Vulvar cancer

Vulvar cancer is cancer that attacks the outer surface of a woman's genital area.

The vulva is part of a woman's external sexual organs, which is the area that surrounds the opening of the urethra and vagina. Other external sex organs from women include the labia minora and majora (inner and outer "lips" that cover the vagina), the clitoris and Bartholin glands on both sides of the vagina.

Vulvar cancer is in the form of a mass or wound in the vulva area. This cancer attacks older women more often, usually those who have experienced menopause.

There are two types of vulvar cancer depending on the type of cells affected. This type of cancer is also useful for doctors to determine the type of treatment that must be followed.

  • Vulvar melanoma, cancer cells that form in pigment-producing cells in the vulva skin.
  • Vulvar squamous cell carcinoma (vulva squamous cell carcinoma), which is a cancer cell that forms on thin cells, has a flat surface that lines the surface of the vulva. Most cases of vulvar cancer come from this type.

Some other types, namely:

  • Basal cell carcinoma, which is a wound in the labia majora or other areas of the vulva, progresses to cancer. If left untreated, this wound can easily reappear.
  • Carcinoma of the Bartholin gland, a rare tumor in the Bartholin gland that usually attacks women in their mid-sixties.
  • Other types of vulvar cancer, such as adenocarcinomas and sarcomas.

Causes of vulvar cancer


The cause of cancer in general is not yet clearly known, as is vulva cancer. Experts are always looking for triggers that allow cells to turn into cancer cells and grow so fast. Cells that divide will continue to grow by multiplying the amount to form a tumor, then spread to other parts of the body. Cancer cells and tumors will continue to grow and divide while healthy cells die.

Although the cause is unknown, some of the following factors are conditions that can increase the incidence of vulvar cancer, namely:

  • Smoke.
  • Increasing age The risk of vulvar cancer generally increases from the age of 65 years and in postmenopausal women. This case rarely occurs in women under 50 who have not experienced menopause.
  • Exposed to infection with HPV (human papillomavirus), a sexually transmitted disease that is commonly found in women who are sexually active. Generally, HPV infection can reduce by itself. In some other cases of this disease, infected cells can mutate and turn into cancer cells.
  • Infected with HIV (Human Immunodeficiency Virus) which weakens the immune system and makes people vulnerable to HPV infection.
  • Suffer from skin disorders in the vulva area, such as Lichen Sclerosus.
  • Once in a precancerous vulvar condition, or intraepithelial neoplasia (VIN) neoplasia, which can develop into vulvar cancer. VIN is a condition when cells undergo changes that do not lead to cancer. Although in most cases the disease can go away on its own, it can actually turn into cancer cells.
Symptoms of vulvar cancer

Vulvar cancer can cause itching which is very annoying in the vulva area. Here are other symptoms of vulvar cancer.

  • The bleeding did not originate from menstruation.
  • Changes in skin conditions, such as skin color and thickness. The skin may be red, white or dark.
  • There are moles in the vulva area that change shape or color.
  • Pieces that look like pimples, boils or open sores.
  • Pain or sensitivity to pain in the pelvic area, especially during sexual intercourse.
  • Feels painful, especially when urinating

Nearly 50% of cases of vulvar cancer attack the labia majora (external "lips" of the genitals), followed by labia minora ("lips"). See your doctor immediately if you experience the symptoms described above.
Diagnosis of vulvar cancer

In addition to ensuring the presence of cancer cells in the vulva, a diagnosis of vulva cancer is also made to determine the level of development or spread of cancer cells. After the information in the form of symptoms, personal and family medical history is collected, the doctor will conduct a physical examination of the patient. This is done to see if there are abnormalities in the vulva area.

