Vulva is another name for your external sex organs, or genitals see Figure 1. Your vulva includes:. Vulvar cancer is rare. Vulvar cancer usually develops slowly over many years. It starts as abnormal cells. Groups of abnormal cells are also called dysplasia or vulvar intraepithelial neoplasia VIN.
Abnormal cells can grow on your vulvar skin for a long time. Treating abnormal cells can help keep them from turning into vulvar cancer. About half of all vulvar cancers are caused by an infection with certain types of human papillomavirus HPV.
Vaccines that protect against these types of HPV may lower your risk of getting vulvar cancer. Use a mirror to examine your vulva once a month.
If you see any of the things below, tell your healthcare provider. These symptoms may be signs of vulvar cancer, or they may be caused by another condition. Your healthcare provider will talk with you and do tests to learn more. Your healthcare provider will ask about your medical history and do a physical exam.
They may also do other medical exams and tests such as a pelvic exam, vulvar biopsy, or imaging scans. During a pelvic exam, your healthcare provider will examine your vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. They will wear gloves and use a lubricating gel to insert 1 finger into your vagina while placing their other hand over your lower abdomen belly.
This will let them feel the size, shape, and position of your organs to see if anything is abnormal. Your healthcare provider may take a sample of your vulvar tissue.
This is called a biopsy. The tissue will be sent to a lab and examined under a microscope to check for signs of cancer.
Stages are a way to describe cancer. Cancer stages are based on where the cancer is, how big it is, and if it has spread. Knowing the stage of your cancer will help your healthcare provider make the best treatment plan for you. When cancer has spread beyond where it started, it is called metastatic cancer. Cancer can spread:. Your healthcare provider will talk with you about the stage of your cancer.
Recurrent cancer is cancer that has come back after it has been treated. Recurrent vulvar cancer can come back in the area of your vulva or in other parts of your body.
The cancer may be in more than one area, so a large amount of tissue may need to be removed. If the tumor is large more than 2 centimeters or has grown deeply into your vulva, the lymph nodes in your groin area may also be removed.
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Resources in other languages. Home Cancer information Types of cancer Vulvar and vaginal cancers. Vulvar and vaginal cancers Contents: Overview Cancer of the vulva Cancer of the vagina Managing side effects. What is vulvar cancer? What are the types of vulvar cancer? Sarcoma A rare type that starts in cells in muscle, fat and other tissue under the skin. Adenocarcinoma A rare type that develops from the mucusproducing glandular cells in the Bartholin glands or other vulvar glands.
Basal cell carcinoma BCC Although the most common form of skin cancer, BCC is a very rare type of vulvar cancer that starts in tall basal cells in the skin's lower layer.
What are the symptoms? These may include: itching, burning and soreness or pain in the vulva a lump, sore, swelling or wart-like growth on the vulva thickened, raised skin patches may be red, white or dark brown a mole on the vulva that changes shape or colour blood, pus or other discharge coming from an area of skin or a sore spot in the vulva, which may have an offensive or unusual smell or colour not related to your menstrual period hard or swollen lymph nodes in the groin area.
How common is it? The exact cause of vulvar cancer is unknown, but factors that increase the risk of developing it include: Vulvar intraepithelial neoplasia VIN This precancerous condition causes changes in the skin of the vulva.
Abnormal cervical screening test If a woman has had any abnormal cell changes detected on a cervical screening test , she has a slightly higher risk of developing vulvar cancer. Other skin conditions Vulvar lichen planus and vulvar lichen sclerosus are skin conditions that can cause itching and soreness.
Other cancers Women who have had cervical cancer or vaginal cancer have an increased risk of developing vulvar cancer. Smoking Cigarette smoking increases the risk of developing VIN and vulvar cancer.
Weakened immune system Women who've had an organ transplant or have human immunodeficiency virus HIV may be at higher risk of developing vulvar cancer because their immune system is not working normally. Diagnosis The main tests used to diagnose vulvar cancer are a physical examination, a procedure called a colposcopy, and the removal of a tissue sample biopsy.
Physical examination Your doctor will ask to do a physical examination of your groin and pelvic area, including the genitals.
Colposcopy To examine the vulva, vagina and cervix in detail, the doctor looks through a magnifying instrument called a colposcope. Biopsy During the colposcopy, your doctor will usually take a small tissue sample biopsy from the vulvar and possibly also the vaginal area. Cervical screening test If you haven't had one recently, your doctor may do a cervical screening test. Further tests Sometimes further tests are needed to assess your general health, determine the size and position of the cancer, and find out whether the cancer has spread.
