Vaginal and vulvar cancer: symptoms, causes and remedies

Definition

What is vaginal cancer and vulvar cancer?

Vaginal cancer is a type of cancer that attacks the vagina. Meanwhile, vulvar cancer is a type of cancer that attacks the outside of the vagina, including the vaginal opening, labia majora (outer lip), labia minora (inner lip), and clitoris.

The vagina serves as a way for the baby to come out during childbirth and a place for blood to come out during menstruation, while the vulva functions as a protector of the vagina. The vagina itself starts from the cervix (cervix) which then ends at the vulva.

Vaginal cancer occurs due to the growth of abnormal cells in the vagina. In general, abnormal cells appear on the vaginal wall, although it does not rule out abnormal cells can develop in other parts of the vagina.

There are several types of vaginal cancer and vulvar cancer that you need to know, namely:

Squamous cell carcinoma

This is the most common cancer tip, and initially occurs in the squamous cells that make up the epithelial lining of the vagina. The area most commonly affected is the top of the vagina near the cervix.

In vulvar cancer, squamous cell carcinoma is divided into several types, such as keratinization type (occurs in older women who are infected with HPV), basaloid type (occurs in young women infected with HPV), and verucous carcinoma (a rare type whose growth is quite slow).

Adenocarcinoma

This type of cancer attacks women over 50 years of age. The affected cells are sweat gland cells in the skin of the vulva or Bartholin's glands which are located just inside the vaginal opening.

Adenocarcinoma can form from clear cells, which generally occurs in female fetuses exposed to diethylistilbestrol.

This type of cancer is quite rare

This type of cancer is very rare, namely melanoma (attacks the pigment-producing cells of the skin), sarcomas (attacks bone, muscle, or connective tissue cells), and basal cell carcinoma.

How common is this cancer?

Vaginal cancer and vulvar cancer are types of cancer that commonly attack women, although the incidence rate is not as much as cervical cancer (cervical cancer).

Based on data from Globocan in 2018, new cases for vaginal cancer reached 412 people, while vulvar cancer reached 1,153 people, with the death rates reaching 208 and 420 people.

Signs & symptoms

What are the signs and symptoms of vaginal cancer and vulvar cancer?

In the early development of vaginal cancer and vulvar cancer, usually no characteristic features are shown. The characteristics generally begin to be felt when vulvar cancer or vaginal cancer has entered an advanced stage (stage).

To be aware of, the characteristics or symptoms of vaginal cancer that generally occur are:

• Unusual vaginal bleeding, for example after sexual intercourse or after you have experienced menopause (if you are no longer menstruating).
• Symptoms of watery discharge.
• There are lumps inside your vagina.
• Urinating becomes painful and when you urinate only a small amount of urine comes out.
• Often experience constipation.
• Pelvic pain is not uncommon.

While the characteristics or symptoms of vulvar cancer that are generally felt are:

• Vaginal itching that doesn't go away.
• The vagina feels painful when pressed and is more sensitive.
• Bleeding outside of menstruation occurs.
• There are wart-like bumps or open sores on the outside of the vagina.
• The outer skin area of ​​the vagina changes and becomes thicker.

Each person is very likely to exhibit different features of vaginal cancer or vulvar cancer. In fact, some of them feel symptoms that are not mentioned above.

When to see a doctor?

If you experience the symptoms of cancer mentioned above, see a doctor immediately. Especially if the signs or characteristics of vaginal cancer or vulvar cancer that you are experiencing do not improve after you treat it.

Cause

What causes vaginal cancer and vulvar cancer?

The cause of vaginal cancer is not known with certainty. Likewise with the causes of vulvar cancer. Even so, research has found findings related to this cancer.

Normal body cells make substances called tumor suppressor products, with the aim that cells do not grow too fast and become cancerous.

However, when the body is infected with HPV (human papillomavirus) and the virus produces E6 and E7 proteins. There are proteins that can inhibit tumor suppressor gene products from working properly so that the body's cells divide very quickly.

In addition, cancer can also be caused by DNA mutations that can activate oncogenes (genes that are modified to increase the malignancy of tumor cells) or turn off tumor suppressor genes.

Risk factors

What are the factors that increase the risk of developing vaginal cancer and vulvar cancer?

Although the cause is unknown, researchers have found various factors that can increase the risk of vaginal cancer and vulvar cancer, such as:

Increasing age

Squamous cell cancer generally occurs in older women. Most affect women aged 70 years, and a few cases attack women under the age of 40 years.

Diethylstilbestrol (DES)

A pregnant woman who is exposed to diethylstilbestrol puts the fetus at risk of cancer in its core organs. The average child who is exposed to DES while in the womb develops cancer in his teens. However, this case is quite rare.

Infected with HPV

HPV can interfere with the work of tumor-suppressing products so that it can trigger body cells to become abnormal.

Women who are infected with this virus usually have warts on their feet, hands, or sex organs. Apart from the intimate organs, this viral infection can also increase the risk of cervical, throat, and anal cancer.

Smoking habits and drinking alcohol excessively

Smoking and drinking alcohol can increase the risk of cancer of the sex organs. This is because cigarettes contain chemicals that can damage the body's DNA. While alcohol contains carcinogenic substances which also trigger cancer.

