalpel (with local anaesthesia) or a punch biopsy (this instrument extracts a little core sample).

— Excising (removing some tissue) under general anaesthetic.

Treatment options

Treatment for vulvar cancer can include:

— Vulvectomy - the first line of treatment is to surgically remove the tumour. Depending on factors including the location, type, stage and severity of the cancer, surgery may include radical vulvectomy (removal of the vulva) with or without removal of the groin lymph nodes from one or both sides.

— Radiation therapy - the use of precisely targeted x-rays to kill cancer cells. This may be used as the primary treatment to avoid removal of the clitoris.

— Chemotherapy - the use of cancer-killing drugs, often in combination. Chemotherapy can be helpful to control secondary cancers because the whole body is treated. It may also be used with radiation to increase the effectiveness of the radiotherapy.

How to reduce the risk

It is possible to reduce your risk by avoiding known risk factors. The most significant risk reduction strategy is to protect yourself from sexually transmissible infections (STIs). This is because women with previous dysplasia or CIN (cervical intraepithelial neoplasia) of the cervix, genital warts and herpes are at increased risk of developing vulvar intraepithelial neoplasia (VIN). Which is the precursor of (comes before) vulvar cancer. Other risk reduction strategies include:

— Don’t smoke cigarettes.

— Don’t dismiss chronic vulval itching as a persistent thrush infection. Don’t treat a vaginal itch with over-the-counter preparations - see your doctor for tests.

— Have regular gynaecological check-ups.

— If you think you may be at increased risk of vulvar cancer, ask your doctor to show you how to perform a self-examination.

Where to get help

— Your doctor

— Women’s health clinic

— Family Planning Victoria Tel. (03) 9257 0100

— Cancer Council Victoria Tel. 131 120

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Vulvar Cancer

January 19th, 2008 by admin

What is vulvar cancer?

The vulva is the skin and fatty tissue between the upper thighs of women, from the area of the anus to about an inch below the pubic hairline. Cancer of the vulva most often affects the two skin folds (or lips) around the vagina, known as the labia.

Vulvar cancer is not very common. However, it is very serious because it can affect a woman’s sexual functioning. It can make sex painful and difficult. This makes some women feel sad and worthless. If found early, vulvar cancer has a high cure rate and the treatment options involve less surgery.

Who is affected?

Vulvar cancer most often affects women 65 to 75 years of age. However, it can also occur in women 40 years of age or younger. Vulvar cancer may be related to genital warts, a sexually transmitted disease caused by the human papillomavirus (HPV).

What are the signs of vulvar cancer?

Tell your doctor if you have any of these warning signs of vulvar cancer:

— Vulvar itching that lasts more than one month

— A cut or sore on the vulva that won’t heal

— A lump or mass on the vulva

— Vulvar pain

— Bleeding from the vulva (different from your usual monthly bleeding)

— Burning in the area that lasts even after your doctor has treated the burning

— Any change in size, color, or texture of a birthmark or mole in the vulvar area

How is vulvar cancer diagnosed?

If your doctor finds an abnormal area on the vulva, he or she may want to take a small piece of skin to look at under the microscope. This procedure can be done in the doctor’s office. It is called a biopsy. A biopsy is the only way to find out if you have vulvar cancer.

How is vulvar cancer treated?

Vulvar cancer is usually treated with surgery. The type of surgery depends on the size, depth and spread of the cancer. Your doctor will review all the options for surgery and the pros and cons of each option. Some people may also need radiation therapy.

When vulvar cancer is found and treated early, the cure rate is over 90 percent. The key to a cure is to tell your doctor about any warning signs early and to have a biopsy right away.

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Can Vulvar Cancer Be Prevented?

January 19th, 2008 by admin

The risk of vulvar cancer can be reduced by avoiding controllable risk factors and by treating pre-cancerous conditions before an invasive cancer develops. These steps cannot guarantee prevention but can greatly reduce your chances of developing vulvar cancer.

