Gynecological Oncology

Vulvar Ca

Vulvar Ca


Vulva; It is the area of ​​the female reproductive system that covers areas such as the inner and outer lips of the vagina, the clitoris, vestibulum and the skin tissue covering these tissues, which are located in the outer appearance of the body. Again, the Bartholin gland and sebaceous glands located in the vaginal opening and responsible for the production of secretions in the region are evaluated within the framework of the vulva. The formation of tumor-like structures by disrupting tissue integrity as a result of abnormal and uncontrolled proliferation of the cells forming the tissues in this region is known as vulvar cancer.

The anatomical regions in the vulva region consist of special tissue structures called epithelium. The cancerization process of epithelial tissue takes place gradually, over a long period of time. In this sense, cells in a certain part of the epithelial tissue may acquire the character of abnormal division. Although it is not possible to talk about a fully developed cancer disease in the tissue at this stage; It can be said that a step towards cancerization has been taken. This condition is called vulvar intraepithelial neoplasia (VIN). Cancer of the vulva in women is usually the result of a chronic process that occurs as a result of the development and progression of VIN.


What Causes Vulvar Cancer?
Since vulvar cancer basically develops through cancerous structures called VIN, factors leading to the development of VIN in epithelial tissue are considered risk factors for vulvar cancer. In this regard, the risk of developing cancer in the vulvar tissues increases in the following cases:
Advanced age: Especially in women aged 55 and over, a predisposition to cancer may occur due to postmenopausal regression and changes called atrophy in the tissues in the vulva region.
Cigarette consumption: Due to the numerous carcinogenic substances in cigarettes, it significantly increases the risk of vulvar cancer.
History of HPV infection or genital warts: Human papilloma virus (HPV) causes infectious disease and genital wart development in the vulva and surrounding tissues, especially in the cervix. HPV Types 11 and 16; Along with cervical cancer, it greatly increases the risk of developing vulvar cancer.
Lichen planus: The risk of developing vulvar cancer increases in the presence of lichen planus, which is a special health problem of this region, which is characterized by symptoms such as dryness and thickening of the skin in the vulva region.
HIV/AIDS infection: In cases such as HIV infection, which results in suppression of the body's immune system, cancer development is facilitated.
Apart from these factors, it is possible that different types of cancers such as malignant melanoma may develop from nevus tissues in the vulva region. In this situation, different risk factors should be considered for specific types of cancer, such as malignant melanoma.



What Are the Symptoms of Vulvar Cancer?
The clinical picture of vulvar cancer in patients is observed in direct proportion to the stage and severity of the disease. In this regard, patients may not have any clinical symptoms in the early stages of the disease. However, as the disease progresses, the development of visible tumor structures in the region may be observed and various clinical manifestations may occur. In this regard, the following symptoms may occur in the course of vulvar cancer:
Itching in the vulva area
Discoloration or thickening of the skin of the vulva
Burning sensation or pain while urinating
Vulvar pain or tenderness
Swelling of the vulva, vulvar oil glands or wart-like structures
Abnormal vaginal bleeding
Sores of the vulva that may appear on the skin or vaginal mucosa
In addition, with the development of vulvar cancer, tumoral structures may develop horizontally along the vulva towards the skin or other tissues. Again, the tumor may spread to deeper tissues or reach the lymph system and spread to the deeper lymph nodes through the lymphatic vessels. Since vulvar cancer usually primarily involves the superficial lymph nodes in the groin area, it can cause swelling and pain in this area. In more advanced stages, it targets the lymph nodes of deeper tissues.

Again, vulvar cancer can metastasize to internal organs through the lymphatic system or bloodstream. In this sense, it can spread to regions located in the inner parts of the female reproductive system such as the vagina, or it can pass to other tissues such as lungs and bones through the blood and lymph circulation. For this reason, it is very important to recognize the disease in the early stages and to apply the appropriate treatment method without wasting time.




How Is Vulvar Cancer Treated?
In order to be able to treat vulvar cancer accurately and effectively, it is necessary to make the correct diagnosis and staging of the disease at an early stage. With an evaluation by a specialist physician, the patient's clinical symptoms and findings are determined as a result of a detailed disease history and detailed physical examination. The physician makes use of additional imaging and laboratory tests when deemed necessary.

In this regard, examination of the region with ultrasonography can be done in the examination of vulvar cancer; The extent of cancer can be detected by computed tomography or magnetic resonance (MR) imaging. If necessary, special imaging methods such as cystoscopy can be used. The definitive diagnosis of vulvar cancer is made after histopathological examination of the biopsy sample taken from the tumor site. The staging of the disease is performed together with the diagnosis and imaging methods. Staging is very important in terms of determining the severity of the disease and the treatment method to be applied.



Accordingly, the disease is staged as follows according to the anatomical region where the tumor tissue is located, the lymphatic system and the spread to distant organs:
Stage 0: It is the absence of an obvious cancer case in the vulva region, but the development of cancerization findings in the epithelial tissue such as VIN.
Stage 1: Cancer is limited to the vulva and perineum only. The perineum is the name given to the area between the vagina and anus openings. Again at this stage, the cancer has not spread to the lymph nodes.
Stage 2: Cancer has spread to areas outside the vulva (inner vagina, urethra, or anus).
Stage 3: The cancer has spread to the lymph nodes.
Stage 4: Cancer has spread to deeper tissues (such as the deep areas of the vagina, bladder, rectum), deeper lymph nodes or distant organs.
Depending on the stage of the vulvar cancer in the patient, different treatment methods such as surgical approaches, radiotherapy or chemotherapy are used in the treatment. Surgical approaches may include various techniques such as laser applications or open surgery. Small-sized tumor structures detected at an early stage with laser therapy can be removed from the body with high-temperature laser beams, and the patient can be discharged from the hospital in a short time with less scarring and side effects such as bleeding.

Open surgical approaches can be used in more extensive and large tumors. Different levels of vulvectomy operations are performed according to the stage of the patient. In advanced stage cancers, radiotherapy and chemotherapy can be applied after surgery to increase the efficacy of treatment. Depending on the extent of the cancer, the removal of certain parts of the affected lymph nodes or organs may be included in the vulvectomy procedure. Again, in advanced stage cancers, radiotherapy or chemotherapy can be applied alone or in combination in cases where the patient is not suitable for surgery.

As a result of early diagnosis in vulvar cancers, the 5-year survival rate of patients with appropriate treatment is over 86 percent. Therefore, the treatment of vulvar cancers is generally good and satisfactory. One of the factors affecting this is that the vulva consists of tissues that can be easily observed and become cancerous in a long time.

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