You will probably not need to have all of these tests: Blood test This checks the number of cells in your blood, and how well your kidneys and liver are working. Chest x-ray A painless scan that produces an image of your lungs. Cystoscopy The doctor uses a slender, flexible tube with a camera and light cystoscope to look inside the urethra and bladder. Proctoscopy The doctor uses a slender tube with a camera and light proctoscope to look inside the rectum and anus.
CT scan A CT computerised tomography scan uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body. MRI scan An MRI magnetic resonance imaging scan uses a powerful magnet and radio waves to create detailed, cross-sectional pictures of the inside of your body. Staging vulvar cancer Based on the test results, your doctor will be able to tell you the stage of the cancer.
Stages of vulvar cancer Stage I: Cancer is found only in the vulva or perineum. Stage IV: Cancer has spread to the upper urethra, upper vagina or more distant parts of the body.
Prognosis Prognosis means the expected outcome of a disease. Treatment Vulvar cancer usually takes many years to develop but, like other types of cancer, it is easier to treat at an early stage.
Surgery Surgery is the main treatment for vulvar cancer. Types of vulvar surgery Depending on how far the cancer has spread, you may have one of the following types of surgery. Local excision Wide local excision The surgeon cuts out the cancer, as well as a small border of healthy tissue called the margin. Radical local excision The surgeon cuts out the cancer with a deeper margin.
Partial vulvectomy The affected part of the vulva is removed. Complete vulvectomy The surgeon removes the entire vulva, sometimes including the clitoris. Other surgical procedures Lymph node dissection The lymph nodes also called lymph glands are part of the lymphatic system.
Sentinel lymph node biopsy Before a lymph node dissection, the surgeon may perform a sentinel lymph node biopsy. This helped him understand what I'd been through.
Pelvic exenteration This operation is very rarely done for vulvar cancer, but may sometimes be considered for advanced cancer that has spread beyond the vulva.
What to expect after surgery Recovery time Your recovery time after the operation will depend on your age, the type of surgery you had and your general health. If only a small amount of skin is removed, the wound will probably heal quickly. You will spend several days in hospital. If your lymph nodes are removed or the surgery is more extensive, recovery will take longer.
You will spend about days in hospital. While you are in bed, you may need to wear compression stockings and have blood-thinning injections. These measures help the blood in your legs circulate and prevent blood clots in the deep veins of your legs deep vein thrombosis.
Do not put anything into the vagina after the surgery until your doctor says the area is healed usually weeks. This includes using tampons and having sexual intercourse. Pain You will be given medicine to reduce any pain. For the first day or two, pain medicine may be given in various ways: by injection into a muscle; by a drip into a vein intravenous or IV drip ; by a drip into a space around the spinal cord epidural , which numbs the body from the waist down; or by injection into specific nerves during or after the surgery nerve block.
When you are ready, you will switch to pain-relieving pills or tablets. After you go home, you can continue taking these for as long as needed. Strong pain medicines and long periods in bed can make bowel motions difficult to pass constipation.
It is important to avoid straining when passing a bowel motion, so you may need to take laxatives. Talk to your treatment team about suitable drugs. Tubes and stitches You may have a tube called a catheter to drain urine from your bladder. This helps keep your wound clean and dry. It will be removed before you leave hospital.
There may be a surgical drain placed in the wound to draw fluid away from the incision. The drain needs to stay in until there is not too much fluid coming out, so you may go home with the drain still in place.
If this is the case, community nurses can help you manage the care of the drain at home until it is removed. Your doctor will tell you how soon you can sit up after surgery and how to walk to avoid the stitches coming apart. Stitches usually dissolve and disappear as the wound heals. Otherwise, they will be removed within a couple of weeks. Some surgeons use surgical glue instead of stitches.
The glue falls off when the wound has healed. Wound care Infection is a risk after vulvar surgery, so it is important to keep the area clean and dry. While you are in hospital, the nurses will wash and dry the vulva for you a few times a day.
They may also apply an ointment to help prevent infection. The nurses will show you how to look after the wound at home. You will need to wash it two to three times a day using a handheld shower or a shallow basin sitz bath. You will also need to rinse the vulva with water after urinating or having a bowel movement.