Avoiding Risk Factors

Human papillomavirus (HPV) infection is a vulvar cancer risk factor that can be reduced by avoiding certain sexual practices outlined in the section on risk factors and by delaying onset of sexual activity. Until recently, it was thought that the use of condoms (”rubbers”) could prevent infection with HPV. But recent research shows that condoms cannot fully protect against infection with HPV. This is because HPV can be passed from one person to another by skin-to-skin contact with any HPV-infected area of the body such as skin of the genital or anal area not covered by the condom.

It is still important to use condoms to protect against HIV/AIDS and other sexually transmitted diseases that are passed on through some body fluids. Because HPV can be present for years with no symptoms and passed on to another person even when there are no visible symptoms, the absence of visible warts cannot be used to decide whether caution is warranted.

The earlier sexual contact with others is begun, the more likely it is that a person will become infected with HPV, and the more time any HPV infection will have to progress to cancer. For these reasons, postponing the beginning of sexual activity in life and limiting the number of sexual partners are 2 ways to reduce the risk of developing HPV infection and vulvar cancer.

A new vaccine has been approved by the FDA that will protect against infection with HPV types 16 and 18. It is currently recommended for use in young females before they become sexually active (to prevent cervical cancers and pre-cancers), and it is being looked at for possible use in males. While studies have not yet been done, the hope is that this may eventually help prevent other cancers linked to HPV, including vulvar cancers.

Not smoking is another way to lower vulvar cancer risk, in addition to obvious benefits of greatly reducing your risk of developing far more common cancers of the lungs, mouth, throat, bladder, kidneys, and several other organs.

Detecting Pre-cancerous Conditions

Pre-cancerous vulvar conditions can be identified by having regular reproductive system (gynecologic) checkups and by having a doctor evaluate any persistent vulvar rashes, moles, lumps, or other abnormalities. Treatment of vulvar intraepithelial neoplasia (VIN) can prevent many cases of invasive squamous cell vulvar cancer.

Some vulvar melanomas can be prevented by removal of atypical moles.

Examination of the vulva is routinely done at the same time a woman has a Pap test and pelvic examination. The American Cancer Society recommends:

— All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.

— Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the conventional (regular) or liquid-based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.

— Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.

— Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.

Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

See the American Cancer Society documents on “Cervical Cancer,” “Pap Test,” and “Cancer Detection Guidelines” for more information about early detection of female reproductive system cancers.

Some doctors recommend self-examination of the vulva as a strategy for early detection of vulvar cancer, as well as certain other vulvar disorders. A woman can become aware of any changes in the skin of her vulva by examining herself monthly. Using a mirror, look for any areas that are red and irritated, white, or darkly pigmented. You should note any abnormal growths, nodules, bumps, or ulcers and report these to a doctor, since they may indicate vulvar cancers or pre-cancerous conditions.

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Vulvar Cancer

January 19th, 2008 by admin

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What is vulvar cancer?

January 19th, 2008 by admin

It is an abnormal growth of malignant cells (neoplasm, tumor) in the vulva. The vulva is defined as the female external genitalia, and includes the labia majora, labia minora, clitoris, and vestibule, or entryway, of the vagina.

About 70% of vulvar cancers involve the labia, (mainly the labia majora), 15% - 20% involve the clitoris, and another 15% - 20% involve the perineum, which is the area of sensitive skin located between the vagina and the anus. In about 5% of cases, the cancer is present at more than one site.

What are the different types of vulvar cancer?

The vulva is essentially epithelial skin, and so the main tumor types that affect this area are skin-related cancers.

The majority of vulvar cancers are squamous cell carcinomas, which typically develop at the edges of the labia majora/ minora or the vagina. As with vaginal squamous cell carcinomas, vulvar squamous cell cancers are slow-growing and usually develop from “precancerous”, pre-invasive areas called vulvar intraepithelial neoplasia (VIN).

Melanoma is the second most common type and represents about 5% - 10% of vulvar cases; roughly half involve the labia majora.

The most common skin-cancer in sun-exposed areas is basal cell carcinoma, and as expected, this type rarely occurs on the vulva.

Adenocarcinomas of the vulva are also rare, but can develop from glands such as the Bartholin’s glands at the vaginal opening.

