Madrid, 8 August 2023-.Vulvar cancer is a type of tumour that affects the outer surface of the female genitalia. Despite accounting for less than 1% of all malignant tumours in women, and 4-5% of all gynecological cancers, it is the fourth cause of neoplasia of the female genital tract, after the endometrium, ovary and cervix1. Usually, vulvar cancer appears as a lump or ulcer on the vulva that often causes itching or pruritus. Although it can occur at any age, vulvar cancer diagnosis is more frequent in older women, at an average age of 68, although over recent years, the onset age has lowered, with early stages detected in age groups between 45 and 60.1
According to Dr. Javier de Santiago, head of the Oncological Gynaecology Service at MD Anderson Cancer Center Madrid – Hospiten, "we find women of advanced age who, out of shame, do not look at certain areas, so early diagnosis is very difficult. It is a tumour that evolves slowly over a number of years, usually accompanied by stinging in the area, which makes it difficult to detect early." In addition to itching or the appearance of lumps or ulcers, other symptoms of vulvar cancer can be pain and tenderness, bleeding that does not come from menstruation or alterations to the skin, such as colour changes or thickening.
Doctor De Santiago insists on the importance of early diagnosis. "Fifteen or twenty years ago we performed surgeries where we had to remove all the skin, all the tissue of the vulva. Now, through earlier diagnosis, we are able to perform limited surgeries by removing the tumours with free margins and, as with breast or cervical cancers, studying the sentinel node, instead of removing all of them." However, he insists, "this is the case when faced with smaller tumours, on which we can perform more conservative surgeries."
Tissues that heal poorly due to the advanced age of the patients
Identifying the type of cell in which vulvar cancer begins helps the doctor plan the most effective treatment. In this regard, there are two tumour types: epidermoid or squamous epithelial vulvar carcinoma, which begins in the thin, smooth cells that line the surface of the vulva, and accounts for 90% of vulvar neoplasms1, and vulvar melanoma, which begins in the pigment-producing cells found in the skin of the vulva.
According to the Head of Oncological Gynaecology at MD Anderson Madrid – Hospiten the treatment is initially surgical and then, depending on the size and stage of the nodes, may later be accompanied by radiotherapy and, less frequently, chemotherapy if very advanced or where operation is impossible because it will affect the urethra." “For more advanced or metastatic cases, we opted for immunotherapy, with which we are starting to see good results," he added.
However, the main problem faced by specialists in surgeries on this type of tumour is scarring. As the women are mostly elderly, their skin is weaker and "we find tissues that heal very badly. This is also very uncomfortable for patients, the wound is close to the urethra and can produce a lot of discomfort,” the doctor said.
Advanced age or HPV exposure, risk factors associated with vulvar cancer
Although the exact cause of vulvar cancer is unknown, certain factors can increase the risk. The most common is clearly advanced age, and the incidence of vulvar cancer increases over the years. The average age of diagnosis is between 65 and 68. Exposure to human papillomavirus (HPV) also heightens the risk of vulvar cancer. Many sexually active young people can be exposed to HPV, but for most, the infection goes away on its own. In some, the infection may cause alterations in the cells and thereby increase the risk of cancer in the future. In fact, the updated classification of vulvar tumours, published by the World Health Organization (WHO), gives prominence to its association with HPV infection. However, approximately two out of three cases are not related to this infection, and these present a worse prognosis than carcinomas that are HPV associated.
Smoking and having a weakened immune system are also factors that can lead to an elevated risk of developing this type of tumour. People who take medications to suppress the immune system, for example those who have had an organ transplant, and those with conditions that weaken the immune system, such as human immunodeficiency virus (HIV), have a higher probability of suffering from this condition. Finally, a history of precancerous related diseases or having a skin disease that affects the vulva also increases the risk.
References
1. ONCOGUÍA. Vulva Invasive Squamous Cancer. Spanish Society of Gynaecology & Obstetrics (SEGO) https://oncosego.sego.es/uploads/app/1283/elements/file/file1677140517.pdf