You may not think about vulval cancer often, but being aware of its symptoms and the importance of early diagnosis can potentially save lives. In this article, we will explore the key symptoms to look out for and the diagnostic methods used to identify vulval cancer. By understanding the signs and seeking medical attention promptly, you can ensure timely treatment and improve the chances of a positive outcome. So let’s shed light on this vital topic and empower you with the knowledge you need to protect your wellbeing.
Symptoms of Vulval Cancer
Persistent itching
One of the common symptoms of vulval cancer is persistent itching in the vulva area. This itchiness may or may not be accompanied by a rash or redness. If you experience persistent itching in the vulva that doesn’t go away with basic treatments like over-the-counter creams or antihistamines, it is important to seek medical advice.
Pain or tenderness
Vulval cancer can cause pain or tenderness in the affected area. This pain may be present even when you are not touching or applying pressure to the vulva. If you notice any unexplained pain or discomfort in your vulva, it is advisable to consult a healthcare professional.
Bleeding
Another symptom of vulval cancer is abnormal bleeding. This can include bleeding between periods, bleeding after sexual intercourse, or bleeding after menopause. Any unexplained or abnormal bleeding should be brought to the attention of your healthcare provider for further evaluation.
Changes in the appearance of the vulva
Vulval cancer can cause visible changes in the appearance of the vulva. This can include changes in color, texture, or shape of the skin. You may notice new growths, bumps, or sores on your vulva. It is important to pay attention to any changes and seek medical advice if you notice anything abnormal.
Skin thickness or texture changes
Vulval cancer may cause changes in the thickness or texture of the skin in the vulva region. The skin may become thicker, rougher, or more textured than usual. These changes can be concerning and should be evaluated by a healthcare professional.
Ulceration or open sores
Open sores or ulcers that do not heal can be an indication of vulval cancer. If you have a sore or ulcer in the vulva area that does not seem to improve or heal after a reasonable amount of time, it is important to have it examined by a healthcare provider.
Palpable lump or mass
A palpable lump or mass in the vulva area can be a symptom of vulval cancer. If you feel a lump or mass during self-examination or notice any unusual growth, it is essential to have it evaluated promptly by a healthcare professional.
Inguinal lymph node enlargement
Vulval cancer can sometimes spread to the lymph nodes in the groin region, leading to their enlargement. If you notice any swelling or enlargement of the lymph nodes in your groin, it is important to have it checked by a healthcare provider.
Vaginal discharge
Vulval cancer may cause changes in vaginal discharge. You may notice an increase in discharge or a change in its color, consistency, or odor. Any significant or unexplained changes in vaginal discharge should be brought to the attention of your healthcare provider.
Pain during urination or sexual intercourse
Vulval cancer can cause pain or discomfort during urination or sexual intercourse. If you experience pain or discomfort in these activities, it is essential to consult a healthcare professional for assessment and appropriate management.
Diagnosis of Vulval Cancer
Medical history and physical examination
When you visit a healthcare provider with symptoms suggestive of vulval cancer, they will begin by taking a detailed medical history. They will inquire about your symptoms, their duration, and any associated factors or risk factors. The healthcare provider will perform a careful physical examination of the vulva and groin regions to evaluate any visible abnormalities or changes.
Biopsy and histopathological analysis
The definitive diagnosis of vulval cancer is made through a biopsy of the affected tissue. There are different types of biopsies that can be performed, including a punch biopsy or an excisional biopsy. A small sample of tissue is collected during the biopsy procedure, which is then sent to a laboratory for histopathological analysis. This analysis helps determine the presence of cancer cells and provides information about the characteristics of the cancer.
Imaging tests
Imaging tests such as ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may be ordered to assess the extent and spread of the disease. These tests provide detailed images of the affected area and surrounding structures, helping healthcare providers determine the stage of the cancer.
Tumor staging
Tumor staging involves determining the size of the tumor and assessing its spread to nearby or distant structures. The TNM staging system is commonly used for vulval cancer. It evaluates the primary tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastases (M). The stage of the cancer helps guide treatment decisions and prognostic information.
Evaluation of lymph nodes
The presence of vulval cancer can be evaluated by examining the regional lymph nodes. This examination may include clinical assessment, ultrasound-guided fine-needle aspiration cytology (FNAC), sentinel lymph node biopsy (SLNB), or inguinal lymph node dissection. These evaluations help determine if the cancer has spread to the lymph nodes, which influences treatment decisions and prognosis.
Medical History and Physical Examination
Assessment of symptoms and risk factors
During the medical history assessment, your healthcare provider will inquire about the symptoms you are experiencing, such as persistent itching, pain, bleeding, or changes in appearance. They will also ask about any risk factors that may contribute to the development of vulval cancer, such as human papillomavirus (HPV) infection, smoking, a weakened immune system, or a history of certain skin conditions.
Review of medical history
Your healthcare provider will review your medical history, including any previous gynecological conditions, such as previous precancerous lesions of the vulva or other cancers. They will also inquire about any relevant medical conditions, medications, allergies, or surgeries that may impact the management of vulval cancer.
