Vulvar Cancer

Symptoms :

Cancer is caused when the normal mechanisms that control cell growth become disturbed, causing the cells to continually grow without stopping. This is usually the result of damage to the DNA in the cell. Although the cause of vulvar cancer is unknown, studies have identified several risk factors for vulvar cancer. These include: Vulvar intraepithelial neoplasia (VIN). This abnormal growth of the surface cells of the vulva can sometimes progress to cancer. Infection with human papillomavirus (HPV). This virus is sexually transmitted and can cause genital warts. Although HPV DNA can be detected in most cases of vulvar intraepithelial neoplasia, it is detected in fewer than half of all cases of vulvar cancer. Therefore, the link between HPV infection and vulvar cancer is unclear. As of 2001, it is theorized that two classes of vulvar cancer exist: one that is associated with HPV infection and one that is not. Herpes simplex virus 2 (HSV2). This sexually transmitted virus is also associated with increased risk for vulvar cancer. Cigarette smoking. Smoking in combination with infection by HPV or HSV2 was found to be a particularly strong risk factor for vulvar cancer. Infection with human immunodeficiency virus (HIV). This virus, which causes AIDS, decreases the body's immune ability, leaving it vulnerable to a variety of diseases, including vulvar cancer. Chronic vulvar inflammation. Long term irritation and inflammation of the vulva and vagina, which may be caused by poor hygiene, can increase the risk of vulvar cancer. Abnormal Pap smears. Women who have had abnormal Pap smears are at an increased risk of developing vulvar cancer. Chronic immunosuppression. Women who have had long-term suppression of their immune system caused by disease (such as certain cancers) or medication (such as those taken after organ transplantation) have an increased risk of developing vulvar cancer. The hallmark symptom of vulvar cancer is itching (pruritus), which is experienced by 90% of the women afflicted by this cancer. The cancerous lesion is readily visible. Unfortunately, because of embarrassment or denial, it is not uncommon for women to delay medical assessment of vulvar abnormalities. Any abnormalities should be reported to a gynecologist. If squamous cell vulvar cancer is present, it may appear as a raised red, pink, or white bump (nodule). It is often accompanied by pain, bleeding, vaginal discharge, and painful urination. Malignant melanoma of the vulva usually appears as a pigmented, ulcerated growth. Other types of vulvar cancer may appear as a distinct mass of tissue, sore and scaly areas, or cauliflower-like growths that look like warts.

Diagnosis :

A gynecological examination will be used to observe the suspected area. During this examination, the physician may use a special magnifying instrument called a colposcope to view the area better. Additionally, the area may be treated with a dilute solution of acetic acid, which causes some abnormal areas to turn white, making them easier to see. During this examination, if any area is suspected of being abnormal, a tissue sample (biopsy) will be taken. The biopsy can be performed in the doctor's office with the use of local anesthetic. A wedge-shaped piece of tissue, which contains the suspect lesion with some surrounding normal skin and the underlying skin layers and connective tissue, will be removed. Small lesions will be removed in their entirety (excisional biopsy). The diagnosis of cancer depends on a microscopic analysis of this tissue by a pathologist. The diagnosis for vulvar cancer will determine how advanced the cancer is and how much it has spread. This is determined by the size of the tumor and how deep it has invaded the surrounding tissue and organs, such as the lymph nodes. It will also be determined if the cancer has metastasized, or spread to other organs. Tests used to determine the extent of the cancer include x ray and computed tomography scan (CT scan). Endoscopic examination of the bladder (cystoscopy) and/or rectum (proctoscopy) may be performed if it is suspected that the cancer has spread to these organs.

Prognosis :

Factors that are correlated with disease outcome include the diameter and depth of the cancerous lesion, involvement of local lymph nodes, cell type, HPV status, and age of the patient. Vulvar cancers that are HPV positive have a better prognosis than those that are HPV negative. The 5-year survival rate is 98% for stage I vulvar cancer and 87% for stage II vulvar cancer. The survival rate drops steadily as the number of affected lymph nodes increases. The survival rate is 75% for patients with one or two, 36% for those with three or four, and 24% for those with five or six involved lymph nodes. The previous statistics were obtained from studies of patients who received surgical treatment only and cannot be used to determine survival rates when adjuvant therapy is employed. Vulvar cancer can spread locally to encompass the anus, vagina, and urethra. Because of the anatomy of the vulva, it is not uncommon for the cancer to spread to the local lymph nodes. Advanced stages of vulvar cancer can affect the pelvic bone. The lungs are the most common site for vulvar cancer metastasis. Metastasis through the blood (hematogenous spread) is uncommon.