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Cancer Lump On Labia Majora

Referral To A Gynaecologist

Topic 51: Vulvar Neoplasms

If a GP feels further tests are necessary, they will refer you to a hospital specialist called a gynaecologist. A gynaecologist is a specialist in treating conditions of the female reproductive system.

The gynaecologist will ask about your symptoms and examine your vulva again, and they may recommend a test called a biopsy to determine whether you do have cancer.

Are There Different Types Of Vulvar Cancer

About 90% vulvar cancers are squamous cell carcinomas and develop on the surface of the vulva. About 5% of vulvar cancers are melanomas. Melanomas develop rapidly and have a high risk of spreading to other areas of the body. They are more likely to affect younger women than older women. The remaining 5% are other rare types of vulvar cancer.

Invasive Squamous Cell Cancer Of The Vulva

Almost all women with invasive vulvar cancers will have symptoms. These can include:

  • An area on the vulva that looks different from normal it could be lighter or darker than the normal skin around it, or look red or pink.
  • A bump or lump, which could be red, pink, or white and could have a wart-like or raw surface or feel rough or thick
  • Thickening of the skin of the vulva
  • Bleeding or discharge not related to the normal menstrual period
  • An open sore

Verrucous carcinoma, a subtype of invasive squamous cell vulvar cancer, looks like cauliflower-like growths similar to genital warts.

These symptoms are more often caused by other, non-cancerous conditions. Still, if you have these symptoms, you should have them checked by a doctor or nurse.

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Check If You Have Lichen Sclerosus

Lichen sclerosus affects people of all ages, including children. But it’s much more common in women over 50.

People with white, brown or black skin can get lichen sclerosus.

It causes patches on the skin that are usually:

  • easily damaged they may bleed or hurt if rubbed or scratched

The patches can appear anywhere, but most often are on the:

Treatment Of Vulvar Cancer

Vulval Cancer: Symptoms, Diagnosis And Treatment Explained
  • Removal of all or part of the vulva

  • Usually removal of nearby lymph nodes

  • For more advanced cancers, surgery and radiation therapy, often with chemotherapy

All or part of the vulva is surgically removed . Nearby lymph nodes are usually also removed. But sometimes doctors can instead do a sentinel lymph node What Is a Sentinel Lymph Node? dissection . Because basal cell carcinoma of the vulva does not tend to spread to distant sites, surgery usually involves removing only the cancer. The whole vulva is removed only if basal cell carcinoma is extensive.

To identify sentinel lymph nodes, doctors inject a blue or green dye and/or a radioactive substance into the vulva around the tumor. These substances map the pathway from the vulva to the first lymph node in the pelvis. During surgery, doctors then check for lymph nodes that look blue or green or that give off a radioactive signal . Doctors remove this lymph node and send it to a laboratory to be checked for cancer. If it is cancer-free, no other lymph nodes need to be removed . For early-stage cancers, such treatment is usually all that is needed. Doctors may remove sentinel lymph nodes on one or both sides of the vulva, depending on the size of the tumor.

If areas of cancer that measure less than 2 mm are detected in the sentinel lymph nodes, they are treated with radiation therapy. If the areas are larger , the lymph nodes in the groin are removed .

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Pams Recovery And Life After Cancer

Treatment for vulval cancer will depend on how developed the cancer is when its found, but can include surgery and therapies like chemotherapy and radiation.

I was very lucky, says Pam of her treatment and recovery. I didnt have any chemo or radiation or anything like that.

While she no longer has to have check-ups as often as she did after her surgery, Pam says she still has her doctor check her out regularly.

I went back at two months, six months, a year and then two years to have it checked. And I still have it checked out every now and then theyve got to take a quick look, because obviously, I dont see down there!

Pam now encourages other women to be aware of their vulval health.

Make sure you get your checks and ask questions if you dont know something or you see something, says Pam. I was very lucky I had a good doctor. Find someone youre comfortable with, and make sure youre looking after yourself.

How Common Is Vulval Cancer

Vulval cancer is a rare cancer. Around 1,400 people are diagnosed in the UK each year.

It’s more common in older women. On average each year more than 40 out of 100 of new cases are in women aged 75 and over.

  • Textbook of uncommon cancers

    D Raghavan and others

    John Wiley and sons

  • Cancer: Principles and Practice of Oncology VT DeVita, TS Lawrence, SA RosenbergWolters Kluwer, 2019

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Fast Facts On Vulvar Cancer:

Here are some key points about the vulvar cancer. More detail is in the main article.

  • Symptoms include a lump, itching, and bleeding, and with some types discoloration of the skin and pain.
  • Early diagnosis increases the chance of successful treatment dramatically, but without treatment, cancer can spread to other parts of the body.
  • Regularly attending smear tests and checking for changes to the vaginal lips can help diagnose vulvar cancer in the early stages.
  • Avoiding smoking and unprotected sex can reduce the risk.

Cancer that originates in the vulva is called primary vulvar cancer. If it starts in another part of the body and then spreads to the vulva, it is called secondary vulvar cancer.

There are several types of vulvar cancer.

