Vulvar cancer

What is vulval? Cancer?

Vulvar (or vulvar) cancer or cancer vulva It represents about 3-5% of female genital cancers. It can occur anywhere on the vulva, but most often affects the clitoris, the inner edges of the labia majora, and the labia minora.

More than 90% of vulvar cancers are scaly cell carcinomas (SCC). The next most common type of vulvar cancer is melanoma But this represents less than 5% of all vulvar cancers. Other rare vulvar cancers are basal cell carcinoma (BCC), Bartholin's gland cancer, and extramammary Paget's disease.

Who gets vulvar cancer and why?

Vulvar cancer can affect women of all ages, but women's 70% is> 60 years old. Human papillomavirus (HPV) is responsible for approximately 60% of squamous cell carcinomas of the vulva.

Some squamous cell vulvar cancers may be preceded by precancerous changes that can last for several years. This precancerous condition of the vulva is known as vulvar intraepithelial. neoplasm (VIN), and when associated with the human papilloma virus infection, also known as high-grade squamous intraepithelial injury (HSIL). Vulvar cancer is more common and more aggressive in cigarette smokers.

Vulvar lichen sclerosus and chronic erosive lichen planus predispose to differentiated VIN (dVIN), which can also lead to vulvar squamous cell carcinoma. DVIN-associated vulvar cancer is not related to HPV infection.

What are the signs and symptoms?

The signs and symptoms of vulvar cancer depend on the type of cancer involved.

Squamous cell carcinoma

• Red, pink or white nodule or nodules or plates
• May have wart-shaped and / or raw surface if ulcerated
• The affected vulvar area may appear white and feel rough.
• About 50% of women complain of itching or pain.
• Other symptoms include painful urination, burning, bleeding, and download not associated with a normal menstrual period

Extramammary Paget's disease

• Wet red asymmetric oozing license plate
• Can cause burning and itching

Basal cell carcinoma

• Painless red patch, nodule or ulcer

Melanoma

• Appearance of a new pigmented injury or change in a pre-existing mole

Bartholin's gland cancer

• Persistent cystic or thickening of soft mass on either side of the opening of the vagina

See images of vulvar cancer ...

Diagnosis and staging of vulvar cancer.

Skin biopsy The injury is performed to obtain an accurate diagnosis of vulvar cancer. Below microscopy, the presence of evil one cells along with other histological The findings will confirm the diagnosis and type of vulvar cancer.

After the initial diagnosis of vulvar cancer, a specialist doctor will perform a comprehensive examination to determine the stage of the cancer. This depends on:

• The size of the tumor
• How deeply the tumor has invaded the tissues at the site of origin.
• The extent of any invasion into the surrounding organs or lymph nodes.

Determining the stage of the cancer is an important factor, as it directs which treatment plan should be used. The FIGO (International Federation of Obstetrics and Gynecology) staging system is commonly used to describe staging of vulvar cancer. The system classifies the disease from Stage 0 to Stage IV. Stage 0 represents precancerous lesions, while stage IV is the most advanced stages of cancer (invasion and metastasis of surrounding and distant tissues and lymph nodes).

Most patients will have blood tests, a chest x-ray, and Connecticut scan of the abdomen and pelvis to help stage the cancer.

In a large center with an experienced multidisciplinary team, some patients with vulvar carcinoma may be offered a sentinel node biopsy to determine if there is microscopic Metastases The requirements are:

• Unifocal tumor
• Small tumor, <4 cm de diámetro
• Not palpable lymph nodes

What is the treatment of vulvar cancer?

Treatment of vulvar cancer depends on the type of cancer and the stage of the cancer. In general, diagnosis and treatment during the early stages of cancer have a much better outcome. There are basically 3 types of treatment options available.

• Surgery (cancer cut)

• Radiotherapy (high-dose x-rays or other high-energy rays to kill cancer cells)
• Chemotherapy (medicines to kill cancer cells, eg cisplatin, gemcitabine)

Surgery is the most common form of treatment for vulvar cancer. Various methods can be used, which often depend on the stage of the cancer. One of them is largely local. excision, which eliminates cancer and part of the normal tissue that surrounds it. Another is the radical local excision that removes the cancer and about a 1 cm portion of surrounding tissue.

The lymph nodes in the groin are usually removed when the cancer is 1 mm or more deep, but in some centers a sentinel node biopsy is done if the nodes are not clinically involved.

Complications from surgery are often related to destruction of the lymphatic groin channels and include lymphocytes and lymphedema in up to 70% of patients undergoing lymph node elimination.

Radiation and chemotherapy are used more frequently in patients with locally advanced recurrent vulvar cancer

How can vulvar cancer be prevented?

The HPV vaccine is expected to reduce the incidence of HPV-associated vulvar cancer in the future. Quadrivalent HPV vaccine (Gardisil ™) protects against HPV 16, 18, 6, and 11; 9-valent Gardisil ™ also protects against HPV 31, 33, 45, 52 and 58. In New Zealand, funded vaccination has been offered to adolescent girls since 2006.

Most sexually active men and women will acquire at least one genital HPV subtype, most within the first 5 years of onset of sexual activity. For the maximum effectivenessVaccination should be carried out before sexual activity begins. HPV infection rates can be reduced by using condoms during sex and limiting the number of sexual partners.

Aside from its role in causing anogenital warts, scaly high-grade vulvar epithelial Injury and vulvar cancer, HPV infection can also lead to cervical intraepithelial neoplasia (CIN), anal intraepithelial neoplasia (AIN), vaginal intra-epithelial neoplasia (VAIN), or other invader anogenital tract tumor such as anal cancer.

It is important that all women have cervical smears regularly in accordance with the national screening program. These offer an opportunity for regular vulvar examinations to detect vulvar cancer early.

Women with vulvar lichen sclerosus and vulvar erosive lichen planus should schedule check-ups with their doctor every year or two, and sooner if they are aware of an enlarged lump or persistent pain.