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Understanding Cancer of the Vulva

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Understanding Cancer of the Vulva An information sheet for women with cancer, their families and friends. This information has been prepared to help you If something goes wrong with the genes that understand more about cancer of the vulva control a cell, that cell may start behaving (vulvar cancer). It is an introduction to the strangely. Instead of growing normally, it may diagnosis, treatment and effects of this cancer. grow and divide in an uncontrolled way, forming a mass of cells. The mass of cells looks We cannot advise you about the best treatment and feels like a lump, and is called a tumour. for you. You need to discuss this with your doctors. However, we hope this information A tumour can be benign (not cancer) or it can will answer some of your questions and help be malignant (cancer). The difference is that you think about the questions you want to ask benign tumours do not spread to other parts of your doctors. the body, while malignant tumours can. For more detailed information on cancer of the A malignant tumour is made up of cancer cells. vulva, you may wish to contact the Cancer When it first develops, the tumour stays in one Council Helpline on 13 11 20 or refer to the place. This is called the primary tumour. list of recommended websites under the heading Information on the Internet on the If the cancer cells that make up the primary back page of this booklet. tumour are not treated, they may start to spread to other areas of the body and form new tumours. These new tumours are called secondary cancers or metastases. What is cancer? Cancer is a disease that can occur in any type of cell in the body. Our bodies are continually making new cells: to replace dead cells, to heal How cancer spreads damaged cells after an injury, and to enable us to grow in size. All cells are controlled by genes. Primary cancer Local invasion The beginnings of cancer Angiogenesis – tumours grow their own blood vessels Normal cells Abnormal cells Abnormal cells Malignant or multiply invasive cancer Lymph vessel Boundary Boundary Metastasis – cells move away from Lymph the primary tumour vessel and invade other parts of the body Blood via blood vessels vessel © The Cancer Council Victoria © The Cancer Council Victoria and lymph vessels Some benign tumours are precancerous and may progress to cancer if left untreated. Other benign tumours do not develop into cancer. Blood vessel The vulva How common is it? The vulva is a general term describing the sex Cancer of the vulva is rare. Around 70 women organs of a woman. The vulva includes: are diagnosed with vulvar cancer in NSW each • Mons Pubis (Mount of Venus): the soft fatty year. It usually affects postmenopausal women tissue covered with pubic hair, which is between the ages of 55 and 75, but can occur in above the labia. younger or older women. It is becoming more common in younger women. • Labia: the two outer larger lips (the labia majora), which surround two inner smaller and thinner lips (the labia minora). • Clitoris: a highly sensitive organ found at the What are the causes? top where the labia minora join. When stimulated, the clitoris fills with blood and Precancerous conditions enlarges in size. Stimulation of the clitoris can result in sexual excitement and orgasm Although the cause of cancer of the vulva or climax. remains unknown, it has been linked to certain early changes in the cells of the vulva, usually called precancerous conditions. Clitoris One such condition is called VIN (vulvar Outer lips intraepithelial neoplasia). This means abnormal (labia vulvar cells and is not cancer. VIN occurs in the majora) skin of the vulva and can develop into vulvar Urethra cancer. Almost one-third of vulvar cancers develop in women who have VIN. Vagina Inner lips The human papilloma virus (HPV), or wart (labia virus, appears to be associated with VIN. minora) HPV is passed from one person to another during sexual activity. Women who have had Perineum multiple sexual partners may be exposed to a Anus variety of HPV and therefore are at greater risk of VIN. However, women who have had only one sexual partner can also develop VIN. Just below the clitoris is the opening through which women pass urine (the urethra) and In younger women, a precancerous lesion (an below this is the vagina, a tubular passage area of tissue with abnormal cells) is more through which menstrual blood flows, sexual likely to be linked with HPV and this increases intercourse occurs, and a baby is born. the risk of vulvar cancer. Older women who get vulvar cancer often don’t have a link with HPV. The area of the skin between the vulva and anus is called the perineum. All these structures For more information Not all women who are visible from outside the body. on VIN and HPV, call have VIN will develop the Cancer Council vulvar cancer. Cancer of the vulva can start on any part of the Helpline on 13 11 20. external female sex organs. The most common areas for it to develop are the inner edges of the outer lips (labia majora) and the inner lips (labia minora). Less often, vulvar cancer may also involve the clitoris or the Bartholin’s glands (small glands, one on each side of the vagina). It can also affect the perineum (the skin between the vulva and the anus). 