Vulvar cancer is the 4th most common cancer of the female genital tract. It develops when the epithelium of the genital area undergoes neoplastic changes that persist over time. This is called precancerous or intraepithelial lesion. When it starts to invade into deeper structures then it is described as invasive cancer. The initial site of change can be the labia minora, labia majora, clitoris, perineum and the mons. Even though this cancer is less common, it can be equally devastating as the consequences of both treatment and no treatment is potentially life altering.
Vulvar cancer accounts for 5% of genital tract malignancies. It succeeds cancer of the uterus, cervix and ovary in frequency. There are approximately 4700 new cases per year in the U.S. with about 990 deaths each year. The incidence is 2.5 cases per 100,000 women. The incidence for invasive cancer has remained stable over the past 20 years but that of the precancerous lesions has doubled.
Vulvar cancer tends to occur in older women, with the average age of diagnosis being 65. This is probably due to the slow growing nature of this malignancy. The precancerous phase can last for years, with some lesions regressing over time. Only a small percentage of precancerous lesions actually develop into cancer. The risk factors for the development of vulvar cancer include postmenopausal status, smoking, immunosuppression, human papilloma virus infection and certain vulvar dystrophies.
The carcinogenic pathway of the vulvar tissue is triggered by chronic inflammation and infection with the human papilloma virus (HPV). Women with chronic inflammatory condition such as lichen sclerosus, lichen planus and squamous cell hyperplasia have a higher risk of developing vulvar cancer. HPV infection has been implicated in genital tract cancers from the cervix to the anus. The common embryologic origin of all these tissues makes it susceptible to the same cancer causing agents. HPV can be found in 60% of vulvar cancers and types 16 and 33 accounts for 55% of those cancers.
Even though vulvar cancer is less frequent than the other genital tract cancers, awareness is still important. The initial symptoms can be vague or even absent. Treatment can be simple and straightforward if it is detected early. Prevention is even better. The steps are simple: avoid or stop smoking, get the HPV vaccine is you are at risk and see your gynecologist on a regular basis for a routine check.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!