Vulvar Cancer: Symptoms, Causes, and Risk Factors

What is Vulvar Cancer?

Vulvar cancer is a rare type of cancer that develops in the outer part of the female genitals. While it most commonly affects older women over 65, it's important for women of all ages to be aware of the signs and risk factors. Early detection greatly improves treatment outcomes, so recognising symptoms like persistent itching, skin changes, and unusual bleeding is crucial. Although the exact causes are unknown, factors like human papillomavirus (HPV) infection and smoking can increase risk. Understanding the warning signs and risk factors can help you take proactive steps towards prevention and timely intervention.

Vulvar cancer develops in the tissues of the vulva, which include the labia, clitoris, and the opening of the vagina. Squamous cell carcinoma, arising from the skin cells of the vulva, accounts for about 90% of vulvar cancers. While vulvar cancer is uncommon, representing about 4% of gynaecological cancers, its incidence is gradually increasing, especially in younger women.

The exact cause of vulvar cancer is not clear, but various factors can increase a woman's risk. Early detection is crucial, as it significantly improves the chances of successful treatment. Being aware of the signs and symptoms and reporting any unusual changes to your doctor can help catch vulvar cancer at an early stage.

Symptoms of Vulvar Cancer

Vulvar cancer symptoms can be similar to those of other, less serious conditions. However, if you experience any of the following persistently, it's important to consult your doctor:

• Persistent itching, burning, or soreness in the vulva
• Thickened, discolored, or rough patches on the vulvar skin
• Appearance of lumps, warts, or ulcers on the vulva
• Unusual vaginal bleeding or discharge, especially after menopause
• Pain or discomfort during urination or sexual intercourse
• Changes in the appearance of a mole or freckle on the vulva
• Swelling in the vulvar area or groin lymph nodes

These symptoms don't necessarily mean you have vulvar cancer, as they can be caused by other conditions like infections. However, it's crucial not to ignore persistent symptoms. If you notice any unusual changes or symptoms lasting more than two weeks, make an appointment with your gynaecologist.

Causes and Risk Factors of Vulvar Cancer

While the exact vulvar cancer causes are unknown, certain factors can increase a woman's risk:

• Human Papillomavirus (HPV) Infection: Exposure to high-risk HPV strains, especially HPV 16, increases vulvar cancer risk. However, HPV is very common, and most women with HPV do not develop vulvar cancer.
• Age: The risk of vulvar cancer increases with age, with over half of cases diagnosed in women older than 70. However, vulvar cancer is becoming more common in younger women.
• Smoking: Cigarette smoking doubles vulvar cancer risk, likely because tobacco chemicals damage vulvar skin cells.
• Weakened Immune System: Conditions or medications that suppress the immune system, such as HIV or prolonged steroid use, can increase risk.
• Skin Conditions: Chronic inflammatory skin conditions of the vulva, like lichen sclerosus, are associated with a slightly elevated vulvar cancer risk.
• Precancerous Conditions: Vulvar intraepithelial neoplasia (VIN), where vulvar skin cells develop abnormally, can potentially progress to cancer if untreated.

Having one or more of these risk factors doesn't mean you'll definitely develop vulvar cancer. However, it's important to be aware of them so you can take steps to reduce your risk where possible and stay vigilant about any potential symptoms.

Diagnosis of Vulvar Cancer

If your doctor suspects vulvar cancer based on your symptoms and physical exam, they will recommend tests to confirm the diagnosis:

• Medical History and Physical Exam: The doctor takes a detailed medical history and conducts a pelvic exam to check for lumps, skin changes, or other abnormalities.
• Colposcopy: A colposcope magnifies the vulva to inspect suspicious areas, which may be treated with acetic acid or toluidine blue for better visibility.
• Biopsy: A tissue sample is taken from the suspicious area and examined under a microscope to confirm cancer.
• Imaging Tests: If cancer is confirmed, imaging tests like CT scans, MRIs, or PET scans are used to check for spread to other parts of the body.
• Staging: The cancer is staged from stage 1 (localised) to stage 4 (spread to distant areas), helping guide treatment decisions.

Your doctor may also recommend additional tests based on your individual situation.

Treatment Options for Vulvar Cancer

Vulvar cancer treatment depends on various factors, including the cancer stage, type, and location, as well as your overall health and preferences. The main treatment modalities are:

• Surgery: The primary treatment for most vulvar cancers is surgical removal of the tumor and a margin of surrounding healthy tissue. In some cases, nearby lymph nodes are also removed. The extent and impact of surgery depend on the cancer's size and spread.
• Radiation Therapy: High-energy radiation beams are used to kill cancer cells. It may be used before surgery to shrink tumors, after surgery to destroy remaining cancer cells, or as the main treatment if surgery isn't possible.
• Chemotherapy: Cancer-fighting medicines are administered orally or intravenously to kill cancer cells throughout the body. Chemotherapy is mainly used for advanced vulvar cancers or in combination with radiation.
• Topical Therapy: For precancerous vulvar changes or very early superficial vulvar cancers, topical medications may be applied directly on the skin.

In many cases, a combination of these treatments offers the best outcome. Your cancer care team will work with you to develop a personalised treatment plan tailored to your specific situation.

Living with Vulvar Cancer

A vulvar cancer diagnosis can feel overwhelming, affecting your physical, emotional, and sexual well-being. Coping with treatment side effects, changes in body image, and intimacy concerns can be challenging. It's crucial to prioritise self-care and reach out for support:

• Follow your treatment plan diligently and keep all follow-up appointments
• Communicate openly with your healthcare team about any side effects or concerns
• Practice healthy lifestyle habits to support your body during treatment and recovery
• Consider joining a vulvar cancer support group to connect with others who understand
• Seek counseling or therapy to process the emotional impact of cancer
• Explore options like pelvic floor physiotherapy to manage physical discomfort
• Be patient and compassionate with yourself as you navigate this journey

Prevention and Early Detection

While there's no guaranteed way to prevent vulvar cancer, certain steps may lower your risk:

• Practicing safe sex and limiting sexual partners to reduce HPV exposure
• Quitting smoking, as tobacco use is linked to increased risk
• Attending regular gynecologic checkups and promptly reporting unusual symptoms
• Considering HPV vaccination, especially for younger women, to prevent infection with high-risk HPV strains

Awareness is key—learning to recognize warning signs can help catch vulvar cancer at an early, more treatable stage.

Conclusion and Key Takeaways

Vulvar cancer, though uncommon, demands our attention and awareness. By familiarizing yourself with the symptoms, causes, and risk factors associated with this condition, you can be proactive in safeguarding your reproductive health. Remember, early detection is paramount to improving treatment outcomes and quality of life.

If you have any concerns or notice unusual changes in your vulvar area, don't hesitate to consult with your doctor. At Metropolis Healthcare, we understand the importance of accurate diagnosis and personalised care. Our team of skilled pathologists and state-of-the-art diagnostic facilities are equipped to provide you with reliable results and support throughout your healthcare journey.

Take charge of your well-being by staying informed, practicing preventive measures, and prioritising regular check-ups. Together, we can work towards better vulvar cancer awareness, early detection, and improved outcomes for women everywhere.