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Vulvar Cancer: A Hidden Disease E-mail
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Vulvar cancer is the fourth most common cancer of the female genital tract. There are several different types of vulvar cancer. The cause of vulvar cancer is unclear, but early detection is the key to survival.

There are several different types of vulvar cancer. More than 90 percent are squamous cell carcinomas. Squamous cells are the same kind of cells that comprise most of the skin on the body and the cells that line the inside the body's cavities.

The second most common type of vulvar cancer is melanoma, accounting for about five percent of cases. Just like on other parts of the body, melanomas develop from the skin cells that produce pigment or color.

The cause of vulvar cancer is unclear, but human papillomavirus is suspected to be a possible risk factor, as is smoking. Patients infected with HIV, the virus that can lead to AIDS may also be more vulnerable to developing vulvar cancer.

"In premenopausal women, many of these cancers are associated with HPV types 16, 18 or 33," says Isabel Blumberg, M.D., a clinical instructor of obstetrics, gynecology and reproductive science at the Mount Sinai School of Medicine in New York, N.Y.

Vulvar cancer, which affects external female genital organs, is most common on the inner edges of the labia majora or the labia minora. The cancer can also affect the clitoris or Bartholin glands, the tiny, mucus-producing glands on either side of the vaginal opening. It most often affects women 65 years and older, but it can also affect younger women.

The symptoms may or may not be obvious. "Itching is a common complaint, although many patients may be asymptomatic," Blumberg said. Other symptoms may include:
  • Pain or tenderness;
  • Burning sensation;
  • Non-menstrual related bleeding;
  • Any change in size, color, or texture of a birthmark or more in the vulvar area; or
  • Open sores, bumps or lumps in the vulvar region.

"Any pigmented lesion in the vulvar area with an increase in size, change in color or development of ulceration should indicate further investigation," says Amy Freeman, M.D., a board-certified dermatologist in private practice in Millburn, N.J.

Like many cancers, the earlier the cancer is detected, the more curable it is. Vulvar cancer has a high cure rate, as long as it is detected and treated early. It's very important for women to seek medical attention if they experience persistent itching, burning or pain in the vulvar region, or if they notice skin changes or open sores that won't heal properly or in a timely fashion.

A biopsy is necessary to make a proper diagnosis. If the doctor finds an abnormal area in the vulvar area, he or she will biopsy a small piece of skin and examine it under a microscope. Vulvar cancer is most often treated with surgery. The type of surgery needed will be based on the size, depth and spread of the cancer. Radiation may also be necessary.

Women with a history of skin cancer may want to ask their dermatologists or gynecologists to add a vulvar examination to their annual check-ups. It is another opportunity for women to take charge of their own health.

More information about vulvar cancer is available from the National Cancer Institute's Web site:

About Cancer

Cancer (medical term: malignant neoplasm) is the general name for a group of more than 100 diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not. The branch of medicine concerned with the study, diagnosis, treatment, and prevention of cancer is oncology.

Cancer cells can spread to other parts of the body through the blood and lymph systems. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.  Cancer types can be grouped into broader categories. The main categories of cancer include:
  • Carcinoma - a cancer which is derived from the lining cells, or epithelium, of an organ. There are 4 major types of epithelium in the body (Glandular, squamous, transitional, and pseudostratified). Some types are only found in a few select organs such as the lung (pseudostratified) or urinary bladder (transitional). Carcinomas can arise from any of these epithelial types. For example, breast carcinoma is most commonly derived from the lining cells of the milk producing glands. A carcinoma with a glandular growth pattern is an adenocarcinoma. Common adenocarcinomas include prostate, colon, and breast. A carcinoma with a growth pattern resembling the squamous lining cells is termed a squamous cell carcinoma. Common squamous cell carcinomas are found in the esophagus and skin. However, any of these organs may have either type of carcinoma arising from it, although these latter diagnoses are exceedingly rare.
  • Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.
  • Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
  • Lymphoma - a cancer derived from the white blood cells that are present in the lymphoid tissues of the body. These sites most commonly include the lymph nodes and spleen. However, lymphomas may arise from any organ and body site.
  • Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking, limiting time in the sun, being physically active, and eating a better diet. Half of all men and one-third of all women in the US will develop cancer during their lifetimes.

Although doctors often cannot explain why one person develops cancer and another does not, research shows that certain risk factors increase the chance that a person will develop cancer. Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or viruses, bacteria, and certain hormones. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Other common risk factors for cancer include:
  • Growing Older
  • Family history of cancer
  • Poor diet, lack of physical activity, or being overweight
  • Alcohol 

About Melanoma 

Melanoma is the most serious type of skin cancer. The National Cancer Institute estimates that more than 62,000 people will be diagnosed with the disease in 2008, and more than 8,000 will die of it. Cancer experts estimate that about ten percent of melanomas are associated with familial or inherited syndromes.

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