Vulvar cancer is the 4th most common cancer of the female genital and even though it affects only a small percentage of women, it can be difficult to detect and treat thereby contributing to significant morbidity and mortality. In addition its existence may indicate the presence of another, nearby malignancy. This article will review its presenting symptoms, the different types and diagnosis.
The presence of vulvar cancer is complicated by a number of factors. The cancer can occur in multiple spots within the same genital area. This is described as multifocal and is present in 5% of the cases of vulvar cancer. In 22% of cases, a second cancer is also present in an adjacent genital organ. This is called multicentric. The areas include the cervix and the birth canal. Finally, in 10% of cases, the vulvar cancer is so advanced and has extended such that the site of origin cannot be identified.
Vulvar cancer typically presents with a single or multiple lesions, which can be a plague, ulcer or mass. The mass may look fleshy, warty or nodular. These lesions can be found on the labia majora, minora, clitoris, perineum or mons. In many cases a woman may not have any symptoms however if present it maybe chronic unrelenting itching. Other symptoms include bleeding, discharge, pain with urination or the appearance of an enlarged lymph node.
Symptoms of persistent itching which is unresponsive to therapy and of unclear cause, warrants further investigation. A thorough examination of the symptomatic area is required and this is usually done under magnification. The procedure is called vulvoscopy and can be done with the colpsocope, which is used to examine the cervix. An acetic acid solution is painted on the vulva and abnormal areas can be seen under magnification. The identified areas should be biopsied.
In cases where an abnormal ulcer, nodule or warty lesion is found then a biopsy is recommended. This can be done in the office using a local anesthetic. It is important to examine the entire vulvar since these lesions can be multifocal. If a diagnosis of vulvar cancer is made, then a complete evaluation of the birth canal and cervix is indicated since a second malignancy might be present in these areas.
If detected early, vulvar cancer can be treated easily. Knowing the signs and symptoms as well as understanding the risk factors can help women become more vigilant. Women at risk of vulvar cancer, those who have precancerous vulvar lesions and those who have been treated for vulvar cancer require close follow-up since they are at higher risk of recurrence or the development of a malignancy in other areas of the genital tract.
I hope this article has provided you with information that will help you make wise choices, so you may:
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