Vulval cancer

About

Vulval cancer is a type of cancer that affects the external female genitalia known as the vulva. There are different types of vulval cancer including squamous cell carcinoma, adenocarcinoma, and other rare types. The most common symptoms of vulval cancer include itching, burning, pain, and/or lumps or bumps on the vulva. Treatment options vary depending on the type and stage of cancer, but typically involve surgery, radiation, and/or chemotherapy. The outlook for vulval cancer can vary depending on the type and stage of cancer, but the 5-year survival rate is typically around 80%.

Symptoms

The most common symptoms of vulval cancer include:

A lump, wart-like growth, or area of thickened skin on the vulva
Bleeding that is not related to your menstrual cycle
Itching or burning sensation
Change in the color of the skin
Discharge from the vulva that has an unpleasant smell
Pain in the vulva
Difficulty urinating or pain when urinating
Pain during sexual intercourse
Swelling of the vulva that may cause the inner lips to press together

Causes

The exact cause of vulval cancer is not known. However, there are some known factors that can increase the risk of developing vulval cancer, including:

Human Papillomavirus (HPV) infection
Smoking
Chronic vulvar inflammation and irritation
Weakened immune system
Being over 55
Having been exposed to diethylstilbestrol (DES)
Having had previous vulval cancer
Having a family history of the disease
Having lichen sclerosus, a chronic skin condition
Having vulvar intraepithelial neoplasia (VIN) or abnormal vulval cells
Having genital warts
Having a history of abnormal cervical pap smears
Having a poor diet low in fruits and vegetables.

Risk factors

The exact cause of vulval cancer is not known, but certain risk factors are linked to an increased risk of developing this cancer. These include:

Age: vulval cancer is most often diagnosed in women over the age of 55.
Human Papillomavirus (HPV): Infection with some types of HPV may increase the risk of vulval cancer.
Smoking: Women who smoke have an increased risk of vulval cancer.
Sexually transmitted infections: Having genital warts, genital herpes, trichomoniasis, or chlamydia may increase a woman’s risk of developing vulval cancer.
Family history: A family history of melanoma, or a personal history of melanoma, may increase a woman’s risk of vulval cancer.
Adverse reactions to certain medications: Taking certain medications, such as anti-epileptics or immunosuppressants, may increase a woman’s risk of vulval cancer.
Vulval intraepithelial neoplasia (VIN): VIN is a precancerous condition of the skin of the vulva. Women with VIN have an increased risk of developing vulval cancer.
Weakened immune system: Women with weakened immune systems, such as those who have HIV/AIDS, are at an increased risk of developing vulval cancer.
Long-term irritation of the vulva: Repeated irritation of the skin of the vulva, such as from wearing tight clothing, may increase the risk of vulval cancer.

Diagnosis

Vulval cancer is usually diagnosed through physical examination, using a microscope, and imaging tests. A doctor or nurse may visually inspect the area and may use a colposcope, a special microscope, to look at the areas around the vulva. Imaging tests such as a CT scan, MRI scan, or ultrasound may also be used to take pictures of the area and look for signs of disease. A biopsy may be taken to examine a sample of the tissue under a microscope to check for cancer cells.

Sub-types

There are four main subtypes of vulvar cancer:

Squamous Cell Carcinoma: This is the most common form of vulvar cancer and accounts for up to 80% of all cases. It begins in the cells of the outer-most layers of the skin and often appears as a raised and discolored bump on the vulva.
Adenocarcinoma: Accounts for about 10-15% of vulvar cancers and begins in the glands of the vulva. It often appears as a lump or mass on the vulva.
Melanoma: Accounts for about 5-10% of vulvar cancers and starts in the cells that make pigment in the skin. It often appears as a dark-colored patch on the vulva.
Sarcomas: These are rare and account for less than 5% of vulvar cancers. They can be soft tissue sarcomas or other subtypes that start in the blood vessels, muscles, or fatty tissues of the vulva. They may appear as a lump on the vulva.

Treatments

The treatment options for vulval cancer depend on the type and stage of the cancer. Commonly used treatments include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy.

Surgery: Depending on the size and stage of the cancer, different types of surgery may be recommended. Options include wide local excision, radical vulvectomy, partial vulvectomy, and lymph node dissection.

Radiation Therapy: Radiation therapy may be used to shrink a tumor before surgery, or after surgery to ensure that any remaining cancer cells are destroyed.

Chemotherapy: Chemotherapy can be used to shrink the tumor before or after surgery, or may be used in combination with radiation therapy.

Immunotherapy: Immunotherapy is a form of treatment that helps the body’s own immune system fight the cancer.

Targeted Therapy: Targeted therapy is a type of treatment that targets specific molecules or genetic changes that drive the growth of cancer cells.

Prevention

Practice safe sex. Using condoms, limiting sexual partners and avoiding any sexual contact with someone who has an active sexually transmitted infection (STI) can reduce the risk of vulval cancer.
Get screened for STIs. Early diagnosis and treatment of STIs can help reduce the risk of vulval cancer.
Get vaccinated. HPV (human papillomavirus) infection is associated with an increased risk of vulval cancer. Getting the HPV vaccine and getting regular Pap tests can reduce the risk of developing vulval cancer.
Reduce risk factors. Smoking and excess sun exposure can increase vulval cancer risk. Limiting or avoiding these risk factors may help reduce the risk.
Eat a healthy diet. Eating a balanced diet, full of vegetables, fruits, whole grains, and high-fiber foods can help reduce the risk of cancer.

Gender differences?

Yes, there are gender-specific differences that may affect the presentation and management of Vulval cancer. Women may be more likely to present with symptoms such as itching, burning, and pain, whereas men may be more likely to present with a lump or sore on the vulva. Additionally, women may be more likely to be diagnosed with a more aggressive form of the cancer, with a higher risk of recurrence and metastasis. Women may also require more frequent and more extensive follow-up than men due to their increased risk of recurrence. Furthermore, the treatment options available to women may be more complex and costly due to the need to preserve reproductive organs and tissue.

Nutrition

Nutrition plays an important role in the management of vulval cancer. Nutrition can help to improve overall body state, boost the patient’s immune system, and increase the chances of successful treatment. Nutritional supplements and therapies can help ensure that the patient is getting the necessary vitamins and minerals needed to support their body’s defences, as well as provide additional energy for the treatment process. A well balanced diet full of healthy foods and plenty of water can be extremely beneficial in controlling and managing vulval cancer. Additionally, adequate nutrients can be used to reduce the risk of further complications that may arise due to the cancer treatment. Proper nutrition can also help the patient to remain positive and supported throughout the entire treatment process.

Physical Activity

Physical activity can help to lower the risk of developing vulval cancer by helping to maintain a healthy body weight, as obesity is a risk factor for the development of vulval cancer. Exercise can also help boost the body’s immune system which can help in defending against cancer. Additionally, maintaining an adequate and healthy level of physical activity can help to reduce stress and fatigue, which can help to protect against certain types of cancer.