Vulvar cancer

Vulvar cancer

Vulvar cancer is the fourth most common gynecological cancer after endometrial, ovarian and cervical cancer, accounting for 5% of genital cancers.

It is diagnosed mainly in menopausal women, with an average age of 65 years, an age that has been constantly decreasing in recent years.

Risk factors include smoking, vulvar dystrophies in general (eg lichen), precancerous lesions of the vulva or cervix, human papillomavirus (HPV), various immunosuppression syndromes, and a history of cervical cancer.

60% of vulvar cancers are due to the HPV virus, while the remaining percentage is due to pathologies that cause chronic inflammation in the vulva. The involvement of HPV seems to be responsible for the fact that the average age of onset has been decreasing more and more in recent years and especially in women who smoke.

Symptoms

Most patients present with a single lesion or ulcer on the labia, perineum or clitoris. Itching, although one of the most common discomforts of the genital area, can be the first symptom, especially in women suffering from lichen sclerosus. Many women, however, do not experience any discomfort at all and the diagnosis is made after a random examination at the gynecologist. Also, bleeding, vaginal discharge, difficulty urinating, or palpation of a lymph node in the groin area are symptoms that usually appear in advanced stages.

Stages

Stage 1: The cancer is strictly confined to the vulva area, with a life expectancy of around 86% at 5 years after diagnosis.

Stage 2: Cancer has spread to adjacent structures in the vulvar area without lymph node involvement, with a 50% life expectancy at 5 years after diagnosis.

Stage 3: Cancer has spread to adjacent perineal structures and/or lymph node involvement, with a 40% life expectancy at 5 years after diagnosis.

Stage 4: Cancer has spread beyond the pelvis, with a 23% life expectancy at 5 years after diagnosis.

The diagnosis is made in any case with a biopsy of the suspicious area as many benign conditions can give the impression of malignancy.

Treatment

Then, once the diagnosis is established, as with any malignancy, the staging of the disease follows with imaging methods (MRI, Pet Scan, etc.). From here on, the surgical treatment is decided, the scope of which depends on the size of the damage, the age of the patient, her physical condition and of course her desire. After surgery, a decision will be made as to whether additional radiotherapy and/or chemotherapy will be needed.