Squamous cell carcinoma affects the flat, outer layers of skin. In medicine, the word squamous refers to flat cells that look like fish scales. About 90 percent of all vulvar cancers are squamous cell carcinomas. It takes several years for noticeable symptoms to develop.

Vulvar melanoma accounts for about 5 percent of all vulvar cancers. A melanoma presents as a dark patch of discoloration. There is a high risk of this type of cancer spreading to other parts of the body, a process known as metastasis. It may affect younger women.

Adenocarcinoma originates in glandular tissue, and in this case, the cells line the glands in the vulva. It accounts for a very small proportion of vulvar cancers.

Moffitts Approach To Treating Vulvar Cancer

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At Moffitt Cancer Center, women with vulvar cancer can receive comprehensive treatment and support. We recognize that our patients time is valuable, so we offer access to every specialist, test and treatment in a single, convenient location.

A key factor that distinguishes Moffitts gynecological clinic from other treatment centers is our multispecialty team, which focuses exclusively on vulvar cancer. Our gynecologic oncologists are highly specialized, and each expert has completed the rigorous process of attaining board certification in his or her area of specialty.

Moffitt remains abreast of research developments so that we can offer our patients the very latest advances in vulvar cancer treatments, including the promising new options available through our clinical trials. Our groundbreaking research has directly led to better outcomes and quality of life for our patients, and our efforts are recognized by the National Cancer Institute, which has awarded Moffitt the prestigious designation of Comprehensive Cancer Center.

In the gynecologic clinic at Moffitt, we take a unique and highly individualized approach to vulvar cancer treatment by utilizing evidence-based clinical pathways. These best practice guidelines:

In sum, Moffitt treats vulvar cancer patients as individuals, not numbers.

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Cancer Of The Vulva: 2021 Update

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Correspondence

Alexander B. Olawaiye, Magee-Women’s Hospital of UPMC, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA.

Mauricio A. Cuello

Department of Gynecology, Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

Linda J. Rogers

Division of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC, Cape Town, South Africa

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Correspondence

Alexander B. Olawaiye, Magee-Women’s Hospital of UPMC, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA.

Mauricio A. Cuello

Department of Gynecology, Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

Linda J. Rogers

Division of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

Tuesday 1 December 2020

Its been nearly 20 years since Queensland woman Pam was diagnosed with vulval cancer, but she still remembers the day clearly.

I went in for a pap smear, she says. The doctor said to me, That looks a bit weird, youve got a lesion down there. Im not happy with that, I want it looked at.

Pams doctor referred her to a gynaecologist. After a biopsy of what was actually two spots on her vulva revealed cancer, she was scheduled for immediate surgery.

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Causes And Risk Factors

The exact cause of vaginal cancer is unknown, but certain risk factors contribute to its development such as:

Human Papilloma Virus Infection. HPV causes genital warts in men and women. The presence of HPV increases the tendency to develop reproductive system cancers such as cervical and vaginal cancer. HPV infection is sexually transmitted, which means that having multiple sexual partners increases the risk for HPV infection.

Being sbove 50 years of age. Age has been a contributing factor for vaginal cancer because increasing age increases the long-term exposure to certain types of carcinogens, which changes the characteristics of cells.

History of other reproductive system malignancies. Previous malignancies in the reproductive system, specifically cervical cancer, increase the risk for secondary vaginal cancer.

Diagnosis And Staging Of Vulval Cancer

Vulvar cancer: Causes, symptoms, and treatments

Skin biopsy of the lesion is performed to get an accurate diagnosis of vulval cancer. Under microscopy, the presence of malignant cells along with other histological findings will confirm the diagnosis and the type of vulval cancer.

After initial diagnosis of vulval cancer, a specialist doctor will perform a thorough examination to determine the stage of the cancer. This depends on:

  • The size of the tumour
  • How deeply the tumour has invaded tissues at the site of origin
  • The extent of any invasion into surrounding organs or lymph nodes.

Determining the cancers stage is an important factor as it directs what treatment plan should be used. The FIGO System of Staging is commonly used to describe vulval cancer staging. The system classifies the disease from Stage 0 through to Stage IV. Stage 0 represents precancerous lesions whilst Stage IV the most advanced stages of cancer .

Most patients will have blood tests, a chest X-ray and CT scan of the abdomen and pelvis to help stage the cancer.

In a large centre in which there is an experienced multidisciplinary team, some patients with vulval carcinoma may be offered sentinel node biopsy to determine if there microscopic metastases. Requirements are:

  • Unifocal tumour
  • Small tumour, < 4 cm in diameter
  • No palpable lymph nodes.

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When You Should See A Doctor

Its a good idea to see a doctor if youre unsure about changes to your body. You should also see your doctor if you have a new lump that doesnt go away in a few weeks. As well, see your doctor if you have pain or signs of infection, such as:

If you dont already have an OBGYN, the Healthline FindCare tool can help you find a physician in your area.

How Is A Vulvar Tumor Treated

The most commonly used treatment of vulvar tumors is surgery.

