New cases of vulva and vaginal cancer are diagnosed in about 100,000 women each year. This encompasses a range of tumours, all of which originate in various cells of the genital region. Most frequently, the labia majora – or large labia – are affected. These types of cancer are triggered by the human papilloma virus (HPV) type 16 and 18, but also by chronic illnesses that cause inflammation, cornification and dryness in the area of the external female genitalia. Infections with herpes, chlamydiae and treponema pallidum as well as chronic irritation in the genital area can promote the emergence of vulvar cancer. Vulvar cancer is a disease of old age, its frequency increasing significantly from the age of about 70.
Vulvar carcinomas do not usually exhibit any symptoms at an early stage. However, reddish spots or wart-like growths on the vulva or can occur. Typical symptoms are itching, a stinging sensation, changes in the skin, often an unpleasant-smelling discharge and irregular bleeding, which can occur more frequently as the carcinoma advances. Although these symptoms may have other causes, they are often signs of vulva cancer and should therefore be regularly discussed with a gynaecologist to identify their causes.
At a later stage, the tumour may manifest more clearly in the form of a lump or ulcer. At that point, it is often discovered by the patients themselves. If a tumour is suspected, a tissue sample is often taken by colposcopy and examined under a microscope.
Early identification is also vitally important in cases of vulva cancer. Detecting the precursor – vulvar intraepithelial neoplasia (VIN) – saves a lot of trouble, as this can usually be removed without leading to permanent impairment.
Redness, swelling and itching may be the first symptoms of this type of cancer and should therefore also be medically examined. Any suspicious changes in the area of the outer genitalia should be biopsied. This involves taking a small tissue sample, usually from the centre of the affected area. If a vulvar carcinoma is diagnosed in the biopsy, a thorough physical examination must be performed, in which especially the lymph nodes in the groin region are closely examined. In addition, MRI (magnetic resonance imaging) can be performed.
The most common histological type of vulvar carcinoma is the squamous cell carcinoma. In younger women, the classic or Bowen’s type, which is associated with HPV infection, especially subtypes 16 and 18 is more common, while the more usual keratinising subtype is found mainly in older women and is not associated with an HPV infection. Melanoma can also occur in the area of the external genitalia and constitute the second most common histological subtypes.
The most important treatment aspect, especially in the early stages of a vulvar carcinoma is the surgical removal of the primary tumour. Stage I and II vulvar tumours are cut out complete with surrounding tissue to ensure the full removal of malignant cells. If early invasive vulvar carcinomas (invasion less than 1 mm) are diagnosed, there is no need to remove the lymph nodes in the groin region; for all other tumours, these lymph nodes should be removed at least on the affected side.
After primary surgery, radiation therapy should be performed if the tumour could not be fully removed or if metastases have already formed in the lymph nodes of the groin region. For more advanced tumour stages, a preoperative treatment accompanied by chemotherapy and radiotherapy is recommended nowadays.
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