A Simple Guide to Vulval Cancer
A Simple Guide to Vulval Cancer
by Kenneth Kee A Family Doctor's Tale
A Simple Guide to Vulval Cancer
What is Vulval Cancer?
Vulval cancer is a rare cancer in women which affects the vulva occuring 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.
What are the symptoms of Vulval cancer?
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.
How is Vulvar cancer diagnosed?
1.Physical examination may revealed a lump or more in the vulval 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.
What is the treatment of Vulval Cancer?
1.Surgery:
If there is no evidence of spread, usually removal of the cancerous lump is sufficient.
If the evidence of spread to the enitre vulval 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 reccurence.
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 very old and frail patients, radiotherapy may be considered as an alternative to multilating operation.
Prognosis:
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%.
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