Vulvar Cancer Treatment in Delhi, India

The vulva is the region around the opening of the vagina that forms the external genitalia in women. It includes labia minora, labia majora, clitoris, vaginal opening, and Mons pubis. Vulvar cancer is a result of uncontrolled growth of cells in the tissues of the vulva. It usually develops in labia majora (the outer lip of the vagina) or labia minora (Inner lip). The survival rate of women after Stage I vulvar cancer is 90%, while that after Stage IV is around 30%.

Associated Anatomy of Vulvar Cancer

Vulva

Types of Vulvar Cancer

The most common type of vulvar cancer is squamous cell carcinoma accounting for 90% of the cases. Other less common types of vulvar cancer include adenocarcinoma melanoma, sarcoma & verrucous carcinoma.

Vulvar Cancer Causes

The exact cause of vulvar cancer is not clear yet. It is believed to be related to :

• Human papillomavirus infection (HPV)

• Smoking

• Lichen sclerosus - a skin condition

• Squamous hyperplasia

• Family history of melanoma

Vulvar Cancer Symptoms

After suffering from any of the following symptoms in or around the vulva, women must visit a gynecologist:

• Vulvar mass, growth, lump, ulcer or wart

• Long standing history of vulval itching or burning

• Redness, white patches or pale skin colour of vulva

• Non-healing rashes or sore

• Bleeding in the vulva that is not due to menstruation

• Vulval discharge

• Burning during urination

• Occasionally a palpable metastatic mass in the groin

Vulvar Cancer Diagnose

There are various tests to diagnose cancer and its spread.

• Vulval and pelvic examination - It includes a physical examination of the vulva to check for lumps or anything unusual. Physical examination is followed by biopsy of suspicious looking area of vulva or vulvar growth. A biopsy helps to confirm or refute the diagnosis. Pap smear helps to check the presence of associated HPV infection.

• Colposcopy – A magnifying instrument called a colposcope visualizes the vulva, vagina, and cervix after application of medicated solution.

• Cystoscopy (Bladder and urethral examination) – A lighted tube with a camera or cystoscope is inserted in the urethra & bladder to look out for tumor extension into the urethra or bladder. Proctoscopy (Rectum and anal examination) –

• Proctoscope or a lighted tube with lens looks for tumour extension into the rectum and may collect some tissue samples for biopsy.

• Imaging modalities like CT Scan, MRI or PET CT scan to look for the disease extent.

Stages of Vulvar Cancer

It is mandatory to diagnose the stage to determine the spread of vulvar cancer in the body.

Stage I – Tumor is confined to the vulva.

Stage II – In this stage, cancer spreads to the lower 1/3 of vagina, anus, or lower 1/3 urethra, but not to the lymph nodes.

Stage III – If cancer spreads to inguino – femoral (groin) lymph nodes, it results in stage III. It is further divided into stages III A, III B, and III C depending upon the size and the number of lymph nodes involved.

Stage IV – This stage is divided into Stage IV A and IV B, depending upon the extent of cancer spread to the upper parts of the urethra, vagina, bladder mucosa, rectal mucosa, fixity to bone and other body parts.

Vulvar Cancer Treatment

Management of vulvar cancer requires an experienced multidisciplinary team approach. The treatment depends upon the stage of the cancer, age and general health of the patient. Various treatment options available for vulvar cancer are:

Surgery for Vulvar Cancer

Surgery removes all the cancerous cells without affecting sexual functioning. The types of surgeries include -

• Radical wide local excision - cancerous growth over vulva is removed with a margin of healthy tissue through wide local excision.

• Radical Vulvectomy – The doctor removes the vulval growth and groin lymph nodes. Skin grafts may be used to replace the removed skin.

• Removal of groin lymph nodes

• Closure of large skin defects by flaps

• Pelvic exenteration - Pelvic exenteration surgery process when the primary disease involves the anus, rectum or proximal urethra, then surgery involves removal of bladder, urethra, anus, rectum, vagina, uterus, cervix and both ovaries along with Radical vulvectomy and bilateral groin lymph node removal.

Therapy for Vulvar Cancer

• Definitive radiation therapy - External radiation therapy delivers high-energy radiation through the skin to the targeted region using a machine and kills the cancerous cells. Internal radiation therapy transfers the radioactive substances sealed in needles, wires, or catheters directly into the cancerous cells.