Some of the tests and procedures used to diagnose vulvar cancer include:

  • A more detailed examination of the vulva uses a magnifying glass to look for signs of vulvar cancer in this area. This examination is called colposcopy.
  • Cystoscopic examination is carried out using a small tube with a camera and a lamp inserted into the bladder.
  • Take a biopsy and examine samples taken from the vulva or lymph nodes for signs of cancer. Patients usually receive local anesthesia in the area to be biopsied. Inspection can be done with or without stitches, depending on the size of the sample taken.
  • Pelvic area examination to determine whether the cancer has spread to this area.
  • X-rays, CT, MRI and PET scans on the chest, lungs, lymph nodes, stomach or other organs to determine the spread of cancer in this area. 
After the diagnosis is made, the doctor will determine the stage of the cancer which will facilitate the selection of treatment steps. Stages of vulvar cancer include:

  • Stage 1 - The cancer has not spread to lymph nodes or other parts of the body. There is a small tumor on the vulva or skin between the vaginal area and the anus (perineum).
  • Stage 2 - Unlike stage 1, at this stage, the tumor has spread to the surrounding area. These areas are located at the bottom of the urethra, vagina and anus.
  • Stage 3 - The spread of cancer at this stage has spread to lymph nodes.
  • Stage 4A - The cancer has spread to a larger area of ​​the lymph node, or to the upper part of the urethra or vagina, or to the bladder and rectum / rectum. In addition, the spread of cancer cells affects the pelvic bone region.
  • Stage 4B - Cancer has spread or spread to other parts of the body not only near the vulva.
Treatment of vulvar cancer

One stage of treatment for vulvar cancer is a procedure to remove cancer and a number of healthy tissue around the vulva (usually about 1 centimeter) or extensive radial excision surgery. But there are also cases of vulvar cancer that require full removal of the vulva, including the clitoris and underlying tissue called radical vulvectomy.

The procedure to remove the vulva carries the risk of infection until discomfort occurs when you sit for long periods. You may not be able to feel the pubic area and will not be able to reach orgasm during sex.

The earlier vulva cancer can be diagnosed, the less likely it is that this procedure will be needed. Here are some other procedures to get rid of vulvar cancer.

  • Partial vulvectomy In this procedure, only a portion of the vulva and underlying tissue are removed.
  • Pelvic exenteration procedure for advanced cancer. This procedure is done if the cancer has spread from the vulva to other organs, removing all parts of the vulva and related organs, such as the large intestine. A hole will be made in the abdomen (stoma) so that dirt or urine can be put into an ostomy bag. This action is included in major operations that are not much done now.
  • Reconstruction procedure. The procedure for removing cancer over a wider area usually leaves a large wound that cannot be closed by itself. This occurs in cancers that have spread to surrounding tissue. In this case, the doctor will perform a reconstruction operation by removing the skin from other parts of the body to cover the area.
In addition to removing the vulva, a procedure to remove lymph nodes can also be done at the same time if the cancer has spread to the area. This process causes fluid retention and swelling in the legs called lymphoedema.

Lymph nodes can also be removed surgically from sentinel lymph nodes (sentinel lymph node biopsy) by taking an example of an infected lymph node and then looking for the presence of cancer cells. If no cancer cells are found, it is possible the cancer has not spread to other lymph nodes.

Like other cancer treatments, vulvar cancer can also be treated with chemotherapy, radiotherapy or a combination of both.

Chemotherapy. Patients with vulvar cancer with the spread of cancer cells in other parts of the body can choose this step to help kill cancer cells. Medication can be taken or inserted into a vein in the arm. Chemotherapy associated with radiotherapy is generally intended to minimize cancer to facilitate surgical procedures.

Radiotherapy. In addition to reducing cancer cells, radiotherapy is also used in cases of cancer cells that have spread to lymph nodes after surgery. This treatment involves exposing high-energy energy, such as X-rays, to specific areas on the surface of the skin.

Routine health checks after treatment for vulvar cancer are still needed to monitor the patient's condition and make sure the cancer cells do not change. Therefore it is very important to check yourself regularly after treatment.
Prevention of vulvar cancer

Carrying out routine health checks (medical examinations) can help you monitor your health while detecting unknown diseases so far. Discuss with your doctor the ideal time for regular medical exams. You can also check the pelvic exam schedule. The pelvic examination procedure will provide information about the condition of your internal reproductive organs.

Some preventive steps that can also be taken to reduce the risk of vulvar cancer or sexually transmitted diseases such as HPV or HIV are as follows:

  • Use a condom every time you have sex.
  • Limit the number or number of sexual partners.
  • Get the HPV vaccine. This vaccine can reduce the risk of vulvar cancer and is recommended for girls aged 12 to 13 years.

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