What Is Vulva Cancer?

Vulva cancer is a a cancer that attacks the outer surface of the female genital area. Vulva is part of the female external sexual organ which is the area surrounding the urethra opening and vagina. Other female external sexual organs include the labia minora and major, clitoris, and Bartholin glands present on both sides of the vagina. Vulvar cancer presents in the form of a lump or wound in the vulva area. This cancer more often attacks older women, who have generally experienced menopause.

There are two types of vulvar cancer based on the type of cells affected. This type of cancer is also useful for doctors to determine the type of treatment step to be taken.

• Vulva melanoma, a cancer cell that forms in the pigment-producing cells found on the vulva skin.
• Vulva squamous cell carcinoma ( vulvar squamous cell carcinoma ), a cancer cell that forms on thin. flat-surface cells that line the surface of the vulva. Most cases of vulvar cancer come from this type.

Some other types, namely:

• Basal cell carcinoma, ie wound on the labia majora or in other areas of the vulva, which develops into cancer long after. If not treated immediately, this wound can easily reappear.
• Bartholin glandular carcinoma, a rare tumor in the Bartholin gland that usually affects women in their mid 60s.
• Other types of cancers of the vulva, such as adenocarcinoma and sarcoma .

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Causes of Vulva Cancer
The cause of cancer in general is still not known clearly, as well as with vulvar cancer. Experts are still finding out the triggers of cells mutating into cancer cells and growing so fast. Cells that divide will continue to grow by doubling the number to form a tumor, then spread to other body parts. Cancer cells and tumors will continue to grow and divide while healthy cells die.
Although not yet known the cause, the following factors are conditions that can increase the incidence of vulvar cancer, namely:

• Smoke.
• Growing age. The risk of vulvar cancer generally increases at age 65 and up and those who are at menopause. This case is rarely encountered in women under 50 who have not experienced menopause.
• Exposure to HPV infection ( human papillomavirus ), one of the most common sexually transmitted diseases in sexually active women. Generally HPV infection can subside by itself. In some other cases of this disease, infected cells can mutate and develop into cancer cells.
• HIV infection ( human immunodeficiency virus ) that weakens the immune system and makes the patient vulnerable to HPV infection.
• Suffering from skin disorders in the vulva area, eg Lichen Sclerosus disease.
• Once in a precancerous condition of the vulva, or vulvar intraepithelial neoplasia (VIN), which can develop into vulvar cancer. VIN is a condition when the cell undergoes a change that does not lead to cancer. Although in most cases that ever happened, this condition can disappear by itself, but in fact can also develop into cancer cells.

Symptoms of Vulva Cancer
Vulvar cancer can cause very disturbing itching in the vulva area. Here are other symptoms of vulvar cancer.

• Bleeding is not from menstruation.
• Changes in skin conditions, such as skin color and thickness. The skin can be red, white, or dark.
• There is a mole in the vulva area that changes shape or color.
• Lumps that resemble acne, ulcers, or open sores.
• Pain or sensitive to pain in the pelvic area, especially when having sex.
• Feels sore, especially when urinating.

As many as 50 percent of cases of vulvar cancer attack the major labia ("lips" outside of the female genitals), followed by the labia minor ("lips"). Immediately see a doctor if you feel the symptoms as above.


Diagnosis of Vulva Cancer
In addition to ensuring the presence of cancer cells in the vulva, the diagnosis of vulvar cancer is also done to determine the extent to which cancer cells have developed or spread. After symptom information, personal and family medical history are collected, the doctor will perform a physical examination of the patient. This is done to see if there are abnormalities in the vulva area.
Several tests and procedures used to diagnose vulvar cancer include:

• A more detailed examination of the vulva using a magnifying glass to look for signs of vulvar cancer in this area. This examination is called colposcopy.
• A cystoscopy examination was performed using a small tube with a camera and lamps inserted into the bladder.
• Perform a biopsy then examine samples that have been taken from the vulva, or lymph nodes, to look for signs of cancer. Patients are usually given a local anesthetic in the area to be biopsied. Examination can be done with or without stitches, depending on the size of the samples taken.
• Examination of the pelvic area, to see if the cancer has spread to this area.
• Examination using X-rays, CT scans, MRI scans, and PET scans, in the chest area, lungs, lymph nodes, stomach or other organs, to determine the spread of cancer in this area.

