Vulvar Cancer (VC) is a malignancy that occurs on the outside of a woman’s genitals, the
vulva.
It can affect the labia majora, labia minora, the clitoris, and the perinium.
VC is a rare disease, there are about 4300 new cases in the U.S. each year
and it is estimated that 1800 women will die as a result.
Cancer
of the vulva is usually seen in women over the age of 50. However, Vulvar
Intraepithelial Neoplasia (VIN) is a pre-cancerous condition and is seen more often
in younger women. The
Human Papilloma Virus
(HPV) is a sexually transmitted disease
and is known to be a contributing factor towards VIN, it is also seen in
about 5% of invasive vulvar cancer.
The symptoms of VIN and/or VC vary, some women have very little while others
seem to be bombarded.
Things to look for are any unusual lumps, bumps, sores, or changes in color or texture
of the vulvar skin. Many women complain of severe itching, burning, stinging, bleeding,
and painful intercourse. Keep in mind there are many
benign vulvar conditions that can
cause these same symptoms, that is why it is very important for you to see a
gynecologist if you have ANY of these symptoms that persist.
The only true way to know what is going on with your body is to have a
colposcopy
and possible biopsy. The colposcopy is painless, the doctor will apply an
acetic wash (vinegar) to the vulva and let it sit for about five minutes,
afterwards the doctor looks at your vulva through a microsope. Any abnormalities will
soak up the solution and this gives the doctor an indication of where a biopsy might
need to be taken. The vulva is then numbed and the area removed, usually through a
punch biopsy. He then sends it off to pathology.
*ALWAYS get a copy of your pathology report, you are entitled to it by law.*
Once you know what you are dealing with, you and your doctor can come up with the
best treatment for your situation.
VIN is divided into three stages depending on how deep into the skin
the abnormal cells are.
- VIN I: mild dysplasia, abnormal cells are found in 1/3 of the tissue
- VIN II: moderate dysplasia, abnormal cells are found in 2/3 of the tissue
- VIN III: severe dysplasia, abnormal cells are found in the full thickness of the tissue,
but they have not broken through the bottom membrane
Stage III is considered severe dysplasia, carcinoma in-situ,
or stage 0 vulvar cancer. VIN III is not considered invasive cancer. It does not have
the ability to metastasize to other parts of the body because it has not broken through
the bottom membrane of the epithelium or tissue, where as Stage 1 VC has.
Although VIN III is not considered invasive or fast growing it still requires treatment so
it does not progress.
If you are diagnosed with VIN there are many different kinds of treatments.
VIN I and II are usually watched very closely by a gynecologist every few months,
but some physicians prescribe creams such as Aldara or 5FU to boost the immune
system and fight off the HPV. It has worked for many ladies to regress the VIN.
VIN III is usually removed by a wide local excision, laser ablation, or very rarely a
skinning vulvectomy. When excising the tissue the main objective is to get clear
margins or make sure that there is no abnormal cells left on the vulva.
Keep in mind, with laser surgery there is no pathology to send off because
the tissue is burned; there is no way to know if you had clear margins.
Invasive VC has four different stages that you can read about at The Mayo Clinic.
If you are diagnosed with VC there are three types of treatment; surgery, radiation, and
chemotherapy. However, surgery is the most common, some women may need a
combination depending on the stage of the cancer.
Different types of surgery:
- Wide Local Excision- takes out the cancer and some normal tissue around it.
- Radical Local Excision- takes out the cancer and a larger area of normal tissue. Lymph nodes may or may not be removed.
- Laser Surgery-burns the abnormal tissue away
- Skinning Vulvectomy- takes out only the cancerous tissue
- Simple Vulvectomy- takes out all of the vulva, but no lymph glands
- Partial Vulvectomy- takes out less than the entire vulva
- Radical Vulvectomy- takes out the entire vulva and the lymph glands
You can protect yourself and catch VIN and VC before it becomes invasive and/or life threatening in several ways.
- Get to know your body! Look at your vulva and get accustomed to the way it
looks. Perform monthly vulvar self-exams. Check for tissue changes; such as,
changes in color, lumps, bumps, sores, or different textures…. anything unusual for you
needs to be examined by a gynecologist.
- Don’t let symptoms go. If you have itching, bleeding, burning, stinging etc…get to the
doctor!
- Keep your yearly check ups. Gynecologists should check the vulva when
performing your annual pap smear. Don’t be embarrassed to talk with your doctor about
any changes you have found, which is what they are there for. It is always better to
be safe and a little embarrassed than sorry.
- Find out if you have HPV. Your gynecologist can run a HPV test from taking a
swab from your cervix. This test can tell you if you have any “high risk” strains that
put you at risk.
If you find that you have “high risks” strains of HPV and/or VIN, you can help
your immune system to become stronger by a few lifestyle changes.
Some ladies have actually been able to regress early stages of VIN by taking better
care of themselves.
- Stop smoking! Smoking weakens the immune system.
- Eat healthy, lots of red and orange vegetables that are high in antioxidants.
- Take a multi-vitamin or supplement of antioxidants.
- Lower your stress level; you would be surprised what stress can do to your body.
Another very important thing you can do for your health is READ!
Educate yourself fully on your condition and pass the word onto other women that
might not be aware that these conditions even exist.
The best way to fight these kinds of diseases is through education and prevention.
