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Diagnosis and management of vulvar cancer

Vulvar cancer is an uncommon cancer that affects the skin of the external female genitalia. Though rare, it is a devastating condition to suffer from as treatment in this sensitive region of the body can be disfiguring and debilitating. Vulvar cancer accounts for about 1% of all gynaecological cancers diagnosed in Singapore and afflicts mostly women who are menopause (>50 years). The incidence in women <40 years is exceedingly rare.

The development of vulva cancers can be due to the high risk HPV virus or certain long standing vulva conditions such as lichen sclerosis or vulva intraepithelial neoplasia (VIN) etc. There are different types of vulvar cancer such as Squamous cell carcinomas, Adenocarcinoma, Melanoma, Sarcoma, Basal cell carcinoma. Symptoms include constant vulvar itching, changes in skin color, pain or presence of an abnormal lump/ulcer. When in doubt, please see a gynaecologist for an opinion.

 

DIAGNOSIS OF VULVAR CANCER

Your doctor will likely conduct a physical exam of your vulva to look for abnormalities. During the physical exam, a colposcope (a device that works like a magnifying glass) is used to closely inspect your vulva for abnormal areas to determine whether an area of suspicious skin on your vulva is cancer, your doctor may recommend removing a sample of the skin for testing. During a biopsy procedure, the area is numbed with local anesthetic and a special tool is used to remove part of the suspicious area for analysis by the pathologist.

Once the diagnosis is confirmed, we would need to determine the stage of the cancer. This would involve imaging of the body with computerized tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET).

 

MANAGEMENT OF VULVAR CANCER

Factors that will help guide your choice of treatments include: the stage of your cancer, your age and general health and whether the cancer has just been diagnosed or has recurred (come back).

 

Vulvar cancer treatment options include the following:

Surgery

Surgery is the most common treatment for cancer of the vulva. The goal of surgery is to remove all the cancer. Surgery is the most common treatment for cancel of the vulva. The goal of surgery is to remove all the cancer. Types of surgery include:

  • Wide local excision/Simple Vulvectomy: This surgery removes the cancel and a small-to-large amount of normal tissue around the cancer. Sometimes nearby lymph nodes are removed.
  • Radical Vulvectomy: This surgical procedure removes all of the vulva and underlying tissue and the nearby groin lymph nodes. Sometimes, skin reconstruction with grafts or flaps may be needed.

Surgery may be followed by chemotherapy or radiation therapy to kill any remaining cancer cells. Sometimes radiation or chemotherapy is recommended prior to surgery if the cancer is advanced.

 

Radiation therapy

Radiation therapy kills cancer cells using high-energy x-rays or other types of radiation. Choice of radiation therapy delivery method depends on the type and stage of the cancer being treated. It is usually given after surgery if indicated.

 

Chemotherapy

Chemotherapy may be necessary if the vulva cancer is in its advanced stages or it may be utilized if the cancer has recurred.

The earlier the cancer is discovered and treated, the better the chance of positive, long-term outcome. You play a large role in your own health. Become familiar with all parts of your body, even your own genital area. Knowing what you look like “down there” now can help you easily identify changes. If you do see changes, make an appointment early to see your gynaecologist.

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