A Family Doctor's Tale - CANCER OF VULVA

DOC I HAVE CANCER OF THE VULVA

Cancer of the vulva is  a rare cancer in women which affects the vulva occurring usually in older women past menopause.

The average age is over 60.

The cancer is usually a squamous carcinoma.

Rare tumors are melanoma, basal cell carcinoma and sarcoma.

The most common site is the labium majus(side wall of the vulva) , followed by the clithoris but it may arise anywhere including the urethral area.

The cancer can spread locally to involve the whole vulva and invade the vagina.

Secondary spread of the cancer is along the lymphatic system.

The symptoms and signs of  cancer of the vulva are:

1.The cancer is usually symptomless until it ulcerates.

2.It can presents as a lump which is cauliflower in appearance or ulcerated or indurated.

3.inguinal lymph nodes may be enlarged in cases of spread.

4.There may be pain with ulceration or long standing itch.

Diagnosis of cancer of the vulva is by:

1.Physical examination may revealed a lump or more in the vulva region.

2.Biopsy of the lump may reveal cancer

3.Ultrasound may be able to detect any spread to the vagina, uterus or lymph gland.

The treatment of Cancer of the vulva is  :

1.Surgery:
If there is no evidence of spread, usually removal of the cancerous lump is sufficient.

If the evidence of spread to the entire vulva region, radical vulvectomy may be done together with removal of the inguinal lymph nodes.

Chemotherapy:
Chemotherapy may help to prevent the spread of the cancer or to prevent a reccurance.

Radiotherapy :
Radiotherapy is not a treatment of choice


Squamous cell carcinoma is relatively resistant to radiotherapy.


The vulval skin is also very sensitive the burning effect of radiotheray.


However in the very old and frail patients, radiotherapy may be considered as an alternative to multilating operation.

Prognosis of cancer of the vulva is:
If the lymph nodes are not involved, there is a chance of 70% 5 year cure rate.

If the superficial lymph nodes are involved, the cure rate drops to 40%.

If the pelvic lymph nodes are involved the cure rate drops to only 20%.