2 The Cancer Council New South Wales Skin conditions What are the symptoms? Women who have certain non-cancerous skin The most common symptoms of cancer of the conditions for a long time have an increased vulva are: risk of developing vulvar cancer. These conditions, called vulvar lichen sclerosus and • itching, burning and soreness of the vulva vulvar lichen planus, affect the skin in the • a lump, swelling or wart-like growth vulvar area. The skin can become inflamed and • thickened, raised, red, white or dark patches itchy, and split and crack, causing pain. The on the skin of the vulva vulva may become distorted and change in • bleeding or a blood-stained vaginal discharge shape and size. not related to menstrual bleeding Almost two-thirds of vulvar cancers occur in • burning pain when passing urine women who have lichen sclerosus. • pain in the area of the vulva Lichen sclerosus is far more common than • a sore or ulcerated area on the vulva vulvar cancer, and only a small percentage of • a mole on the vulva that changes shape or women with lichen sclerosus (less than 15%) colour. go on to develop vulvar cancer. Cancer of the vulva usually takes many years to develop but, as with other cancers, it is Smoking easier to treat and cure at an early stage. Any of the above symptoms can be a sign of many Cigarette smoking increases the risk of conditions other than cancer, but always get developing the precancerous condition VIN, checked by your doctor to be sure. as well as the risk of developing vulvar cancer. This may be because smoking can make the immune system work less effectively. Cancer of the vulva, like other cancers, is not Types of cancer of the vulva infectious and cannot be passed on to other Squamous cell carcinoma: Most vulvar cancers people. An inherited faulty gene does not cause (90%) develop from squamous cells, the skin it and so other members of your family are not cells of the vulva. These cancers usually grow likely to be at risk of developing this cancer. very slowly over a few years. Vulvar melanoma: Vulvar melanomas develop from melanin, the cells that produce pigment Why do we have to be ashamed about and give skin its colour. Only about 2-4% of having vulvar cancer? No one is vulvar cancers are melanoma. embarrassed when they have breast Adenocarcinoma: These are very rare. They cancer. When you connect with develop from cells that line glands in the another woman who has had vulvar vulvar skin. Paget’s disease of the vulva is a cancer, you soon find out that there is pre-malignant condition where glandular cells spread outwards and across the vulvar skin. no need for shame or embarrassment. Verrucous carcinoma: This rare, very slow- growing type of cancer looks like a large wart. Sarcomas: These are extremely rare. Sarcomas develop from cells in tissue, such as muscle or fat under the skin, and tend to grow more quickly than other types of cancer. Understanding Cancer of the Vulva 3 Diagnosis Biopsy Usually you begin by seeing your GP, who will A biopsy is the best way to diagnose cancer of examine you. If there is a chance you have the vulva. This means removing a sample of vulvar cancer, you should be referred to a tissue from the affected area of the skin. First, specialist called a gynaecological oncologist. an injection of local anaesthetic is given where A gynaecological oncologist is a doctor who the abnormal cells occur on the vulva. The specialises in diagnosing and treating cancer of doctor then takes a small amount of these cells women’s reproductive organs (including the (a biopsy) so that a pathologist can examine vulva). This specialist is very experienced with them under a microscope, to confirm whether gynaecological cancers and is the best type of cells are cancerous, and if so, show which type doctor for you to be seen and treated by. of vulvar cancer it is. Your doctor may also arrange for you to have a blood test and chest x-ray to check your Further tests general health.
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