Vulvar Cancer

Tumor cancer means that a cancerous tumor has formed somewhere in the vulva, which are the outer parts of the female genital tract.

What is vulva cancer?

Cancer  of the vulva means that a cancerous tumor has been formed in the outer parts of the genitals. The vault is the outer and inner labia, the clitoris, the urethra, the ventricle and the middle. Here you can read more about the genitals .

You do not know everything about the causes of vulva cancer, but there are some known risks:

  • Skin diseases similar to sclerosus and atrophicus .
  • HPV infections .
  • Smoking .
  • Impaired immune system, for example due to immunosuppressive treatment following an organ transplant.

Tumor cancer is divided into different stages depending on whether the disease has spread and how much it has spread.

The most common is that the cancer tumor is limited to the vulva. In later stages, vulvar cancer can spread to the lymph nodes of the groin and pelvis. The pelvis is the lower abdomen where, for example, the ovaries and uterus are located.

It is rare, but sometimes the cancerous tumor can spread to the bladder or rectum. It is unusual for the cancer disease to spread to other parts of the body.

symptoms

Tumor cancer can cause one or more of the following symptoms:

  • It may feel like a hard lump or knot.
  • It can be a wound that does not heal.
  • It can be a bleeding wound.
  • It can itch or burn in the vulva.

If itching or burning it is usually due to something other than cancer, such as fungi, eczema or dry mucous membranes. You can read more in the text about itching in the genital area .

When and where should I seek care?

Contact a gynecologist or health care center  if you have had any or all of the symptoms for a few weeks. Many receptions can be contacted by logging in .

Investigations and investigations

There are various examinations that the doctor may need to do to investigate your complaints.

Gynecological examination

The doctor examines the vulva, vagina and uterus to make sure that the problems are limited to the vulva and that you feel good otherwise. The doctor may need to take tissue samples in the vulva. Then you first get local anesthesia . Tissue tests are also called biopsy.

You will usually be referred to a women’s clinic who will continue the investigation if you need further examination. For example, more and more detailed tissue samples may need to be taken. Then you may sometimes need to be anesthetized for a short while. Most people go as usual afterwards and can go home the same day.

The tissue samples are sent to a laboratory and analyzed under a microscope to answer if you have cancer or any other disease and which treatment will be best.

The investigation is conducted according to a standardized course of care

You are offered an examination according to a standardized course of care if the doctor suspects you may have vulvar cancer.

Standardized care is a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the investigations that may be needed.

The doctor who writes the referral tells you why you should be investigated according to a standardized course of care and what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you, so that you do not miss any notice.

Investigations if you have cancer

Most often you need to be examined more if you have cancer. The studies can show if the cancer has spread. The doctor may suspect it, for example if the cancer tumor is large or if you have enlarged lymph nodes that the doctor can feel with your hands in your groin.

Lung X-ray, ultrasound, computer tomography or magnetic camera

You may need to be examined with pulmonary x-ray , ultrasound , computed tomography or magnetic camera  to map the disease and show if it has spread.

The lymph nodes are examined

Tumor cancer can spread to the lymph nodes in the groin. Therefore, one or both groins may need to be examined. It can be done with one or more tissue samples.

The doctor can take a tissue sample by inserting a needle into a lymph node, sometimes using ultrasound . You can get local anesthesia  and in addition to the needle stick, the sampling usually does not hurt.

Sometimes one or more lymph nodes need to be removed for further examination. It is called surgery of the gateway gland or sentinel node surgery. The operation is usually done at the same time as the operation in the vulva. Read more in the chapter on Treatment.

Treatment

The most common treatment is to remove the cancer. Sometimes the lymph nodes in one groin or both groins also need surgery. After surgery, you may need radiation therapy. Some receive radiotherapy along with cytostatic therapy.

Sometimes it is possible to receive radiotherapy instead of being operated on.

A group of different gynecologic cancer specialists advise on all people who have been diagnosed with vulvar cancer. Your doctor will contact the specialists so that they can suggest the treatment that they believe will be best for you based on the examinations that have been done.

Your doctor will tell you what the specialists will come up with.

The cancer tumor is removed

The doctor removes the tissue where there is cancer. Also, some of the tissue around it is removed to reduce the risk of cancer cells being left behind.

The extent of the operation depends on the size of the cancer and whether it has spread.

The surgical wound is usually sewn together directly or the surgeon covers the wound with skin from, for example, the thighs or buttocks. Anesthesiaor  back anesthesia is common  .

Operation to remove or examine the lymph nodes

The operation in the vulva may need to be combined with some type of surgery in one groin or both groin. There are lymph nodes to which the cancer can spread.

Lymph node clearance if the cancer has spread

Lymph node clearance means that all lymph nodes in one or both groins are removed. It is needed if the studies conducted so far show that the cancer has spread there or if there may be a risk of it spreading. The lymph node evacuation can be done at the same time as the operation in the vulva.

Doorman gland surgery to examine spread

Sometimes it is unclear whether the cancer has spread despite the investigations conducted to date. Then the vulva operation is combined with an operation where only one or a few lymph nodes are removed. The lymph nodes are called doorman glands because the cancer only reaches them if the disease spreads.