Physical examination of the vulva and groin regions
During the physical examination, your healthcare provider will conduct a thorough inspection and palpation of the vulva and groin regions. They will carefully examine the vulva for any visible abnormalities, changes in color, texture, or the presence of ulcers, lumps, or masses. The examination may also include a visual inspection of the anus and vagina.
Biopsy and Histopathological Analysis
Punch biopsy
A punch biopsy is a type of biopsy commonly performed to obtain a tissue sample from the vulva. It involves using a special tool called a punch to remove a small circular piece of tissue. The procedure is usually performed under local anesthesia in an outpatient setting. The collected tissue sample is then sent to a laboratory for histopathological analysis.
Excisional biopsy
An excisional biopsy may be recommended in some cases where a larger area of tissue needs to be removed for examination. During this biopsy, a surgeon removes a piece of tissue along with a surrounding margin of healthy tissue. The excised tissue is sent to the laboratory for histopathological analysis.
Laboratory analysis of tissue sample
The tissue sample obtained from the biopsy is sent to a laboratory for histopathological analysis. Highly trained pathologists examine the tissue under a microscope to determine the presence of cancer cells and to identify the subtype of vulval cancer. The analysis also helps evaluate the grade of the tumor, which provides information about the aggressiveness of the cancer.
Determination of histological subtype
There are different subtypes of vulval cancer, including squamous cell carcinoma, melanoma, adenocarcinoma, or basal cell carcinoma. Determining the histological subtype helps guide treatment decisions and provides important prognostic information.
Evaluation of tumor grade and invasion depth
The histopathological analysis also involves assessing the grade of the tumor and the depth of invasion. The grade of the tumor indicates the level of abnormality of the cancer cells and helps predict the cancer’s aggressiveness. The depth of invasion determines how deeply the cancer has invaded the surrounding tissues and provides information about the stage of the cancer.
Imaging Tests
Ultrasound
Ultrasound imaging utilizes sound waves to create a detailed image of the vulva and surrounding structures. It helps evaluate the size and characteristics of the tumor, assess lymph node involvement, and determine the presence of any other abnormalities.
Computed tomography (CT) scan
A CT scan uses X-rays and computer technology to produce detailed cross-sectional images of the body. It may be used to evaluate the extent of the tumor, identify spread to nearby lymph nodes or organs, and detect the presence of distant metastases.
Magnetic resonance imaging (MRI)
MRI uses a powerful magnetic field and radio waves to generate detailed images of the vulva and nearby structures. It provides high-resolution images that help assess the tumor’s size, invasion depth, involvement of lymph nodes, and spread to adjacent tissues.
Positron emission tomography (PET) scan
PET scan involves injecting a small amount of radioactive material into the body, which is absorbed by cancer cells. A scanner then captures images that highlight areas of increased metabolic activity, indicating the presence of cancer cells. PET scan is useful in detecting distant metastases and assessing the overall extent of the disease.
Tumor Staging
TNM staging system
Vulval cancer staging is typically determined using the TNM staging system. This system assesses the primary tumor (T), regional lymph nodes involvement (N), and presence of distant metastases (M). The results are combined to assign an appropriate stage to the cancer, ranging from stage 0 (in situ) to stage IV (advanced).
Evaluation of tumor size
The size of the primary tumor is an essential factor in staging vulval cancer. It helps predict the risk of spread and influences treatment decisions. The tumor’s size is determined through clinical examination, imaging tests, and analysis of the tissue sample obtained during biopsy.
Involvement of regional lymph nodes
Determining the involvement of regional lymph nodes is crucial in staging vulval cancer. The presence of cancer cells in the lymph nodes indicates a higher risk of spread and influences treatment decisions. Clinical examination, imaging tests, and sentinel lymph node biopsy (SLNB) are commonly used to assess lymph node involvement.
Presence of distant metastases
The presence of distant metastases, where the cancer has spread to distant organs or tissues, is a significant factor in determining the stage of vulval cancer. Imaging tests, such as CT scan, MRI, and PET scan, are used to assess the presence of distant metastases.
Evaluation of Lymph Nodes
Clinical examination
Clinical examination involves assessment of the regional lymph nodes through palpation and inspection. Your healthcare provider will carefully examine the lymph nodes in the groin region for any signs of enlargement or abnormality.
Ultrasound-guided fine-needle aspiration cytology (FNAC)
Ultrasound-guided FNAC is a minimally invasive procedure performed to evaluate the presence of cancer cells in the lymph nodes. Under ultrasound guidance, a thin needle is used to extract a small sample of cells from the lymph nodes for cytological examination.
Sentinel lymph node biopsy (SLNB)
A sentinel lymph node biopsy is a surgical procedure performed to identify and remove the first lymph node(s) to which cancer is most likely to spread. A radioactive substance or dye is injected near the tumor site, which helps identify the sentinel lymph node(s). The removed lymph node(s) are then examined for the presence of cancer cells.
