Vulvar Cancer Samples
The Vulva
Vulvar Cancer Overview
- Squamous cell carcinoma: Squamous cell carcinoma is a type of skin cancer that accounts for about 90% of vulvar cancers, most of which are found on the labia. Squamous cancer can develop through a “precancerous” condition, which is when changes in cells may, but do not always, become cancer. This is called vulva intraepithelial neoplasia (VIN). VIN is a premalignant growth of cells on the vulva and is treated differently from invasive cancer. Premalignant means that it is not yet cancer. Vulva intraepithelial neoplasia (VIN) is further divided into two groups based on how the cells look under a microscope, called usual-type vulva intraepithelial neoplasia (VIN) and differentiated vulva intraepithelial neoplasia (VIN). Usual-type vulva intraepithelial neoplasia (VIN) usually appears in younger women and is associated with human papillomavirus (HPV).Differentiated vulva intraepithelial neoplasia (VIN) is less common, usually appears in older women, and is not associated with human papillomavirus (HPV). Differentiated vulva intraepithelial neoplasia (VIN) often arises in women who have a skin condition called lichen sclerosus, and this kind of vulva intraepithelial neoplasia (VIN) can develop into a fast-moving, aggressive squamous cancer.
- Adenocarcinoma: Adenocarcinoma starts in the Bartholin’s glands or vulvar sweat glands. This type of cancer accounts for a small percentage of vulvar cancer. It is usually found on the sides of the vaginal opening.
- Melanoma: Melanoma is another type of skin cancer that accounts for about 2% to 4% of vulvar cancer. Melanomas are usually found on skin in parts of the body commonly exposed to the sun, but occasionally it can develop where there is no sun exposure. When it develops in the vulva, it occurs most often on the clitoris or the labia minora. Women with melanoma on other parts of their body have an increased risk of developing vulvar melanoma. Vulvar melanoma is often treated using similar approaches for the treatment of melanoma in other parts of the body.
- Sarcoma: Sarcoma is a tumor of the connective tissue beneath the skin.
- Verrucous carcinoma: This is a slow-growing subtype of squamous cell carcinoma that looks like a wart.
Signs and Symptoms of Vulvar Cancer
- A lump or growth in or on the vulvar area or groin (enlarged lymph node)
- A patch of skin that is differently textured or colored than the rest of the vulvar area
- Persistent itching, pain, soreness, or burning in the vulvar area
- Painful urination
- Bleeding or discharge that is not menstrual blood
- An ulcer that persists for more than one month
- A change in the appearance of an existing mole (this symptom is for vulvar melanoma specifically)
- Wart-like growths that are similar to genital warts
Risk Factors of Vulvar Cancer
Following are the risk factors which may increase a woman’s risk of developing vulvar cancer:
- HPV: Research indicates that infection with human papillomavirus (HPV) is a risk factor for vulvar cancer. Human papillomavirus (HPV) may be responsible for about one-third to two-thirds of all vulvar cancers. Sexual activity with someone who has human papillomavirus (HPV) is the most common way someone gets human papillomavirus (HPV). There are different types of human papillomavirus (HPV), called strains. Research links some human papillomavirus (HPV) strains more strongly with certain types of cancers. Many types of cancer caused by human papillomavirus (HPV) are associated with precancerous conditions, which are changes in cells that may, but do not always, become cancer. There are vaccines available to protect you from some human papillomavirus (HPV) strains.
- Smoking: Smoking tobacco may increase a woman’s risk of developing vulvar cancer.
- Age: Most women diagnosed with vulvar cancer are older than 50. Only a small percentage of invasive vulvar cancer occurs in women younger than 40.
- Immune system deficiency: Women with lowered immune systems have a higher risk of developing vulvar cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, organ transplantation, treatment for other types of cancer, or human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS). When a person has a lowered immune system, their body is more likely to develop infections, including an human papillomavirus (HPV) infection.
- Precancerous conditions: Precancerous conditions of the vulva can increase a woman’s risk of developing vulvar cancer. These include vulva intraepithelial neoplasia (VIN), Paget’s disease, cervical cancer, vaginal cancer, or melanoma elsewhere on the body.
- Lichen sclerosus. This condition affects the vulvar skin, making it thin and itchy. About 4% of women with lichen sclerosus develop vulvar cancer.
Diagnosis of Vulvar Cancer
In addition to a physical examination, the following tests may be used to diagnose vulvar cancer:
- Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed will depend on the location of the suspicious tissue. If the biopsy shows invasive vulvar cancer, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer.
- Colposcopy: The doctor may do a colposcopy to check the vagina, vulva, and cervix for any abnormalities, especially when Pap or HPV tests return abnormal results. A colposcope is a special instrument, similar to a microscope, that magnifies the surface of the cervix, vagina, and vulva. The colposcope gives the doctor a lighted, magnified view of these areas. The colposcope is not inserted into the woman’s body. The examination is not painful, can be done in the doctor’s office, and has no side effects. This examination can also be performed on pregnant women.
- Chest x-ray: An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. A chest x-ray would be used to see if cancer has spread to the lungs.
- Computed tomography (CT or CAT) scan: A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given by mouth and swallowed, usually as a liquid.
- Positron emission tomography (PET) or PET-CT scan: A PET scan is usually combined with a CT scan, called a PET-CT scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
- Magnetic resonance imaging (MRI): An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye usually is injected into a patient’s vein.
- Endoscopy: An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The woman may be sedated as the tube is inserted through the urethra into the bladder, called cystoscopy, or through the anus into the rectum, called proctoscopy or colonoscopy. Sedation is giving medication to become more relaxed, calm, or sleepy.
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