Certain health conditions

The risk of vaginal cancer and vulvar cancer also increases due to health problems, such as:

• Vaginal adenosis. Women with this condition have abnormalities in the cells in the vagina as a result of being exposed to DES while still in the womb.
• Irritation of the vagina. The use of a pessary, which is a device to keep the uterus from sagging due to the stretching of the pelvic ligaments in the long run can increase the risk of cancer in the area of ​​the intimate organs because it causes irritation.
• Infected with HIV. This viral infection makes the immune system decrease so that HPV infection becomes more susceptible to increase the risk of cancer.
• Vulvar intraepithelial neoplasia (VIN). This condition refers to precancerous conditions due to the presence of abnormal cells in the surface layer of the vulva. This condition is usually experienced by young women who are infected with HPV.
• Lichen sclerosus. This condition causes the skin of the vulva to become very thin, easily irritated and itchy, which can increase cancer in the area.

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is vaginal cancer diagnosed?

The specialist will ask about other symptoms and diseases that you are experiencing. Then, the doctor will ask you to do the following tests:

• Physical examination and medical history: The specialist will ask about your symptoms and check for signs that indicate vaginal cancer or vulvar cancer as well as check your medical history.
• Pelvic examination: During a pelvic exam, the doctor will examine the outside of the genitals and insert 2 fingers into the vagina and press the hand on your stomach to feel the uterus and ovaries. The doctor will also insert a device called a speculum into the vagina. The speculum opens the vaginal canal so that the doctor can examine the vagina and cervix.
• Pap smear test: Usually used to look for cervical cancer, but sometimes vaginal cancer can be detected by a Pap test.
• Colposcopy: A test to view the vagina using a colposcope, which is a type of microscope with light. It works like a magnifying glass. This test takes about 10-15 minutes. It usually doesn't hurt, but it may be a little uncomfortable.
• Biopsy: During a colposcopy, the doctor may take a small sample of tissue (biopsy) from an area that looks abnormal and examine it under a microscope.

How to treat vaginal cancer and vulvar cancer?

Ways to treat vaginal cancer and vulvar cancer that are generally recommended by doctors are:

Precancerous treatment

If vulvar precancer occurs, the doctor will perform topical chemotherapy treatment. That means chemotherapy drugs will be applied directly to skin sarees that have abnormal cells.

One of the drugs used for vulvar precancer is fluorouracil (5-FU). Once applied, the skin will peel off and precancerous cells can be separated from the healthy skin tissue.

There are also drugs imiquimod, which are not chemotherapy drugs. This drug works to increase the body's immune response to abnormal cells around the vulva.

Operation

Surgery is the treatment for vulvar cancer and vaginal cancer. On the vulva, the operations performed include laser surgery (burning the abnormal outer layer of skin) and excision surgery (cutting the edge of the healthy skin around the abnormal cells and the fat layer underneath).

If the condition is more severe, a vulvectomy (removal of part or all of the vulva) may be performed. After that, there will be another operation to reconstruct the vulva by taking tissue from other parts of the body.

In the case of the vagina, the surgery may include local excision (removing the abnormal cells with the side of the skin around the healthy one) or vaginectomy (removing part or all of the vagina).

There is also a trachelectomy, which is the removal of the affected vagina and cervix. If it is widespread and more severe, a hysterectomy may be performed. This procedure removes the vagina, uterus, and cervix.

In some cases, lymph nodes near the affected vagina may also need to be removed. This cancer treatment causes side effects, ranging from bleeding, infection, to blood clots.

Radiotherapy

This cancer treatment relies on beams of radiation to shrink the tumors that have formed while killing cancer cells. Side effects include vaginal dryness or sores and fatigue.

Chemotherapy

Apart from topical forms of chemotherapy, drugs in this medication can also be given by injection or taken in pill form. The goal of treatment is the same as radiotherapy.

Medicines used in chemotherapy for vaginal cancer and vulvar cancer are:

• Cisplatin
• Carboplatin
• Vinorelbine
• Paclitaxel
• Erlotinib

Side effects of chemotherapy that may occur are weakness, nausea, vomiting, diarrhea, and hair loss.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat vaginal cancer and vulvar cancer?

Home remedies for vaginal cancer or vulvar cancer that can be done is to adopt a healthy lifestyle that is suitable for cancer patients. This includes adjusting to activities such as exercise, and adopting a cancer diet.

Until now, alternative medicine or herbal medicines have not been proven to be effective in curing vaginal or vulvar cancer. So, don't rely on this medication as the main treatment. Consult your doctor if you want to use drugs other than those prescribed.

Prevention

How to prevent vaginal cancer and vulvar cancer?

Although not 100% prevent vaginal cancer or vulvar cancer, the following methods can help you reduce your risk, such as:

Avoid transmission of HPV and HIV

HPV and HIV virus infection can increase the risk of cancer in the female sex organs. A person can get this infection from unsafe sex or sharing needles.

Therefore, always use condoms when having intercourse and avoid changing partners. Do not share needles or syringes without the supervision of the medical team. Follow the HPV vaccine so that it can protect you from infection with the virus.

Quit smoking

Smoking can increase the risk of lung cancer, and even cancer of your sex organs. So, if you have a smoking habit, it is better to stop this habit.

Make a reduction in the number of cigarettes smoked slowly until you can completely get rid of the smoking habit. If you have trouble quitting this habit, don't hesitate to consult a doctor or therapist.

Get regular pelvic exams

Precancerous conditions generally go unnoticed because they cause no symptoms. Therefore, the only way to detect the presence of this condition is to perform a pelvic exam.

The condition of your vagina will be checked, both the outer and inner areas. Often times you will also be asked to have a Pap smear and HIV test along with a pelvic exam.

Finally, always pay attention to the changes that occur in your vagina. If you find anything worrying, see a doctor immediately.