Painful urination could be a sign of Vulvar Cancer in women

Cancer of reproductive organs and genitals in both men and women is usually overlooked in many instances. Despite having a generic knowledge on various gynaecological related cancer, many are completely left in the dark when it comes to symptoms and the potential threat it causes to the intimate region. One such potentially rare form of cancer is the Vulvar cancer. Cancers of the vagina and vulva are rare and usually curable when found and treated early.

Vulvar cancer is a rare type of cancer. It forms in a woman’s external genitals, called the vulva. The cancer usually grows slowly over several years. This cancer affects the vulva, the outer part of the female genitals. Vulvar carcinoma mostly affects the vaginal outer lips. Cancer that begins in the vulva is called primary vulvar cancer. When cancer spreads from some other part of the body to the vulva it is termed secondary vulvar cancer. Precancerous lesions usually appear first and are identified as abnormal cell development in the skin's outermost layer.

Although this is predominately common in postmenopausal women, due to a sudden transformation in lifestyle and unhealthy habits such as smoking, women of all ages should be cautious of vulvar cancer.
Signs and symptoms

Vulvar cancer doesn’t show any symptoms at first.  Over a period of time your body shows symptoms such as a lump in the vulva, vulvar itching or tenderness, bleeding that is not your period and changes in the vulvar skin, such as the colour changes or growth that looks like a wart or ulcer.

Varied forms of vulvar cancer have various symptoms, and in some situations, no symptoms are present.

Risk factors
You are at a greater risk if you have had Human Papillomavirus (HPV) infection or a history of genital warts. Women who have Vulvar Intraepithelial Neoplasia (VIN), a disorder in which vulvar skin cells grow into cancer cells, have a significantly higher chance of developing vulvar cancer. Lichen Sclerosus, a condition that causes the skin to thicken and become itchy, and this might slightly raise the risk of vulvar cancer. Women who smoke on a regular basis are three to six times more likely to get vulvar cancer. If the habitual smoker additionally has an HPV infection, the risk increases even more.

Diagnosis of vulvar cancer
Doctors diagnose vulvar cancer based on how large it is or where it is and whether it has spread to nearby lymph nodes. This is determined during surgery to remove the cancer. These stages range from stage I to stage IV.
Stage 0 - The cancer is only visible on the skin's surface.
Stage 1 and 2 - The cancer is localized to the vulva and grows to a size of up to 2 cm. In Stage 3 - The cancer is found to have spread to adjacent tissue such as the anus or vagina and to the lymph nodes.
Stage 4 - After spreading to the lymph nodes on both sides of the groin, the cancer may spread to the intestines, bladder, or urethra, the passageway through which urine exits the body.
 
Treatment
Surgery, chemotherapy, radiation therapy, and biologic therapy are the most common treatments for vulvar cancer. The primary method of treating vulvar cancer is surgery. The objective is to cure cancer while ensuring that sexual functions remain intact. If cancer is detected in its early stages, it can be treated with just a minor surgery. Surgery will be more complex if done in the later stages when cancer has spread to neighbouring organs such as the urethra, vagina, or rectum. Doctors work closely with the woman to develop a treatment plan that is best suited to her and takes into account the age of the woman, sexual lifestyle and any other medical problems.
Practicing safe sex, not smoking, having the HPV vaccination, and going for cervical smear tests are a few measures that can help prevent vulvar cancer.
The best way to lower the risk is to be aware of the symptoms and to get checked as soon as they appear. It is also crucial to schedule frequent gynaecological health checks, including a physical exam at least once a year.

Authored by: 
Dr. Ajay Mehta, Senior Consultant & Head of Surgical Oncology, HCG NCHRI Cancer Center Nagpur.