Dry the vulva well. If the area is numb, be careful patting it dry. Some women use a hair dryer on a low heat setting and at a safe distance. To air the wound, avoid wearing underwear and wear loose-fitting clothing. Report any redness, pain, swelling, wound discharge or unusual smell to your surgeon or nurse. Recovering from surgery at home When you return home from hospital after surgery for vulvar cancer, there will be a period of recovery and adjustment.
Exercise Check with your surgeon or nurse about when you can start doing your regular activities. Rest Get plenty of rest in the first week after you return home. Sexuality You may feel concerned about the impact on your sex life. Using the toilet If the opening to your urethra is affected, you may find that going to the toilet is different.
Emotions If you have lost part of your genital area, you may feel a sense of loss and grief. Driving You will need to avoid driving after the surgery until your wounds have healed and you are no longer in pain.
Radiation therapy Also known as radiotherapy, this treatment uses a controlled dose of radiation, such as x-rays, to kill or damage cancer cells.
You can have radiation therapy: before surgery to shrink the cancer and make it easier to remove neoadjuvant treatment after surgery to get rid of any remaining cancer cells and reduce the risk of the cancer coming back adjuvant treatment instead of surgery to control symptoms of advanced cancer palliative treatment. External beam radiation therapy EBRT This is the most common type of radiation therapy for vulvar cancer.
Internal radiation therapy Also called brachytherapy, this delivers radiation therapy to the tumour from inside your body. Side effects of radiation therapy The side effects you experience will vary depending on the dose of radiation and the areas treated. Short-term side effects Fatigue Your body uses a lot of energy to heal itself after the treatment, and travelling to treatment can also be tiring.
Bladder and bowel problems Radiation therapy can irritate the bladder and bowel. Nausea and vomiting Because the radiation therapy is directed near your abdomen, you may feel sick nauseous , with or without vomiting, for several hours after each treatment. Vaginal discharge Radiation therapy may cause or increase vaginal discharge. Skin redness, soreness and swelling The vulva may become sore and swollen.
Long-term or late effects Hair loss You may lose your pubic hair. Bladder and bowel changes Bladder changes, such as frequent or painful urination, and bowel changes, such as diarrhoea or wind, can also be late effects, appearing months or years after radiation therapy finishes. Lymphoedema Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly from the legs, making the legs swollen.
Narrowing of the vagina The vagina can become drier, shorter and narrower vaginal stenosis , which may make sex and follow-up pelvic examinations uncomfortable or difficult. Menopause In premenopausal women, radiation therapy to the pelvis can stop the ovaries producing hormones, and this causes early menopause. Chemotherapy Chemotherapy uses drugs to kill or slow the growth of cancer cells. For women with vulvar cancer, treatment may be given: during a course of radiation therapy, to make the radiation therapy treatment more effective to control cancer that has spread to other parts of the body as palliative treatment, to relieve the symptoms of the cancer.
Side effects of chemotherapy There are many different types of chemotherapy drugs. I know things were difficult - it's not easy to see someone you love go through such a hard time. But we got through it together. Palliative treatment Palliative treatment helps to improve people's quality of life by managing the symptoms of cancer without trying to cure the disease.
Key points about vulvar cancer What it is Vulvar cancer is cancer that starts in any part of the external female genitals. Tests The main tests are a physical examination, a colposcopy and the removal of a tissue sample biopsy.
Main treatment Surgery is the main treatment for vulvar cancer. Other treatments Radiation therapy uses radiation to kill or damage cancer cells. External beam radiation therapy is the most common type used for vulvar cancer. Side effects may be short-term or long-term, or may appear later. Chemotherapy uses drugs to kill or damage cancer cells. Side effects can include nausea and fatigue.
For advanced vulvar cancer, palliative treatment can help with symptoms and improve quality of life. Cancer of the vulva. Managing side effects. Cancer information. Questions about cancer? Shop online Contact us Other languages Website policies and information Aboriginal communities.
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Cancer Wellness Program. Contact a Cancer Nurse. Newsletter sign-up. Financial and legal. Conclusion: The occurrence of distant metastasis from vulvar cancer is a rare event with very limited prognosis. Further efforts, especially translational research will be crucial to identify prognostic markers as well as therapeutic targets to improve survival in these patients. Abstract Objective: Metastatic vulvar cancer is a rare disease.
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