What is vulvar cancer? Is there any link to the menopause?
Vulvar cancer is a cancer of the vulva, which is the external part of the vagina. The vulvar area undergoes many changes after menopause. This is because the lack of oestrogen stimulates vulvar and vaginal atrophy. The entire epithelium of the area around the vulva and vagina have oestrogen receptors, alpha and beta, which are critical for mediating numerous biochemical and physiological functions of this area during a woman’s reproductive years.
VVA (Vulvo Vaginal Atrophy) is characterised by the thinning of the epithelial lining of the vagina and lower genito-urinary tract, loss of the vaginal walls elasticity, vaginal dryness and an increase of vaginal Ph, which determines a significant impact on sexual health and quality of life. All of these changes, make the vulvar area more delicate and prone to different diseases. Alongside VVA there is also Lichen Sclerosus of the vulva, which also causes pruritus, inflammation and tissue scarring. Additionally, some women also report cracking or bleeding of the vulvar skin and perianal area. Women affected by Lichen sclerosus, especially those with squamous cell hyperplasia (meaning an extra growth of the tissue) have an increased risk of vulvar malignancy. So, it appears that menopause triggers most of the situations described above and therefore, more vulnerable to cancer. The other problem is, that because all of these changes are often caused by other conditions that are not usually pre-cancerous, some women don’t even realize that they may have a serious underlying condition. Some other women instead, try to treat the problem themselves with over-the-counter remedies, thinking that it is nothing too serious. Sometimes doctors may not even recognize the condition at first, therefore, the diagnosis can be worryingly late.
We then have different types of vulvar cancer. Almost all women with invasive vulvar cancers will have at least one of the following symptoms.
Invasive squamous cell cancer
- An area or a part of the vulva that looks different from normal (it could be lighter or darker than the rest of the skin around it, or could be more red or pink)
- A lump, which could be a different colour such as red, pink, or white and could also have a wart-like or raw surface.
- Thickening of the skin of the vulva
- Itching (that does not go away)
- Pain or burning (especially during sexual intercourse)
- Bleeding or discharge which are not related to the normal menstrual period (moreover if you are undergoing menopause you are likely not to have a period)
- An open sore (especially if it lasts for quite a long period like a month or even longer)
Women with vulvar melanoma can have many of the same symptoms as other vulvar cancers, such as:
- Anything looking/feeling like a lump
- Itching (that does not go away)
- Pain (also during sexual intercourse)
- Bleeding or discharge
Most vulvar melanomas are black or dark brown, but they also can be white, pink or red. They can be noticed and found throughout the vulva, but are mostly found in the area around the clitoris or on the labia majora or minora.
If you get some of these symptoms, or even one and it feels strange, speak to your doctor immediately. The only real diagnosis will then be a biopsy, however, it is always better to get yourself checked out. A biopsy consists of taking a small piece of tissue to be analysed under the microscope. Sometimes it can be necessary for the doctor to analyse the situation carefully by doing a colposcopy. A colposcope is an instrument that has magnifying lenses. It lets the doctor see the surface of the vulva closely and clearly, by staying in front of the vulva. The vulva is then treated with a dilute solution of acetic acid (something similar to vinegar) that can cause areas of vulvar intraepithelial neoplasia (VIN) and vulvar cancer to turn white. This makes them easier to see through the colposcope. This examination is called a vulvoscopy. Less often, the doctor may wipe the vulvar area with another dye (called toluidine blue) to find areas of abnormal vulvar skin to biopsy. This dye causes skin with certain diseases to turn blue. If a vulvar cancer is found, then the procedure is the same than all the other cancers. There is the staging part and then the therapy. It is important to say that, as for any cancer, the earlier it is diagnosed, the better.
It is pivotal then to maintain this area healthy and with the proper pH, always using an appropriate intimate wash to preserve epithelial integrity (see Megsmenopause intimate wash).
Therefore, if you are experiencing any of the symptoms listed above, don’t ignore them. Go and speak to your doctor.
By Ornella Cappellari
Transl Med UniSa. 2016 Nov 1;15:74-79. eCollection 2016 Nov.
Evaluation of Symptoms and Prevention of Cancer in Menopause: The Value of Vulvar Exam. Palumbo AR, Fasolino C, Santoro G, Gargano V, Rinaldi M, Arduino B, Belli M, Guida M.