How common is vulvar cancer?

Vulvar cancer is a relatively rare diagnosis, representing about 5% of all gynecologic cancers, and only about 1% of all female cancers in general. There are about 3,000 new cases in reported annually in the US, but the incidence has been rising over the past several years. In fact, the American Cancer Society (ACS) is estimating ~3,800 new cases will be diagnosed in 2005. The cause for the growing number of cases is not well-understood.

Who gets vulvar cancer?

Vulvar cancer is most common in women over 50 years of age, with a median age of 65 – 75 years old at diagnosis.

What are the risk factors for vulvar cancer?

In addition to older age, vulvar cancer has been associated with a history of:

— infection with high-risk HPV types, (ie: HPV 16,18,31)

— multiple sexual partners/ sexually transmitted diseases

— cervical cancer

— immunodeficiency

— presence of chronic vaginal and vulvar irritation

— smoking

What are the symptoms of vulvar cancer?

The classic symptom is vulvar itching (pruritus), reported in almost 90% of the women with vulvar cancer. There can also be associated pain, bleeding, vaginal discharge, and/or painful urination (dysuria).

Also, women often develop a visible vulvar mass: the squamous cell subtype can look like elevated white, pink or red bumps, while vulvar melanoma characteristically presents as a colored, ulcerated growth. There can be portions of the tumor that look sore and scaly, or cauliflower-like (similar to HPV-related warts)

How is vulvar cancer diagnosed?

First and foremost, a thorough gynecological examination should be performed using a colposcope (special magnifying instrument) for better visualization. Any suspicious areas should be tested by applying a dilute solution of acetic acid to the region; abnormal areas typically turn white, making them easier to identify. Also, any abnormal-appearing area should be sampled along with surrounding normal tissue using a thick wedge-shaped biopsy (usually under local anesthesia). If the area is small, it should be entirely removed in the process of the biopsy (so-called excisional biopsy).

Chest x-ray and CT scan of the abdomen/pelvis can be done to look for disease spread to lymph nodes and/or distant organs. If spread to bladder or rectum is suspected, endoscopy (cystoscopy andproctoscopy, respectively) should be performed.

Once it is diagnosed, how is vulvar cancer staged?

Unlike vaginal cancer, which is typically clinically staged, the International Federation of Gynecology and Obstetrics (FIGO) uses a surgical staging system for vulvar cancer. This means that the stage of the cancer is not actually determined until after surgery is performed and the specimen is examined by the pathologist.

Like vaginal cancer, vulvar cancer has five main FIGO stages (0, I, II, III, and IV). They are:

— Stage 0 - Vulvar intraepithelial neoplasia

— Stage I - cancer is limited to the vulva and perineum, and measures < 2 cm in size

— Stage II - cancer is limited to the vulva and perineum, but tumor is > 2 cm in size

— Stage III - cancer spread to vagina, urethra, anus, and/or the lymph nodes in the groin

— Stage IV - cancer spread to bladder, bowel, pelvic bone, pelvic lymph nodes, and/or other parts of the body

How is vulvar cancer treated?

Surgery, radiation therapy and chemotherapy are the main treatment options, and are typically used in various combinations. As with many cancers, the optimal treatment depends on the disease stage and patient factors such as age and other medical conditions.

Treatment options by stage are as follows:

Stage 0

— Wide local excision, laser surgery, or a combination of both

— Skinning vulvectomy

— Chemotherapy ointment

Stage I

— Wide local excision

— Radical local excision with removal of all nearby groin/ upper thigh lymph nodes

— Radical vulvectomy and removal of nearby groin lymph nodes (and sometimes lymph nodes on opposite side of the body)

— Radiation therapy alone (in selected patients)

Stage II

— Radical vulvectomy and removal of groin lymph nodes on both sides of the body, plus postoperative radiation therapy to the pelvis if lymph nodes are positive for cancer

— Radiation therapy alone (in selected patients)

Stage III

— Radical vulvectomy and removal of groin/ upper thigh lymph nodes on both sides of the body, plus postoperative radiation therapy to the pelvis and groin if lymph nodes are positive for cancer or if the primary vulvar tumor is very large

— Radiation therapy and chemotherapy, followed by radical vulvectomy and removal of lymph node removal of lymph nodes on both sides of the body.

