Vulvar carcinoma, also known as vulvar cancer, is a relatively rare but serious cancer of the female genital area. As with all forms of cancer, early detection is crucial for successful therapy for vulvar cancer.
What is vulvar cancer?
A vulvar carcinoma is a malignant, i.e. malignant tumor in the area of the external genital organs of the woman. This area consists of the outer and inner labia as well as the clitoris and vaginal vestibule. For iliotibial band syndrome (itbs), please visit nonprofitdictionary.com.
In about 90 percent of all cases, such a vulvar carcinoma develops from the uppermost layers of the mucous membrane and is then referred to as squamous cell carcinoma. But all other types of tumours, such as so-called black skin cancer, are also grouped under the term vulva carcinoma if they occur in the area of the vulva.
Vulvar carcinomas are rather rare; Every year around 3,400 to 4,000 women fall ill in Germany. The risk of developing vulvar cancer increases significantly with age; those affected are mostly older than 60 years.
The causes of vulvar carcinoma have not yet been finally clarified, but the disease is often associated with certain risk factors. The most important of these is infection with the so-called human papilloma virus, HPV for short.
These viruses are transmitted through sexual intercourse and are associated with numerous other diseases in the genital area, including cervical cancer. The viruses can lead to skin changes in the area of the vulva, which in turn can then develop into vulvar carcinoma.
The development of a vulva carcinoma can also be preceded by an infection with herpes viruses, chlamydia or the syphilis pathogen Treponema pallidum and the so-called white callus disease (leukoplakia). A weakening of the immune system, for example due to AIDS, can also promote the development of vulva carcinoma. Increased nicotine consumption due to smoking was also observed in connection with vulvar carcinomas.
Symptoms, Ailments & Signs
Statistically, vulvar cancer affects very few women. The disease is usually only diagnosed at an advanced stage. This is because only then does pain appear. Sometimes a gynecologist can make an early diagnosis during a routine examination. A lasting symptom-free removal of the tumor is usually possible in the early stages without any problems. A distinction must be made between early and advanced signs of a disease.
Initially, affected women complain of unusual itching. This occurs on the outer labia or between the clitoris and the urethral opening. Sometimes reddish spots or scars have also formed there. Hardening, reminiscent of warts, occurs regularly. But increased vaginal discharge also indicates vulvar carcinoma.
Unusual bleeding may occur during or after sex. After the tumor has grown to a certain size, women often feel pain when they empty their bladder. The genital area feels sore during the day and night. ulcers have formed.
Knots can also be felt. In advanced stages, vulvar cancer can cause symptoms in other parts of the body. Pain in the back is just as common as it is in the legs. The nerves in the spinal cord are responsible for this.
Diagnosis & History
Especially in the early stages, vulvar cancer is hardly noticeable through specific symptoms, about one fifth of all affected women feel no symptoms. However, persistent itching occurs relatively frequently.
Further indications can be skin changes in the form of reddish spots or wart-like elevations, as can discharge, which may also be bloody. In the advanced stage, ulcers or nodules develop, the surface structure of which is comparable to that of a cauliflower.
The first examinations at the doctor’s include a palpation examination and a colposcopy. With the colposcope, the mucous membrane of the vulva is enlarged several times and can thus be better examined for abnormalities. A definitive diagnosis of vulvar cancer is made via biopsy, i.e. the removal and examination of a tissue sample.
It is advantageous to diagnose it as early as possible because vulvar carcinomas can already form metastases in the neighboring lymph nodes in the early stages.
If vulvar cancer is discovered in time, there are usually no complications to be expected. However, if the therapy only begins at an advanced stage, the risk that the tumor will begin to spread increases. In these cases, metastases form, which often first affect the lymphatic system, particularly the lymph nodes in the groin area.
In the next step, carcinomas form in the small pelvis. If the patient does not respond to the therapy attempts, other internal organs, in particular the liver or kidneys, can also be affected in the further course. This can lead to other serious, potentially life-threatening complications such as multi-organ failure.
Complications can also result from the therapy itself. In vulvar cancer, the tumor is usually surgically removed. As with any operation, severe bleeding and infection of the surgical wound, resulting in sepsis, can occur. Furthermore, the tumor is often given radiation therapy before surgery, especially if it is already very large, in order to shrink it.
