THOUSANDS of women across the world are diagnosed with gynaecological cancers yearly; some of the most common being cervical, ovarian and endometrial. But there are other forms of cancer which affect at least one reproductive organ that we pay little attention to because they are so rare — one being cancer of the vulva, which obstetrician-gynaecologist at ICON Medical Centre Dr Keisha Buchanan said accounts for only four per cent of reproductive organ cancers.
“The vulva is the external area of the female genital organ; it consists of the labia minora, labia majora and mons pubis. Cancer of the vulva occurs most often in or on the labia and is typically a squamous cell carcinoma, which is the most common type of skin cancer. Less often, as in the case of melanoma, it can occur on the clitoris or the Bartholin's glands, which are located on the sides of the vaginal opening,” Dr Buchanan said.
She pointed out that the usually slow-growing cancer is most frequently seen in women over 60 years. However, there are other pre-existing conditions which increase a woman's risk of the disease, most notably smoking, having been infected with the Human Papilloma Virus, and having a weakened immune system. Dr Buchanan said that Lichen Sclerosus that causes itching and thinning of the vulva also predisposes a woman to vulvar cancer.
While many patients who are later diagnosed with the precancerous condition vulvar intraepithelial neoplasia often do not experience any symptoms, in people with the more aggressive form of the disease, Dr Buchanan said there are a number of symptoms commonly seen.
“Vulvar cancer will present as a persistent focal itching (mimicking a yeast infection). You may also notice a change in the colour of the vulvar skin and bleeding at a focal point of the skin. You may also notice a bump or raised wart-like lesion, an ulcer or a cut on the vulva that does not heal, and persistent bleeding from the vulva,” Dr Buchanan outlined.
Diagnosing vulvar cancer involves taking a biopsy of vulvar lesions. Dr Buchanan explained that at times the lesion is large enough and can be visualised with the naked eye and biopsied; however, in the case of less obvious lesions or to evaluate an area on the vulva that persistently itches or bleeds, a colposcopy can be performed. This, she says, involves using a microscope to improve visualisation of the vulva allowing for accurate biopsies to be taken.
“If a cancer is diagnosed then an assessment to see if it has spread needs to be done. This involves a Pelvic MRI or CT scan, of which the MRI is the better test, to see if a tumour has spread to lymph nodes, urethra (opening to the bladder), vagina, liver or rectum. A chest X-ray is also done to check for spread to the lungs. Blood tests are also ordered to assess for anaemia, liver spread and kidney function.
The stages of vulvar cancer are categorised as one to four, and the first two stages are curable. Dr Buchanan said that stage one is treated by removing the tumour and surrounding normal tissue, while the treatment for stage two involves removing more of the vulva and lymph nodes.
“The first lymph node that a tumour spreads to is the sentinel node. If this node is negative for cancer, then further node removal is unnecessary. More extensive node resection may be needed if a tumour has spread more extensively. The larger the tumour, the more extensive vulvar resection is needed. In some cases, radiation may be needed to eradicate or shrink a tumour. Radiation to the diseased lymph node may be done to kill tumour cells,” Dr Buchanan underscored.
Another method of treatment, which Dr Buchanan said is also used, is chemotherapy. She said that it may be beneficial in cases of advanced vulvar cancer or to shrink a tumour prior to radiotherapy to increase the effectiveness.
“Along with the medical care of the patient, psychological support will be needed and support groups and psychologists/psychiatrists are available to provide additional care for both the patient and family. Additional social support may be needed as many patients will need a caregiver at some point,” Dr Buchanan advised.
She said that a nutritionist will also be needed to provide healthy dietary guidelines as proper nutrition is important for a healthy outcome. Depending on the person's spiritual beliefs, Dr Buchanan said that spiritual support may also be important.
Importantly, Dr Buchanan said that while persistent vulvar itching is most commonly due to a yeast infection, which should resolve within a few days of treatment with antifungal medications, she recommends that women over 60 who persistently present with vulvar itching should have an assessment completed and a biopsy taken. This will increase the chances of early diagnosis and therefore improve the chances of a cure.