Ladies, if you were asked what your vulva is, would you be able to say? Don’t tell anyone, but this health reporter could not have done so a while back.
So, if you don’t know what it is, you may not know that you can develop cancer in this area.
Vulvar cancer is very rare and can be treated successfully – if it’s caught early.
Here are some things you may want to know about this intimate cancer, along with symptoms you don’t want to ignore.
What is the vulva?
The vulva isn’t a separate organ. Rather, it’s the skin and tissue that makes up a woman’s external genitals. This tissue surrounds and protects the opening of the vagina and urethra – the tube urine flows through as it leaves the body.
The vulva includes the inner and outer lips (major and minor labia) of the vagina, the glands inside the vagina and the clitoris.
What is vulvar cancer?
Cancer occurs when cells get out of whack and start growing wildly. Vulvar cancer is no different.
About 5,000 women in the US are diagnosed with vulvar cancer and roughly 1,000 American women die from the disease every year.
The vast majority - 90 percent - of vulvar cancers appear on the labia.
Less often, cancer can grow in the clitoris or in glands in the vagina that make lubricating fluid. These are known as the Bartholin's glands.
There are three types of vulvar cancer. The names describe the cells where the cancer starts.
Squamous cell carcinoma starts in the skin cells of the labia. This is by far the most common type of vulvar cancer, making up about 90 percent of all cases. It shows up as a bump on the labia.
Adenocarcinoma appears in the Bartholin's glands or the sweat glands of the vulva. It’s most often seen just inside the opening of the vagina.
Melanoma – a serious form of skin cancer – can, but rarely does develop on the inner lips (minor labia) or clitoris. Women with melanoma on other parts of their body are at increased risk of this form of vulvar cancer.
There are rarer forms of this rare cancer, including Paget’s disease (a skin cancer that looks like eczema) of the vulva, other types of skin cancer and sarcoma - a soft tissue cancer that is seen in connective tissue.
What are the risk factors for vulvar cancer?
There are several things that increase a woman's chances of developing vulvar cancer:
Age: As with most cancers, age is a risk factor. This cancer is most often seen in women older than 50 who have a skin condition called lichen sclerosus that makes the skin feel itchy. They may also have certain altered genes that are seen in tissue after the disease is diagnosed.
HPV: Infection with the human papillomavirus (HPV) is also a risk factor. HPV infection is the reason this disease is now being seen in women in their 30s. HPV is also linked to other cancers, including cervical cancer.
Smoking: This habit is another known risk factor for vulvar cancer.
Weak immune system: Having conditions that weaken the immune system, such as human immunodeficiency virus (HIV) - the virus that causes acquired immune deficiency syndrome (AIDS) - can also be a gateway for vulvar cancer. The body is then less able to fight off infection in the presence of cancer.
Organ transplant: Women who have undergone an organ transplant are also more vulnerable to this cancer, as are women who have had melanoma.
Precancerous lesions: These spots can develop in the vulva, cervix or vagina and can later turn into cancer.
What are the symptoms of vulvar cancer?
dailyRx News spoke with a gynecologic oncologist, Ernst Lengyel, MD, PhD, professor of gynecologic oncology at the University of Chicago. He has treated around 75 women with vulvar cancer.
Dr. Lengyel told us, “There are early symptoms: itching and a bump. Most women ignore them or ashamed to go and see a doc.”
He continued, “Women who are elderly tend to ignore these symptoms, and their gynecologists think it is normal atrophy caused by hormone depletion in menopause.
“It is so rare that many doctors don’t see more than 1-2 a year if at all,” Dr. Lengyel said.
Other symptoms of vulvar cancer include:
- A lump or growth in the area
- A spot on the skin that has a different texture or color from other areas of the vulva
- Itching, pain, soreness or a burning sensation in the vulvar area
- Painful urination
- Abnormal bleeding or discharge that's not related to menstruation
- Ulcers - raw open sores - that last for more than a month.
- Change in a mole that's in the area.
- Growths that look like warts - can be confused with genital warts.
How is vulvar cancer treated?
Treatment involves surgery to remove the lesion and surrounding tissue. Sometimes lasers are used for this procedure.
When the cancer is more advanced, an operation called a vulvectomy may be performed. This surgery removes part or the entire vulva, including the clitoris.
At advanced stages of vulvar cancer, other organs may also need to be removed.
Depending on the stage of the disease, surgery may be followed by radiation and/or chemotherapy to kill any remaining cancer cells.
What women need to know most about vulvar cancer.
When asked this question, Dr. Lengyel said, “The most important aspect is to diagnose it. Every persistent vulvar lesion should be biopsied!”
He urges all women who have ongoing itching or a bump on the labia or elsewhere in the genitalia to visit with a gynecologist.