The side effects of radiation therapy are significantly less stressful for most patients than those of chemotherapy, but side effects can occur that massively reduce the quality of life. In sensitive people and in patients whose general condition is already severely weakened, damage can occur to the mucous membrane of the mouth and throat, as well as to the bladder and genitals. Severe gastrointestinal disorders are also occasionally observed.
When should you go to the doctor?
Naturally, vulvar cancer can only develop in women or girls. Therefore, they belong to the risk group of the disease. Already at the first disturbances and irregularities of the female sex, it is necessary to consult a doctor. The disease can end in premature death without early medical and medical care.
Therefore, there is an acute need for action if visual abnormalities occur or complaints are noticed. Swelling, itching or problems with going to the toilet should be discussed with a doctor. If there are irregularities in the emptying of the bladder, this is to be understood as an early warning signal. Pain, general malaise, or anxiety should be investigated.
Hardening of the labia, the formation of scars or spots as well as palpable warts and lumps should be examined and treated. If there are irregularities during the sexual act, changes in libido and menstrual disorders, a doctor should be consulted. If existing complaints continue to spread in the body or if an increase in intensity is observed, there is a need for action.
A doctor should be consulted as soon as possible if problems with the back are noticed in addition to the complaints in the genital area. Irregularities in locomotion, discomfort in contact with genital textiles, and unusual vaginal discharge must be investigated.
Treatment & Therapy
In the overwhelming majority of cases, vulvar cancer is treated by vulvectomy, which means that the vulvar cancer is surgically removed. How extensive this operation is depends on the progress of the disease. Your goal is to completely remove the vulvar cancer, i.e. with all metastases that may be present. That is why sometimes the operation also involves the neighboring lymph nodes, uterus, urinary bladder or bowel.
Depending on the location and size of the vulvar carcinoma, it may make sense to irradiate the tumor before its surgical removal in order to shrink it in this way. Radiation after surgery serves the purpose of reducing the risk of a recurrence of vulvar cancer. Chemotherapy may be necessary to treat metastases.
Depending on the extent of the vulvectomy, further interventions to restore and maintain the function of the genitals may follow. After the operation, a follow-up examination is necessary every three months for the first two years and every six months for the next three years.
Prevention of vulvar cancer is only possible to a limited extent. However, with the vaccination of young women against human papilloma viruses, as recommended for cervical cancer screening, a major risk factor for vulva carcinomas can also be eliminated. Regular cancer check-ups at the gynecologist ‘s are also crucial for early detection.
Following the treatment of the vulva carcinoma, a clinically oriented aftercare is carried out. The patient regularly attends gynecological examinations. In the first three years, the check-ups are carried out every quarter. They take place every six months for the next two years, and then at one-year intervals.
The examining doctor looks at the patient’s medical history and carries out a symptom-related gynecological examination. If there are any abnormal findings during the follow-up examinations, a tissue sample (biopsy) is taken. The goals of aftercare also include recognizing the after-effects or concomitant diseases of the vulva carcinoma and their appropriate therapy.
Possible relapses can also be detected and treated at an early stage in this way. It is therefore extremely important that the patient attends the appointments for the check-ups regularly. Part of the control examinations are clinical examinations of the vulva region and examination of the groin area, which is usually carried out by sonography (ultrasound examination). If there is a suspicion of a recurrence, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) take place.
You can do that yourself
The everyday life of the affected women is usually severely restricted by the cancer. Due to the necessary treatments, many patients are unable to pursue their professional activities for a longer period of time.
In most cases, the disease also represents a major psychological burden for the affected woman, her partner and the family. Those affected can find help in self-help groups or in internet forums for cancer patients and their relatives. Vulva cancer can also lead to difficulties in the partnership. Both the disease and its treatment can result in a total loss of libido. An understanding partnership environment is therefore helpful.
Depending on the location and course of the vulva carcinoma, the disease is treated surgically by partially removing the vulva. This is usually very stressful for the women affected. In some cases it is advisable to consult a couples therapist or psychologist.
During and after treatment for vaginal cancer, patients should strengthen their immune system through a healthy lifestyle. A healthy, vitamin-rich diet is particularly important. In most cases, the pelvic floor is weakened after surgical treatment. It is therefore advisable to train this specifically.