Vulvar & Vaginal Cancer Treatment & Survival Rates: Know Your Options
A study by the Indian Council of Medical Research (ICMR) reveals that vaginal cancer accounts for about 0.5% and vulvar cancer for about 1.5% of all gynaecological cancers in India. Though the numbers are much lower compared to other common types of cancer, these are significantly life-threatening,
Proper awareness and early detection can significantly improve treatment outcomes and survival rates. In this blog, we will cover the symptoms, cancer treatment options, and survival rates you should be aware of. Read on!
How does vaginal and vulvar cancer start?
Vaginal cancer is the growth of cancerous cells anywhere in the lining (skin) of the vagina. Human papillomavirus (HPV) is considered the main cause of vaginal cancer.
There are different types of vaginal cancer classified as:
- Squamous Cell Carcinoma is the most common type among others, which occurs in thin and flat cells in the vagina called squamous cells, which line the surface of the vagina.
- Adenocarcinoma is the second most common type of vaginal cancer, which occurs in the glandular cells of the vagina, responsible for the production of mucus and other fluids.
- Melanoma is a type of cancer that starts in cells called melanocytes, which give the vagina its colour.
- Sarcoma is a type of cancer that occurs in the cell walls of the vagina and its connective tissues or muscle walls.
Vulvar cancer affects the outer area of the vagina, particularly the labia majora (outer lips), labia minora (inner lips), and clitoris. Early signs may include the formation of a sore or mass lump, which may cause itching and bleeding.
The two most common types of vulvar cancer are:
- Vulvar squamous cell carcinoma, which accounts for about 90% of vulvar cancer, occuring in squamous cells lining the surface of the skin.
- Vulvar melanoma is a cancer that occurs in pigment-producing cells of the vulva.
Other rare types of vulvar cancers are:
- Basal cell carcinoma
- Sarcoma
- Verrucous carcinoma
Is HPV a direct cause of vaginal and vulvar cancer?
HPV is not a direct cause of vaginal and vulvar cancer. However, it may increase the risk of developing it. The Human papillomavirus (HPV) is a sexually transmitted virus that generally affects the genitals, skin, and throat.
Is HPV treatable?
As there is no cure for HPV as of now, being vaccinated is the only preventive measure that can help.
- Girls between the ages of 9 and 14 should get their vaccines before they get sexually active.
- The vaccine can be given in two doses, but in cases of low immunity, it may take two to three doses. Seek a healthcare professional’s advice before getting vaccinated.
What are the signs and symptoms of vaginal and vulvar cancer?
The common symptoms of vaginal and vulvar cancer are:
- Continuous itching or pain in the genital areas.
- Discomfort or pain during sexual activity.
- Formation of lump or tumour in genitals.
- Abnormal vaginal discharge that is watery, foul smelly and contains blood spots.
- Bleeding has no relation with the menstrual cycle.
- Soreness and tenderness in the genital area.
What are the treatment options available for vaginal and vulvar cancer?
In vaginal cancer, the course of treatment will be decided by the patient's age, cancer stage, and type. It may change according to pregnancy plans.
1. Radiation therapy: This is the common therapy for vaginal cancer and is combined with chemotherapy in most of the cases.
- External radiation uses a beam of radiation to the vaginal region from the outer side of the body.
- Internal radiation (brachytherapy) places radioactive sources directly into the vagina.
Cancer management can be a daunting task. The common side effects for this type include dryness in the vagina, itching, difficulty and change in the pattern of urination.
2. Chemotherapy: Chemotherapy is done alongside radiation therapy if the cancer is in an advanced stage or if it has spread. Chemotherapy medicines function anywhere in the body to destroy cancer cells and raise radiation treatment's efficacy.
3. Surgery: Surgery is not very frequent in case of vaginal cancer but might be required in case of localised operable tumours. Measures can be a tumour excision or, in more advanced cancer stages, a radical vaginal hysterectomy, the removal of the vagina and the surrounding tissues. This may sometimes need reconstructive surgery and can also have possible effects on sexual activity.
4. Personalised Treatment Plans: The treatment option depends on the stage and site of the cancer, the type of cancer, and the general considerations of the patient. This means that most oncologists have specific treatment goals.
They shall ensure that they have achieved the maximum level of cure while maintaining the quality of the patient's life by explaining procedures and controlling the side effects of the treatment.
Treatment for vulvar cancer is determined by how far the cancer has spread, your overall health, and personal preferences.
1. Surgery: Surgery is a primary treatment for vulvar cancer. It involves removing a lump or mass of tumour and the tissues surrounding it. The depth of the surgery also depends on the stages of the tumour and its location:
Local Excision: This is a procedure in which the tumour and its surroundings are removed by surgery to ensure complete excision of cancer cells from the vulva while preserving the vulva's structure as much as possible.