Inguinal lymph node dissection
In some cases, a complete inguinal lymph node dissection may be performed to accurately evaluate the extent of lymph node involvement. This procedure involves surgically removing the lymph nodes in the groin region for thorough examination.
Differential Diagnosis
Conditions that mimic vulval cancer symptoms
Some conditions may present symptoms similar to vulval cancer but are noncancerous. These conditions need to be considered during the diagnostic process to ensure an accurate diagnosis. Healthcare professionals will evaluate symptoms and perform necessary tests to differentiate vulval cancer from other conditions.
Human papillomavirus (HPV) infection
HPV infection can cause genital warts or precancerous changes in the vulva. It is important to exclude HPV infection as a potential cause of symptoms before confirming a diagnosis of vulval cancer. Testing for HPV may be done as part of the diagnostic process.
Vulvodynia
Vulvodynia is a chronic pain condition affecting the vulva. It can cause persistent pain, burning, or discomfort in the vulval region. However, unlike vulval cancer, vulvodynia is not associated with visible changes or growths. Healthcare providers may perform additional tests to differentiate vulval cancer from vulvodynia.
Lichen sclerosus
Lichen sclerosus is a chronic inflammatory condition that primarily affects the vulva. It can cause itching, pain, and changes in the appearance of the vulva. These symptoms overlap with vulval cancer, highlighting the importance of careful evaluation and diagnostic testing to differentiate between the two conditions.
Bartholin’s cyst or abscess
Bartholin’s cyst or abscess can cause pain, swelling, or a lump in the vulva area. Although it is not a malignant condition like vulval cancer, it is important to distinguish between the two to ensure appropriate management. Physical examination and imaging tests may be performed to differentiate Bartholin’s cyst or abscess from vulval cancer.
Prognostic Factors
Tumor stage and size
One of the crucial prognostic factors in vulval cancer is the stage and size of the tumor. The stage determines the extent of the disease, while the tumor’s size helps predict the risk of spread and the effectiveness of treatment options. Higher stages and larger tumor sizes are generally associated with a lower prognosis.
Lymph node involvement
The involvement of regional lymph nodes in vulval cancer significantly impacts prognosis. If the cancer has spread to the lymph nodes, there is a higher risk of further spread and recurrence. The presence of cancer cells in the lymph nodes is a negative prognostic factor.
Histologic subtype and grade
Different histologic subtypes of vulval cancer, such as squamous cell carcinoma or melanoma, have different prognostic implications. Additionally, the grade of the tumor, which indicates the level of abnormality of the cancer cells, helps predict the cancer’s aggressiveness and prognosis.
Presence of metastases
Vulval cancer that has spread to distant organs or tissues (metastases) is associated with a poorer prognosis. The presence of metastases indicates a more advanced stage of the disease and affects treatment options and survival rates.
Patient’s age and overall health
Patient-related factors, such as age and overall health, can also influence prognosis in vulval cancer. Younger patients with good overall health generally have a better prognosis than older patients or those with other significant health conditions.
Management of Vulval Cancer
Multidisciplinary approach
The management of vulval cancer involves a multidisciplinary approach, which means that a team of healthcare professionals collaborates to provide comprehensive care. This team may include gynecologic oncologists, radiation oncologists, medical oncologists, pathologists, radiologists, and specialized nurses. The team works together to develop an individualized treatment plan.
Individualized treatment plan
The treatment plan for vulval cancer is tailored to each patient based on factors such as the stage of the cancer, the presence of lymph node involvement, and the patient’s overall health. Treatment options may include surgery, radiation therapy, chemotherapy, or a combination of these modalities. The goal is to effectively treat the cancer while preserving aesthetic and functional outcomes whenever possible.
Follow-up care and surveillance
After the initial treatment, regular follow-up care and surveillance are essential in the management of vulval cancer. Follow-up appointments may include physical examinations, imaging tests, and blood tests to monitor for any signs of recurrence or metastasis. These appointments also provide an opportunity to address any ongoing concerns or side effects.
Supportive care and psychological support
The management of vulval cancer not only focuses on treating the disease but also aims to address the emotional and psychosocial needs of patients. Supportive care services, such as pain management, sexual counseling, and psychosocial support, are essential components of comprehensive care. These services help patients and their families cope with the challenges of living with and recovering from vulval cancer.
In conclusion, vulval cancer presents with various symptoms, including persistent itching, pain or tenderness, bleeding, changes in appearance, ulcers, lumps, or masses. To diagnose vulval cancer, healthcare professionals use a combination of medical history and physical examination, along with biopsies and imaging tests. Proper evaluation of symptoms and risk factors, as well as determining the histopathological subtype, tumor staging, and lymph node involvement, are crucial for accurate diagnosis and prognostication. Treatment of vulval cancer involves a multidisciplinary approach, individualized treatment plans, and regular follow-up care. Supportive care and psychological support also play a vital role in the management of vulval cancer, ensuring comprehensive care for patients.
