Vulvar Cancer (Vulvar Cancer)

A Vulvar cancer, also as Vulvar cancer known, is a relatively rare but serious cancer in the female genital area. As with all forms of cancer, early detection of vulvar cancer is crucial for the success of the therapy.

What is vulvar cancer?

At a Vulvar cancer it is a malignant, i.e. malignant tumor in the area of ​​the external genital organs of women. This area consists of the outer and inner labia as well as the clitoris and vaginal vestibule.

In about 90 percent of all cases, such a vulvar carcinoma develops from the uppermost layers of the mucous membrane and is then referred to as squamous cell carcinoma. However, all other types of tumors, such as so-called black skin cancer, are summarized under the term vulvar carcinoma, provided they occur in the area of ​​the vulva.

Vulvar cancer is rare; Every year around 3,400 to 4,000 women fall ill in Germany. The risk of developing vulvar cancer increases significantly with age; those affected are mostly older than 60 years.

causes

The causes of one Vulvar cancer could not yet be finally clarified, but the disease is often associated with certain risk factors. The most important of these is infection with the so-called human papilloma viruses, or HPV for short.

These viruses are transmitted through sexual intercourse and are associated with numerous other diseases in the genital area, including cervical cancer. The viruses can cause skin changes in the vulva, which in turn can lead to vulvar cancer.

Vulvar cancer can also be preceded by infection with herpes viruses, chlamydia or the syphilis pathogen Treponema pallidum, as well as so-called white callous disease (leukoplakia). A weakening of the immune system, for example due to an AIDS disease, can also promote the development of vulvar cancer. Increased nicotine consumption through smoking was also observed in connection with vulvar cancer.

Symptoms, ailments & signs

Statistically speaking, vulvar cancer only affects very few women. The disease is usually only diagnosed at an advanced stage. This is because only then does pain arise. Sometimes a gynecologist can make an early diagnosis as part of a routine examination. A sustained, symptom-free removal of the tumor is usually possible without any problems in the initial stage. A distinction must be made between the beginning and advanced signs of a disease.

Affected women initially complain of unusual itching. This occurs on the outer labia or between the clitoris and the urethral opening. Sometimes red spots or scars have also formed there. Hardenings that are reminiscent of warts occur regularly. But increased vaginal discharge also indicates vulvar cancer.

Unusual bleeding may occur during or after sex. After the tumor grows to a certain size, women often feel pain when emptying their bladder. The genital area feels sore during the day and night. Ulcers have formed.

Lumps can also be felt. At an advanced stage, vulvar cancer can cause symptoms in other parts of the body. Pain in the back is just as common as in the legs. The nerves in the spinal cord are responsible for this.

Diagnosis & course

Especially in the early stages it makes itself Vulvar cancer hardly noticeable through specific symptoms, around a fifth of all women affected do not feel any symptoms. However, persistent itching occurs relatively often.

Further indications can be given by skin changes in the form of reddish spots or wart-like bumps, as well as discharge, which can also be bloody. In the advanced stage, ulcers or lumps develop, the surface structure of which is comparable to that of a cauliflower.

The first medical examinations include a palpation exam and a colposcopy. With the colposcope, the mucous membrane of the vulva is shown enlarged several times and can thus be better viewed for abnormalities. A final diagnosis of vulvar cancer is made via biopsy, i.e. the removal and examination of a tissue sample.

A diagnosis as early as possible is advantageous because vulvar carcinomas can already form metastases in the neighboring lymph nodes in the early stages.

Complications

If the vulvar cancer is discovered in time, no complications are usually to be expected. However, if therapy only begins at an advanced stage, the risk increases that the tumor will begin to spread. In these cases, metastases form, which often first affect the lymphatic system, especially the lymph nodes in the groin area.

In the next step, carcinomas then form in the pelvis. If the patient does not respond to the therapy attempts, other internal organs, in particular the liver or kidneys, can also be affected in the further course. This can lead to further serious, possibly life-threatening, complications such as multiple organ failure.

Complications can also result from the therapy itself. In vulvar cancer, the tumor is usually removed surgically. As with any operation, severe bleeding and infection of the surgical wound and, as a result, sepsis can occur. Furthermore, the tumor is often subjected to radiation therapy before the operation, especially if it is already very large, in order to make it shrink.

