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    Cancer - vulva

    Cancer - perineum

    Vulvar cancer is cancer that starts in the vulva. Vulvar cancer most often affects the labia, the folds of skin outside the vagina. In some cases, vulvar cancer starts on the clitoris or in glands on the sides of the vagina opening.

    Causes

    Most vulvar cancers begin in skin cells called squamous cells. Other vulvar cancers are:

    • Adenocarcinoma
    • Basal cell carcinoma
    • Melanoma
    • Sarcoma

    Vulvar cancer israre. Risk factors include:

    • Human papilloma virus (HPV, or genital warts) infection in women under age 50
    • Chronic skin changes such as lichen sclerosis or squamous hyperplasia in women over age 50
    • History of cervical cancer or vaginal cancer
    • Smoking

    Women with a condition called vulvar intraepithelial neoplasia (VIN) have ahigh risk of developing vulvar cancer that spreads. Most cases of VIN, though,never lead to cancer.

    Symptoms

    Women with this condition will often have itching around the vagina for years. They may have used different skin creams. They may also have bleeding.

    Other skin changes that may occur around the vulva:

    • Mole or freckle, which may be pink, red, white, or gray
    • Skin thickening or lump
    • Skin sore (ulcer)

    Other symptoms:

    • Pain or burning with urination
    • Pain with intercourse
    • Unusual odor

    Some women with vulvar cancer have no symptoms.

    Exams and Tests

    The following tests are used to diagnose vulvar cancer:

    • Biopsy
    • CT scan or MRI of the pelvis to look for cancer spread
    • Pelvic examination to look for any skin changes

    Treatment

    Treatment involves surgery to remove the cancer cells. If the tumor is large (more than 2 cm) or has grown deeply into the skin, the lymph nodes in the groin area may also be removed.

    Radiation, with or without chemotherapy, may be used to treat advanced tumors or vulvar cancer that comes back.

    Support Groups

    You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

    Outlook (Prognosis)

    Most women with vulvar cancer who are diagnosed and treated at an early stage do well.But a woman's outcome depends on:

    • The size of the tumor
    • The type of vulvar cancer
    • Whether the cancer has spread

    The cancer commonly comes back at or near the site of the original tumor.

    Possible Complications

    Complications may include:

    • Spread of the cancer to other areas of the body
    • Side effects of radiation, surgery, or chemotherapy

    When to Contact a Medical Professional

    Call your health care provider if you have any of these symptoms for more than 2 weeks:

    • Local irritation
    • Skin color change
    • Sore on the vulva

    Prevention

    Practicing safer sex may decrease your risk of vulvar cancer. This includes using condoms to protect against sexually transmitted infections (STIs).

    A vaccine is available to protect against certain forms of HPV infection. The vaccine is approved to prevent cervical cancer and genital warts. It may help prevent other cancers linked to HPV, such as vulvar cancer. The vaccine is given to young girls before they become sexually active, and to adolescents and women up to age 26.

    Routine pelvic exams can help diagnose vulvar cancer at an earlier stage. Earlier diagnosis improves your chances that treatment will be successful.

    References

    Fuh KC, Berek JS. Current management of vulvar cancer. Hematol Oncol Clin N Am.2012;26:45–62.

    Jhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Abeloff MD, Armitage JO, Niederhuber JE, et al., eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 91.

    National Cancer Institute: PDQ Vulvar Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified 02/21/2013. Available at http://cancer.gov/cancertopics/pdq/treatment/vulvar/HealthProfessional. Accessed 03/06/2013.

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          Review Date: 3/4/2013

          Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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