Cancer of The Outer Surface of Vagina – Diagnosis and Treatment for Vulvar Cancer

Cancer of The Outer Surface of Vagina – Diagnosis and Treatment for Vulvar Cancer

Cancer of the vulva or vulvar cancer is a rare condition but is a deadly one. As with other types of cancer, early diagnosis and timely treatment can increase the likelihood of living more graceful years of life. Below is the in-depth diagnosis, staging and treatment procedure of vulvar cancer a woman must know.

How is Vulvar Cancer Diagnosed?

As soon as you spot the symptoms such as abnormal vaginal bleeding, irritable itching and open sore or bump, your very first goal would be to seek an appointment with the doctor. On your first appointment, you can expect following things:

Physical examination

The doctor will first physically examine the vulva, the external part of female genitals. It will then be followed by questions about your medical history and lifestyle. The doctor might also use a special magnifying glass called colposcope to get a close view of the vulva and inspect any abnormalities.

Biopsy

If the doctor suspects some abnormalities within an area of the vulva, he might suggest a biopsy. In this procedure, a sample skin tissue will be removed for testing in the laboratory. During the biopsy, the vulvar area is numbed with a local anesthetic and a special tool or scalpel is used to cut off some or all the part of the suspicious area. You might need stitching after this procedure, depending on how much area of the skin is removed.

If the biopsy results point towards vulvar cancer, you might be referred to a gynecologic oncologist, a doctor specializing in cancers of the female reproductive system. The oncologist will review your report and might conduct additional tests for staging the condition and chalking out an appropriate treatment plan. These tests include:

  1. Pelvic examination – Your pelvic area will be thoroughly examined for signs of cancer.
  2. Imaging tests – Next step probably would be to determine the size and extent of cancer. This could be made easier with imaging tests such as Computerized Tomography (CT) scan, magnetic resonance imaging (MRI) and cystoscopy/proctoscopy.
  • CT scan can help identify enlarged lymph nodes in area between the abdomen and thigh (groin area)
  • MRI scan will let your doctor find tumors in the pelvic region and tumors that have reached the brain or spinal cord.
  • Cystoscopy and proctoscopy can assist the doctor in determining whether the tumor is still in the pelvic region or has spread to the bladder and rectum.

Staging of Vulvar Cancer

The staging process is a classification of cancer that determines the severity of the condition. This classification can help the doctor create an effective treatment plan. The staging mainly covers the location of the primary tumor, the spread of the tumor to nearby lymph nodes and the size of the tumor.

Vulvar cancer has primarily four major stages:

  1. Stage 1 – This stage refers to very early cancer stage in which the tumor is confined to the vulva or skin between the vaginal opening and anus. In this stage, cancer hasn’t spread to the lymph nodes. The size of the tumor remains around 2 cm at this stage.
  2. Stage 2 – Tumors has spread beyond vulva to nearby structures such as the lower parts of the urethra, vagina, and anus.
  3. Stage 3 – The tumor has spread to the nearby 2-3 lymph nodes.
  4. Stage 4 – This is the most severe form that indicates that cancer has invaded the lymph nodes more extensively, or has spread to the bladder, rectum or the pelvic bone. This stage also signifies that cancer has metastasized or spread to distant organs or tissues of the body.

According to National Cancer Institute, the 5-year survival rate for stage 1 cancer is 86 percent, stage 2 and stage 3 is 54 percent while stage 4 is 16 percent.

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What are the treatments options for vulvar cancer?

The treatment of vulvar cancer will mainly depend on the type and stage. There are four standard treatment procedures that are usually followed.

Surgery

Surgical procedures are the most common treatment methods for vulvar cancer. The surgery can be performed in a variety of ways depending on the type or stage of cancer and overall health preference. Generally, following types of surgeries are performed.

Local Excision

Also known as radical excision, this surgical method involves removing cancer and a small margin of the surrounding tissue. This option is adopted in those cases in which cancer hasn’t spread to distant lymph nodes or organs. The doctor might also remove the lymph nodes.

Vulvectomy

Under this procedure, the surgeon will either remove part of the vulva (partial vulvectomy) or the entire vulva (radical vulvectomy) including the underlying tissue. The doctor may also opt for radiation or chemotherapy to shrink the tumor before surgery. This ensures hassle free and less extensive operation.

Radical vulvectomy or removing the entire vulva carries certain risks such as infection and difficulty in healing around the cut or incision. Vulvar surgery can also make your genital area lose sensation. Depending on the type of surgery, the genital area might feel numb and you won’t be able to achieve orgasm anymore.

Pelvic Exenteration

This is known as surgical removal of the organs within the pelvis. This technique is most often used in advanced cases. Depending on what extent cancer has spread, the doctor will remove the following:

  • Cervix
  • Lower colon
  • Vagina
  • Bladder
  • Vulva
  • Rectum
  • Ovaries
  • Lymph nodes

If the bladder and rectum are removed, you won’t be able to pass urine and stool normally. For the passage of stool and urine, the doctor will create an opening called stoma.

Laser Therapy

In laser therapy, high-intensity lights are used to destroy cancer cells. The light radiates through a thin tube known as endoscope and target cancer cells. The advantage of laser therapy is that it causes less bleeding and scarring as compared to other methods of treating vulvar cancer.

The therapy can also be conducted on an outpatient basis, you could be discharged from the hospital or clinic on the same day of receiving the treatment.

Radiation Therapy

This therapy uses high-powered energy beams to shrink the tumor or kill cancer cells. Radiation therapy is typically administered externally via a machine that moves around your body and directs radiation to specific points on your skin.

In some other cases, radiation therapy might be administered internally via inserting radioactive wires or seeds. Radiation therapy can also be combined with chemotherapy for more effectiveness and accuracy, and also in order to prevent recurrence.

Chemotherapy

This drug treatment procedure is quite an aggressive form of slowing down or stopping cancer cells from growing. Chemotherapy is usually administered intravenously (through veins) or orally. This treatment is often used in advanced stages where cancer has invaded other organs of the body.

Outlook

After completing the treatment, your doctor might suggest periodic follow-up tests to check for cancer recurrence. There is 24 percent chance that even after successful treatment, vulvar cancer can return. The follow-up exams are generally performed 2-4 times in a year.

The survival rate is quite high when vulvar cancer is diagnosed early and timely treated. Besides, you would need a strong support network to help you deal with the challenges you would go through the course of diagnosis and treatment. You can also consider joining a cancer support group with whom you can share your concerns.