Partial Vulvectomy: This is a procedure where some portions of the vulva that are affected by cancerous cells are cut off, which may cause some damage to the structure. This can affect the normal structure and function of the vulva.
Total Vulvectomy: It involves cutting off the entire vulva, including the clitoris. The side effects of vulvectomy are disturbances in sexual life and urinary function. It may thus call for reconstructive surgery to enhance the looks and function of the vulva. In rare occurrences, the lymph nodes may also be taken out for biopsy at the cancer site.
2. Radiation Therapy: This therapy uses high-energy radiation to kill cancer cells. It can be used in cases where surgery cannot be done or given after surgery to eliminate any cancer cells left behind. The side effects that may occur are skin changes, pain, and urinary or bowel dysfunction.
3. Chemotherapy: Chemotherapy utilises some drugs that are effective in either destroying or slowing down the rate of growth of cancerous cells. It is usually used if the disease has spread to other parts or if the cancer is fixed and cannot be removed. It can also be used together with radiation therapy to increase the general effectiveness of the treatment.
4. Immunotherapy and Targeted Therapy: The targeted therapy deals with genetic changes in tumours, and Immunotherapy increases the body's immune system to fight against cancer.
What is the prognosis and survival rate for vaginal and vulvar cancer?
The prognosis of vaginal and vulvar cancer depends upon the medical history, overall health, cancer type and its stage. The doctor may predict the expected outcome.
The survival rate for vaginal cancer is 57% for vaginal cancer that affects the regional area of the body through the vaginal wall or nearby lymph nodes. The five-year relative survival rate is 26% for vaginal cancer that has spread to other parts of the body, inclusive of the liver, lungs and bones. Here is the detailed statistics:
- In the localised stage, where the cancer is limited to the vaginal wall, it is 69%.
- In the regional stage, the cancer is spread to the vaginal wall, tissues around the vagina, and also lymph nodes, which account for 57%.
- In the distant stage, where cancer has spread to the different parts of the body, such as the bones, liver and lungs, which account for 26%.
- All SEER stages combined account for 51%.
The five-year survival rate for vulvar cancer is 71%; here are the detailed statistics:
- In the localised stage, the cancer is only present in the vulva without affecting any other parts of the body, which accounts for 86%.
- In the regional stage, the cancer has spread to tissues around the vulva and lymph nodes, which accounts for 53%.
- In the distant stage, the cancer has spread to organs of the body like bones, liver and lungs, which accounts for 19%.
- All SEER stages combined result in 71%.
Expert's take
Dr Shalini Rajaram, a renowned gynecologic oncologist at UCMS, Delhi, suggests that awareness and vaccination against HPV can significantly reduce the incidence of vaginal and other HPV-related cancers.
She also notes the importance of multidisciplinary care involving gynaecologists, oncologists, and radiologists to provide comprehensive treatment plans tailored to individual patients.
Dr Beth Y. Karlan, a prominent gynecologic oncologist at the UCLA Jonsson Comprehensive Cancer Centre, states that "vulvar cancer, while relatively rare, has seen improvements in treatment outcomes due to advanced surgical techniques and a better understanding of the disease. Early detection and a multidisciplinary approach to therapy are key factors in improving survival rates. It's crucial for patients to cooperate closely with their healthcare team to explore all available treatment options."
Frequently Asked Questions (FAQ's)
How to avoid vaginal and vulvar cancer?
You can’t avoid vaginal and vulvar cancer as their causes are unknown. You can reduce the risk of having it by taking an HPV vaccination, practising safer sex, and quitting smoking.
How does a vulvar or vaginal cancer lump look or feel like?
The lump may look red, pink, or white and feel hot, itchy, and painful. If a lump lasts more than two weeks, it is better to seek your doctor's advice.
At what age can you get vaginal cancer?
It can occur at any age, but the risk of developing vaginal and vulvar cancer increases with age. It usually affects people aged between 65 to 74 and older.
Take-away notes
Vaginal and vulvar cancer are very rare and uncommon when compared to other cancers. However, being aware of the signs and symptoms and treatment options might help. Proper screening and early detection may increase the survival rate and treatment. Preventive measures such as HPV vaccination and reducing the cancer-causing risk factors may help for a better tomorrow.
References
- https://www.webmd.com/cancer/what-is-vaginal-cancer
- https://www.mayoclinic.org/diseases-conditions/vaginal-cancer/symptoms-causes/syc-20352447
- https://pubmed.ncbi.nlm.nih.gov/32644552/
- https://www.ncbi.nlm.nih.gov/books/NBK567798/
Note: The information provided in this blog is intended for general knowledge. It is important to remember that it should not replace professional medical advice. If you have any concerns about your health or cancer symptoms, please consult a healthcare provider.