Depending on the extent of the vulvar tumor, your doctor may perform any of the two following surgeries:

  • Wide local excision : Your doctor will remove the tumor and part of adjacent healthy tissue that is likely to become cancerous.
  • Vulvectomy: Removing the tumor along with a greater part of the vulva is known as partial vulvectomy. Removing the entire vulva is known as radical vulvectomy.
  • In addition to the above surgeries, your doctor may remove the lymph nodes that are likely to be cancerous. A small piece of the lymph nodes is then sent to the laboratory to check if vulvar cancer has spread to the lymph nodes.

    Radiation therapy and chemotherapy

    Radiation therapy uses high-energy waves that are focused on the vulvar tumor. It may be done before the surgery to shrink the tumor and make the surgery easier to be performed.

    Chemotherapy uses strong medications to kill cancer cells. This therapy is most often reserved for people whose cancer has reached an advanced stage and spread to other organs of the body. It may be given alone or in combination with radiation therapy before the surgery to shrink the tumor.

    Targeted drug therapy

    Immunotherapy

    Immunotherapy is reserved for certain cases of advanced vulvar cancer. It involves giving medications intravenously that use your immune system to fight against the cancer cells.

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    After A Diagnosis Of Vulvar Cancer

    After a diagnosis of vulvar cancer you may feel disbelief, sadness, shock and anxiety. It may help to talk to family and friends about how you feel.

    The days and weeks after a diagnosis of vulvar cancer can be very stressful and you may feel like things are moving either too fast or too slowly. Ask your specialist to explain the treatment options available to you, timelines and potential side effects. You may wish to have a family member or friend go with you to your appointment. Take as much time as you can so you can make well-informed decisions.

    Reducing The Risk Of Vulvar Cancer

    Having pain, swelling, irritation, or burning in your Vulvar region? It might be Vulvodynia.

    It is possible to reduce your risk of vulvar cancer by avoiding known risk factors.

    The most significant risk reduction strategy is to avoid sexually transmissible infections . This is because some STIs cause changes to the cells of the cervix. Women who have previously experienced changes to the cells of their cervix are at increased risk of developing VIN, which is the precursor of vulvar cancer.

    Other risk reduction strategies include:

    • Dont smoke.
    • Dont dismiss chronic vulvar itching as a persistent thrush infection.
    • Dont treat a vaginal itch with over-the-counter preparations see your doctor for tests.
    • Have regular gynaecological check-ups.
    • If you think you may be at increased risk of vulvar cancer, ask your GP to show you how to perform a self-examination.

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    Treatment For Lichen Sclerosus

    Lichen sclerosus cannot be cured, but prescription steroid cream usually helps relieve the symptoms.

    Unless your doctor tells you otherwise, follow the directions on the patient information leaflet that comes with the medicine.

    You may need to use the cream regularly for a few months to get your symptoms under control.

    If your symptoms keep coming back, you may have to keep using it every now and again.

    You can get more cream from a GP if you need it.

    Types Of Vulvar Cancer

    Vulvar cancer is classified according to its cell of origin. This can include:

    • squamous cell carcinoma originating in the skin cells. This type accounts for about 90 per cent of cases
    • melanoma originating in the pigment cells deeper in the skin. This type accounts for about five per cent of cases
    • adenocarcinoma originating from the Bartholins glands, the structures that supply lubricant to the genitals. This type accounts for less than one per cent of cases
    • sarcoma originating from supporting cells. This type is quite rare
    • lymphoma originating from the immune cells. This type is quite rare
    • basal carcinoma a form of skin cancer. This type is quite rare.

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    Ciliated Cyst Of The Vulva

    At the ninth week of gestation, the paramesonephric duct develops into the fallopian tube. Remnants of this duct can form a ciliated, or paramesonephric, cyst found incidentally on the labium majorum during pregnancy, puberty, or with other hormonal influences. The lesion is usually a single cyst cavity, 13 cm in diameter, and drains clear or amber-coloured fluid if ruptured.

    Living With Vulvar Cancer

    Giant Fibroepithelial Polyp of Vulva â A Rarest of its Occurrence

    If surgery is part of your treatment, your body may look different afterward. Talk to your doctor about this so that you are prepared. These changes may make you feel different or less attractive. It may take time to get used to the changes. Remember, your friends and family love you. Let them support you during this time. Do not push them away.

    Even with treatment, vulvar cancer may not completely go away. Or, if it does, you may live in fear of it coming back. That can cause much stress for you and your loved ones. Consider joining a support group or talking to a therapist about your feelings. Invite your family to do the same.

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    Who Gets Skin Cancer And Why

    Sun exposure is the biggest cause of skin cancer. But it doesnt explain skin cancers that develop on skin not ordinarily exposed to sunlight. Exposure to environmental hazards, radiation treatment, and even heredity may play a role. Although anyone can get skin cancer, the risk is greatest for people who have:

    • Fair skin or light-colored eyes
    • An abundance of large and irregularly-shaped moles
    • A family history of skin cancer
    • A history of excessive sun exposure or blistering sunburns
    • Lived at high altitudes or with year-round sunshine
    • Received radiation treatments

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