• Chemo-radiation therapy

• Chemotherapy - Chemotherapy includes medications that kill cancerous cells

Risk factors of Vulvar Cancer

Not every woman is at risk of suffering from vulvar cancer. Several factors can increase the risk of vulvar cancer:

• History of genital warts

• Human Papillomavirus (HPV) infection

• Vulvar intraepithelial neoplasia (VIN)

• Abnormal pap smears

• Lichen sclerosus (skin condition involving vulva)

• Multiple sexual partners

• Smoking

• Weak immune system

• Old age

Possible Complications of Vulvar Cancer

• Spread of cancer to lymph nodes, anus, or lower vagina

• Spread of cancer to the bladder, pelvic bone or urethra

• Urinary tract infections

• Lower limb swelling

• Cellulitis

Vulvar Cancer Prevention

Primary Prevention of Vulvar Cancer

There is no screening test for vulvar cancer, so it is necessary to be aware of the signs and symptoms for early diagnosis. Prevention of HPV -

• Prevention of infection by Human Papillomavirus (HPV) can prevent women from vulvar cancer.

• Vaccines – There are two types of vaccines to prevent infection with high risk HPV: Recombinant HPV Quadrivalent Vaccine and Recombinant HPV Nonavalent Vaccine.

Secondary Prevention of Vulvar Cancer

Follow-up after the treatment includes physical examination and some tests to determine the effectiveness of treatment and to detect any recurrent growth.

• Regular checkups and physical examinations by the gynaecologist

• Avoid smoking

• Self-examination of vulva

Expected Prognosis of Vulvar Cancer

The survival rate of vulvar cancer is very high. Nearly 70% of the survivors live for at least 5 years after the diagnosis.

Vulvar Cancer Epidemiology

Vulvar Carcinoma is predominantly a disease of postmenopausal women occurring in women between the age group 65 to 74. Eighty percent of women with untreated vulvar intraepithelial neoplasia are at risk of vulvar cancer.

Natural Progression of Vulvar Cancer

This cancer develops slowly over years. Precancerous lesions are abnormal cells in the outermost layer of the skin or epidermis. These are termed vulvar intraepithelial neoplasia (VIN).

Frequently Asked Questions

1. Does vulvar cancer appear suddenly?

Vulvar cancer does not usually appear suddenly. It typically develops over time due to changes in the cells of the vulva. Early signs may be subtle; if there are any changes in the vulva, visit a gynaecologist for examination.

2. What are the three most common Signs and Symptoms of Vulvar Cancers in the patients?

The three most common signs and symptoms of vulvar cancer are:

• Persistent itching, tenderness, or pain in the vulva.

• Changes in the colour or thickness of the skin on the vulva.

• Development of a lump, wart-like growth, or open sore on the vulva.

3. Does immunotherapy work for vulvar cancer?

Immunotherapy is being studied as a potential treatment for vulvar cancer, but its effectiveness is still being evaluated. Current standard treatments for vulvar cancer include surgery, radiation therapy, and chemotherapy.

4. Can vulvar cancer be treated without surgery?

The treatment of vulvar cancer depends on the stage and extent of the disease. While surgery is the most common treatment, other approaches like radiation therapy and chemotherapy may be used. The best treatment plan is determined by the healthcare team based on the individual's condition.

5. Is sex painful with vulvar cancer?

Vulvar cancer itself may not cause pain during sex, but it can lead to symptoms like discomfort due to changes in the vulva. If you experience pain during sex or notice any abnormalities in the vulva, consult a healthcare professional for evaluation.

6. How can I find the best specialist for vulvar cancer in Delhi?

To find the best specialist for vulvar cancer in Delhi, consider factors like the doctor's experience in treating gynaecological cancers, hospital affiliations, patient reviews, access to advanced treatment options, and expertise in vulvar cancer management.

7. Is Stage 2 vulvar cancer completely curable?

Stage 2 vulvar cancer is considered locally advanced but is often treatable with a combination of surgery, radiation therapy, and sometimes chemotherapy. The probability of success and cure are generally higher than in later stages, but individual cases vary.

8. Do blood tests show vulvar cancer?

Blood tests alone do not diagnose vulvar cancer. Diagnosis is made on the basis of physical examination, biopsy, and potentially imaging tests like CT scans or MRI. Blood tests may be used to assess general health and the overall impact of cancer on the body, but they do not directly detect vulvar cancer.

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