Once the diagnosis is obtained, the doctor will determine the stage of the cancer that will assist in the selection of treatment steps. The stage stages of vulvar cancer include:

• Stage 1 "Cancer has not spread to lymph nodes or other body areas. There is a small tumor of the vulva or skin between the vaginal area and the anus (perineum).
• Stage 2 - Unlike stage 1, at this stage, the tumor has spread to the surrounding area. The areas in question are at the bottom of the urethra (urethra), vagina, and anus.
• Stage 3 "The spread of cancer at this stage has specifically spread to the lymph nodes.
• Stage 4A - The cancer has spread to a larger area of ​​the lymph nodes, or to the top of the urethra or vagina, or to the bladder, and rectum / rectum. In addition, the pelvic area has been affected by the spread of cancer cells.
• Stage 4B "Cancer has spread  to other body parts that are not only located near the vulva.

Treatment of Vulvar Cancer
One step of treatment of vulvar cancer is the procedure of removal of cancer and some healthy tissue around the vulva (usually about 1 centimeter) or extensive radial surgery excision. However there are also cases of vulvar cancer that require the vulva to be completely removed, including the clitoris and underlying tissue called radical vulvectomy.
The procedure of removal of the vulva has a risk of infection until the appearance of discomfort while sitting for a long time. You may not be able to feel the genital area and can not reach orgasm during sexual intercourse.

The earlier the vulvar cancer can be diagnosed, the less likely it is that this procedure is needed. Here are some procedures for removal of other vulvar cancers.

• Partial Vulvectomy . In this procedure, only a portion of the vulva and underlying tissue are removed.
• Pelvic exenteration procedure for advanced cancer . This procedure is performed if the cancer has spread beyond the vulva to other organs, by removing all parts of the vulva and related organs, eg the large intestine. A hole will be made in the stomach (stoma) so that dirt or urine can be inserted into the ostomy pouch. This action includes into major operations that are currently not done much anymore.
• Reconstruction procedure . Cancer removal procedures in larger areas usually leave wide wounds that can not close by itself. This occurs in cancer that has spread to surrounding tissue. In this case, the doctor will perform reconstructive surgery by taking the skin from other body parts to cover the area.

In addition to the removal of the vulva, lymph node removal procedures may also be performed at the same time if the cancer has spread to this area. This process causes fluid retention and swelling of the feet called lymphedema.
Lymph nodes can also be removed through sentinel node biopsy surgery by taking samples of infected lymph nodes, then testing them on the presence of cancer cells. If no cancer cells are found, then there is a chance the cancer has not spread to other lymph nodes.

Like other cancer treatments, vulvar cancer can also be treated with chemotherapy, radiation therapy, or a combination of both.

• Chemotherapy . Patients with vulvar cancer with the spread of cancer cells in other body areas can choose this step to help kill cancer cells. Medicines can be consumed or inserted through a blood vessel in the arm. Chemotherapy combined with radiation therapy generally aims to minimize cancer in order to facilitate surgical procedures.
• Radiation therapy . In addition to shrinking cancer cells, radiation therapy is also used in cases of cancer cells that have spread to the lymph nodes after undergoing surgery. Therapy is done by exposing high-power energy, such as X-rays, to areas that have been determined on the surface of the skin.

Routine medical examination after handling of vulvar cancer will still be necessary to monitor the patient's condition and ensure the cancer cells are not re-established. Therefore it is very important to check regularly post-treatment.

Prevention of Vulva Cancer
Performing a routine medical check-up ( medical check-up ) can help you monitor health as well as detect diseases that are not previously known. Talk with your doctor about the ideal time range for regular medical check-ups . You can also consult about pelvic exam schedule. Procedure pelvic examination will provide information about the condition of your reproductive organs.
Some preventive measures that can also be done to reduce the risk of vulvar cancer and sexually transmitted diseases such as HPV or HIV are:

• Using a condom each time you have sex.
• Limit the number or not bergonta sexual partner.
• Obtain HPV vaccine. This vaccine can reduce the risk of developing vulvar cancer and is recommended for girls aged 12-13 years.

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