What is the vulva?
The vulva is the external genital area of women.
It consists of the mons pubis, the labia majora and labia of the
vagina, clitoris and the vulvar vestibule, which is its innermost part,
which contains the urethral meatus (exit hole urine) and the vaginal
opening ( entrance to the vagina).
What is vulvar cancer?
Vulvar cancer is the "malignancy" of existing cells in any of the bodies just mentioned. These malignant cells have the power to multiply indefinitely, and can spread to other organs or body systems.
Microscopically, the most common type is squamous cell carcinoma (90%). There are other types of cancers such as melanoma , sarcomas and adenocarcinomas, but appear less often.
70% is located in the labia, 10% of the clitoris, and 5% in the
perineal region, which is the area that lies between the external
genitals and anus.
Vulvar cancer is the most frequent and constitutes less than 5% of malignant tumors of the female genital tract.
This cancer is more common among older women (70-80 years), with an
average age of 60, although it can also occur in children under 40
years.
Evolution may be a carcinoma "in situ" in a woman of 44 years (the
tumor is confined and does not extend in depth, may be so for years); Microinvasive at age 58 (when it begins to invade cells around the tumor); 60 and invasive carcinoma (cancer breaks every barrier and extending through in the tissue).
The appearance of vulvar cancer is linked to diseases like hypertension pressure, the diabetes , the obesity , and sexually transmitted diseases such as genital herpes , condyloma acuminata, human papilloma virus and syphilis . It is also associated with poor personal hygiene, with the snuff and the number of sexual partners they have had. There is also the possibility of vulvar cancer and cervix cancer have a common cause, since in some patients both tumors coincide.
An interesting fact is that most women with chronic diseases of the
vulva, or inflammatory processes or chronic irritation, do not develop
vulvar cancer.
How vulvar cancer behaves?
Growth is slow and located in the genital area where it starts, with
invasion of adjacent structures, and spreads ganglia neighboring regions
(nodes are affected in 30-50% of patients with cancer vulva).
It should also be noted that there is a direct relationship between the
infiltration of the lymph by the tumor and the size thereof.
In lesions larger than 2 cm and those with greater infiltration depth,
there is a greater possibility that the nodes are affected. Hematogenous spread, ie the possibility that spreads through blood, is rare and usually occurs late.
The extent of disease is measured by three variables: the size of the
tumor (T), the extension to the lymph nodes (N) and spread to other
organs (M). Thus, the different cases are classified according to their greater or lesser extent. If we combine these three parameters, we obtain classified into four stages: I, II, III, IV. Stage I is the least advanced stage IV is the most advanced and therefore the most serious.
Surgical treatment
There are various techniques, from the partial surgery of the vulva
(hemivulvectomía) until complete and aggressive suppression (radical
surgery) with bilateral inguinal and pelvic lymphadenectomy. In lesions smaller than 2 cm and less invasion of 5 mm can be seen performing a hemivulvectomía.
The main surgical complications include: wound infection, edema
(swelling of tissue fluid accumulation), bleeding, thromboembolism,
sepsis (generalized infection of the body), lymphatic fluid
accumulation, vascular inflammations (phlebitis), urinary incontinence
with leakage of urine or feces, or sexual dysfunction.
Radiotherapy
It may be used alone or in conjunction with surgery.
As the only radical intent or technique, the treatment is applied
during a period of about 6-7 weeks, and the most common is the use of
cobalt machines or linear accelerators that produce high-energy
radiation to destroy tumor tissue.
In some cases the technique called brachytherapy, which involves
applications at the same point where the tumor radiation emitting
elements, such as needles, etc. may be used is
In other cases, palliative radiotherapy can also be used: trying to get
an improvement of symptoms in the patient, or that do not appear. In these cases, the duration of treatment may be less prolonged.
Side effects of radiation therapy may include: urinary discomfort, digestive disorders, infections, redness and skin lesions. More serious but less frequent changes, they can be: lymphedema (fluid in tissue), tissue ulceration with fibrosis and urinary incontinence .
How is vulvar cancer treated?
The recommended treatment is surgery.
Specifically, treatment for carcinoma "in situ" is wide excision, with
margins of safety, to protect it against some of the tumor at the edges
of the region intervened.
Tumors less than 2 cm, and less invasive than 5 mm are considered
microinvasive, and surgery may be performed to remove them completely,
without the need for any other additional treatment.
In lesions larger than 2 cm radical surgery is performed with bilateral
inguinal and pelvic lymphadenectomy (if the latter has been affected
inguinal) that involves removing lymph vulva and the surrounding region,
where the tumor may have come.
Locally advanced tumors with invasion of neighboring organs such as the
urethra, bladder, rectum, or exhibit lymphadenopathy (infiltrated
lymph) inguinal fixed (non-moving) are treated mostly for palliation
(without aspiring to healing, only to mitigation of symptoms).
One possible treatment consists of applying radiation in order to
decrease tumor size and then perform surgery for complete removal. Pelvic surgery, especially as more aggressive, higher risk of complications involved in both the short and long term.
In cases of local recurrence in the same area where the tumor
originally started, you can resort back to surgery or radiotherapy.
What prognosis is vulvar cancer?
Survival is determined by the phase you are in, size, location,
structure and degree of invasion of lymphatic and vascular involvement.
Overall survival at five years is 50-70% of patients treated. Phased, survival can be estimated as 90% in phase I; 60-80% in phase II; 20-50% in stage III; 25% in stage IV.
In the absence of lymphatic involvement, survival ranges from 70-80%; down to 30-40% if the nodes are involved. If the nodes in the pelvis are affected worse prognosis, falling survival to 20-30%.
30-70% of patients with advanced disease experience a local recurrence, being more common in those with involvement of lymph.
The recommended treatment depends on the extent of the recurrence and
treatments that have already been performed previously, being able to
opt for surgery or radiotherapy.
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