— Radiation therapy (in selected patients) with or without chemotherapy.

Stage IV

— Pelvic exenteration, which entails radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread), as well as the uterus, cervix, and vagina

— Radical vulvectomy followed by radiation therapy

— Radiation therapy followed by radical vulvectomy

— Radiation therapy (in selected patients) with or without chemotherapy, and possibly following surgery

What is the prognosis?

In early stage disease, when lymph nodes are not involved, the overall 5-year survival rate is 90%.

Once cancer has spread to the lymph nodes, the overall 5-year survival rate drops to 50% - 70%.

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Vulvar Cancer

January 19th, 2008 by admin

Description of Vulvar Cancer

Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a woman’s vagina and looks much like a pair of lips. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal.

Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40. Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. You should see your doctor if you have bleeding or discharge not related to your periods (menstruation), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough.

Like most cancers, cancer of the vulva is best treated when it is found (diagnosed) early. If you have symptoms, your doctor may do certain tests to see if you have cancer, usually beginning by looking at the vulva and feeling for any lumps. Your doctor may then go on to cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. You will be given some medicine to numb the area when the biopsy is done. You may feel some pressure, but you usually won’t feel any pain. This test is often done in a doctor’s office.

Your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the vulva or has spread to other places) and your general state of health.

Stages Of Cancer Of The Vulva

Once cancer of the vulva is diagnosed, more tests will be done to find out if the cancer has spread from the vulva to other parts of the body (staging). Your doctor needs to know the stage of your disease to plan treatment. The following stages are used for cancer of the vulva:

Stage 0 Or Carcinoma In Situ Stage 0 cancer of the vulva is a very early cancer. The cancer is found in the
vulva only and is only in the surface of the skin.

Stage I

Cancer is found only in the vulva and/or the space between the opening of the rectum and the vagina (perineum). The tumor is 2 centimeters (about 1 inch) or less in size.

Stage II

Cancer is found in the vulva and/or the space between the opening of the rectum and the vagina (perineum), and the tumor is larger than 2 centimeters (larger than 1 inch).

Stage III

Cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra (the tube through which urine passes), the vagina, the anus (the opening of the rectum), and/or has spread to nearby lymph nodes. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)

Stage IV

Cancer has spread beyond the urethra, vagina, and anus into the lining of the bladder (the sac that holds urine) and the bowel (intestine); or, it may have spread to the lymph nodes in the pelvis or to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vulva or another place. How Cancer Of The Vulva Is Treated There are treatments for all patients with cancer of the vulva. Three kinds of treatment are used: surgery (taking out the cancer in an operation) radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment for cancer of the vulva. Your doctor may take out the cancer using one of the following operations:

Wide local excision takes out the cancer and some of the normal tissue around the cancer.

Radical local excision takes out the cancer and a larger portion of normal tissue around the cancer. Lymph nodes may also be removed.

Laser surgery uses a narrow beam of light to remove cancer cells.

Skinning vulvectomy takes out only the skin of the vulva that contains the cancer.

Simple vulvectomy takes out the entire vulva, but no lymph nodes.

Partial vulvectomy takes out less than the entire vulva.

Radical vulvectomy takes out the entire vulva. The lymph nodes around it are usually removed as well.

If the cancer has spread outside the vulva and the other female organs, your doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (pelvic exenteration).

You may need to have skin from another part of your body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or before or after surgery.

Chemotherapy uses drugs to kill cancer cells. Drugs may be given by mouth, or they may be put into the body by a needle in the vein or muscle. Chemotherapy is called systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Treatment By Stage

Treatment for cancer of the vulva depends on the stage of your disease, the type of disease, your age, and your overall condition.

You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

Clinical trials are going on in most parts of the country for stages III and IV of cancer of the vulva. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

STAGE 0 VULVAR CANCER