The side effects of radiation therapy are significantly less stressful for most patients than those of chemotherapy, but side effects can arise that massively reduce the quality of life. In sensitive people and in patients whose general condition is already severely weakened, damage to the mucous membrane of the mouth and throat as well as to the bladder and genital organs can occur. Serious gastrointestinal disorders are also occasionally observed.

When should you go to the doctor?

Vulvar cancer can naturally only develop in women or girls. Therefore they belong to the risk group of the disease. A doctor must be consulted at the first disturbances and irregularities of the female sex. Without early medical and medical care, the disease can end in premature death.

Therefore, there is an urgent need for action if visual abnormalities occur or complaints are noticed. Swelling, itching or problems with using the toilet should be discussed with a doctor. If there are irregularities in the emptying of the bladder, this is to be understood as an early warning signal. Pain, general malaise, or restlessness should be investigated.

Hardened labia, the formation of scars or spots as well as warts and lumps that you can feel should be examined and treated. If there are irregularities in sexual intercourse, changes in libido or menstrual disorders, a doctor should be consulted. If existing complaints in the body spread further or if an increase in intensity is observed, action is required.

A doctor should be consulted as soon as possible if problems of the back are noticed in addition to the complaints in the genital area. Irregular locomotion, discomfort in contact with textiles in the genital area and unusual discharge from the vagina must be examined.

Treatment & Therapy

Treatment of the Vulvar cancer In the overwhelming majority of cases, this is done by vulvectomy, which means that the vulvar cancer is removed as part of an operation. How extensive this operation will be depends on the progression of the disease. Your goal is to completely remove the vulvar cancer, that is, with any metastases that may be present. This is why the operation sometimes also involves nearby lymph nodes, uterus, urinary bladder or intestines.

Depending on the location and size of the vulvar carcinoma, it can be useful to irradiate the tumor before it is surgically removed in order to reduce it in size. Radiation after surgery is used to reduce the risk of vulvar cancer recurring. Chemotherapy may be necessary to treat metastases.

Depending on the extent of the vulvectomy, further interventions to restore and maintain the function of the genital organs can follow. After the operation, a follow-up examination is required every three months for the first two years and every six months for the following three years.

prevention

A prevention against Vulvar cancer is only possible to a limited extent. By vaccinating young women against human papilloma viruses, as recommended for cervical cancer screening, however, a major risk factor for vulvar cancer can also be eliminated. Regular cancer screening with a gynecologist is crucial for the earliest possible detection.

Aftercare

After the treatment of vulvar cancer, a clinically oriented follow-up is carried out. The patient regularly has gynecological examinations. The check-ups are carried out every quarter for the first three years. They take place every six months for the next two years, and then every year.

The examining doctor looks at the patient's medical history and performs a symptom-related gynecological examination. If the follow-up examinations reveal any abnormal findings, a tissue sample is taken (biopsy). The goals of aftercare also include the detection of sequelae or concomitant diseases of vulvar cancer and their corresponding therapy.

Possible relapses can also be identified and treated early in this way. It is therefore extremely important that the patient regularly keeps the appointments for the check-ups. Part of the control examinations are clinical examinations of the vulvar region as well as the examination of the groin area, which is mostly done by a sonography (ultrasound examination). If a relapse is suspected, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) are used.

You can do that yourself

The everyday life of the women affected is usually severely restricted by the cancer. The necessary treatments mean that many patients are unable to pursue their professional activity for a long period of time.

In most cases, the disease also represents a major psychological burden for the woman concerned, her partner and the family. Those affected can find help in self-help groups or in Internet forums for cancer patients and their relatives. Vulvar cancer can also lead to difficulties in the partnership. Both the disease and its treatment can result in a complete loss of libido. An understanding, partnership-based environment is therefore helpful.

Depending on the location and course of the vulvar carcinoma, the disease is treated surgically by partially removing the vulva. This is usually very stressful for the women concerned. In some cases, it is advisable to consult a couples therapist or psychologist.

During and after treatment for vaginal cancer, patients should strengthen their immune systems through a healthy lifestyle. A healthy diet rich in vitamins is particularly important. In most cases, the pelvic floor is weakened after surgery. It is therefore advisable to train this specifically.