Frequently Asked Questions About Vulvar Cancer
Q. What is vulvar cancer?
A. Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a woman’s vagina. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal. Vulvar malignancies are rare and account for 3 percent to 5 percent of all female genital cancers.
Q. What are the causes and risk factors for vulvar cancer?
A. It is difficult to discover what causes cancer from one person to another, but researchers have found several factors that increase a woman’s likelihood of developing vulvar cancer. Some risk factors for vulvar cancer include:
- Age – Of women who develop vulvar cancer, three-fourths are over 50 and two-thirds are over 70.The average age at diagnosis is 65 years; however, vulvar carcinoma is becoming more common in women under 40.
- Human papillomavirus (HPV) infection – Human papillomavirus infection is thought to be responsible for up to 90 percent of vulvar cancers.
- Tobacco use – Smoking exposes the body to many cancer-causing chemicals that affect more than just the lungs. These harmful substances can be absorbed into the lining of the lungs and spread throughout the body. Among women who have a history of genital warts, smoking further increases the risk of developing vulvar cancer.
- Vulvar intraepithelial neoplasia (VIN) – Women with VIN have an increased risk of progression to invasive vulvar cancer. Although most cases of VIN never progress to cancer, it is not possible to tell which will, so treatment and/or close medical follow-up are needed.
- Immunosuppression – Also a risk factor for vulvar cancer.
Q. What are the symptoms for vulvar cancer?
A. A doctor should be seen if a woman observes any of the following:
- Vulvar mass or lump
- Pruritus (itching)
Q. How will my doctor know if I have vulvar cancer?
A. If there are symptoms, a doctor may do certain tests to see if there is cancer, usually beginning by looking at the vulva and feeling for lumps. The doctor may then cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. A patient will be given some medicine to numb the area when the biopsy is done. Some pressure may be felt, but usually with no pain. This test is often done in a doctor's office.
Q. What about treatment? What should I ask?
A. There are treatments for all patients with cancer of the vulva. Three kinds of treatment are used:
- Surgery (taking out the cancer in an operation)
- Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
- Chemotherapy (using drugs to kill cancer cells)
A doctor may use just one method or combine methods to treat the cancer most effectively; however, surgery is the most common treatment of cancer of the vulva.
The standard therapy for cancer localized to the vulva includes radical surgery resection of the primary lesion and inguinal lymphadenectomy. Inadequate local surgical excision results in a high local recurrence rate. Radical excision with bilateral groin node dissection has been the recommended treatment for larger vulvar lesions. When vulvar cancers are diagnosed earlier, smaller localized, less traumatic surgeries with unilateral lymph node dissection can be performed.
Here are some questions a woman may want to ask her doctor before treatment begins:
- What is my diagnosis?
- What is the stage of the disease?
- What are my treatment choices? Which do you recommend for me? Why?
- What are the chances that the treatment will be successful?
- Would a clinical trial be appropriate for me?
- What are the risks and possible side effects of each treatment?
- How long will my treatment last?
- Will I have to change my normal activities?
- What is the treatment likely to cost?
Q. What are the side effects of treatment?
A. It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects.
The side effects of cancer treatment vary, depending on the type of treatment. Also, each woman reacts differently. Doctors try to keep side effects to a minimum, but problems may occur.
The consequences of curative surgery can be psychologically devastating, as vulvar surgery can result in lifelong anatomic alterations. Sexual dysfunction is common because of loss of clitoris in some clinical situations and in general because of alteration in body image. Lower extremity lymphedema (leg swelling) can occur, causing difficulty walking, pain, recurrent infections and disfigurement. Therefore, all therapy includes pretreatment counseling about sexual and physical function.
If the cancer has spread outside the vulva and the other female organs, the doctor may take out the lower colon, rectum or bladder (depending on where the cancer has spread), along with the cervix, uterus and vagina (pelvic exenteration). Physicians have developed ways for patients to store and eliminate wastes after these procedures, and it is sometimes possible to reconstruct or reattach these organs so no external appliances are needed. A patient may need to have skin from another part of the body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.
Radiation therapy is delivered by exposing cancer cells to high-energy rays or particles to destroy them. The most common method of radiation therapy is known as external beam radiation or teletherapy. With this method, a beam from a machine outside the body is focused in the area of the cancer. Treatment usually involves receiving teletherapy for five days a week for about six weeks. The side effects for this method of radiation therapy include a skin reaction like a sunburn on the outside of the skin, fatigue, nausea and diarrhea. When delivered to the pelvis, premature menopause and problems with urination may also occur.
Q. Will I be able to adjust to this disease well?
A. Each cancer survivor’s recovery is different, and a person’s adjustment after cancer treatment depends on a number of factors. Vulvar cancer can cause major life changes in its survivors. Treatments often affect a woman’s ability to have intercourse and to have children. It is important for women to seek support during and after cancer treatment. In fact, behavioral scientists have found that women who take advantage of a social support system, such as a cancer support group, survive with a better quality of life. Maintain an open dialogue with your cancer care team to address any concerns you have.
Q. Are there clinical trials available for vulvar cancer?
A. Yes. For some vulvar cancer patients, treatment may involve a clinical trial. Clinical trials are studies conducted with the consent of patients to evaluate a new treatment. Speak with your doctor. Click here for more information on clinical trials.