The doorman glands are sent to the laboratory where they are analyzed. No more lymph nodes need to be removed if the doorman glands are free of cancer. If there is cancer in the doormat glands, a lymph node clearance is made at a later time.

You may come to the hospital earlier on the day you are to be operated on in the vulva if a concussion gland surgery is also to be done. Then you will be examined so that the doctor knows which lymph nodes are the guard glands.

A harmless radioactive substance and a blue color are injected around the cancer tumor. From there, they spread to the lymph nodes in the same way as cancer cells. This allows the doctor to see which lymph nodes are the guard glands.

The gatekeeper gland is also called the sentinel lymph node.

Before the operation

You get information in advance about what will happen during the operation. When you come to the hospital you get to talk more with the contact nurse, the surgeon and the anesthetist so you can ask more questions if you need it.

After the surgery

How long you need to stay in the hospital depends on the size of the operation and how you feel. Most people need to stay for one to three days. You need to stay three to five days if a lymph node clearance in the groin or groin was done at the same time as the vulva operation.

At the hospital you get help to rinse and ventilate the operating area a few times every day to make it heal well.

You may need antibiotics to prevent wound infections. You can also get syringes with blood thinners to prevent blood clots.

Some need a catheter in the bladder after surgery. The catheter usually needs to stay for a few days, sometimes longer. It varies from person to person.

You may need a small plastic tube in one groin or both groin if you have operated on the lymph nodes. This is to allow blood and fluid to drain from the operating wound. It’s called drainage.

The drainage may need to remain even after you leave the hospital. You can get a referral to the district nurse who helps with the drainage and can remove it when it no longer needs to be left. It can take from a few days to several weeks.

When you leave the hospital, you will be given a prescription for pain-relieving drugs. You take the drugs if you need to, but most people do not feel so bad after the surgery.

The operating wound may need to be re-examined several times so that it heals well. The healing can take two to six weeks. During that time, you should avoid bathing or having sex that includes the operating area.

radiotherapy

Radiation therapy  after surgery is sometimes needed to remove cancer cells that may have remained. Then you often receive radiotherapy every weekday for five to six weeks. Each treatment session takes about 15 minutes.

Radiation therapy can sometimes be an alternative to surgery to remove the cancerous tumor. This applies, for example, if the cancer tumor is large or if it sits so that it is difficult to get enough of the tissue around. This also applies if the cancer tumor is located close to the rectum as there is a risk that an operation will damage the end muscle, making you difficult to hold tight .

You may need treatment every weekday for up to seven weeks if you are to receive radiotherapy instead of surgery.

Side effects of radiation therapy

The radiation is not felt, but after one to two weeks of treatment it can start to burn and sometimes become sores where you get the radiation. The staff will help you take care of your skin. You get protective and pain-relieving ointment.

Radiation can also make it difficult for you to hold tight if you become pissed off and you get loose stools. There are medicines that relieve.

Many people get tired of getting radiation treatment. Most side effects go away or are alleviated a few weeks after treatment.

Chemotherapy

Cytostatic  drugs are various drugs that inhibit cancer cells. You can get cytostatic drugs while receiving radiation therapy. Then the cytostatics makes the cancer cells more sensitive to the radiation.

Side effects of cytostatic therapy

The treatment can make you feel tired and nauseous and difficult to concentrate. Blood levels can be affected so you need blood transfusions . Nausea can be prevented with drugs. There are several varieties. Concentration difficulties often go away after treatment.

Good to quit smoking

Those who smoke and are going to have a lot to gain from  quitting before surgery . The wounds heal faster, blood circulation and fitness improve so you recover faster. Stop smoking completely, if you can. Otherwise, make a stop before the surgery and a few weeks afterwards.

Smoking can also affect whether you should receive radiation therapy. Treatment becomes more effective if you smoke less or preferably not at all.

Talk to your doctor if you need help to quit smoking. 

after Controls

You need to go on post-check on multiple occasions for about five years when treatment is complete. Some need to go beyond five years. It is different how many post-checks are needed, but it is common to go more often the first time.

At the post-checks you will be told how you are doing. The doctor does a gynecological examination and feels the groin.

Seek care if you have new problems between the post-checks or after the post-checks have ceased. Contact the women’s clinic where you have gone after a check-up.

If the disease comes back

The cancer may return in the form of a new cancer tumor at another location in the vulva. Then it can be possible to get rid of the disease again. The doctor does a new examination to see which treatment can work. The most common thing is to be operated on.

If the disease is not removable

If you can’t get rid of the cancer, you can get treatment with cytostatic drugs that slow down the disease. You also get the treatment you need to relieve the hassles you may have. It is called palliative care .

You can get care in another place

The clinic’s contact nurse can help you with practical questions, for example if you live far from the clinic and have a close relative who comes with you. 

Post-checks are done at your nearest women’s clinic.

Life after treatment

It is good if you move as soon as you can after the treatment, but in the first few days you may need to take it a little carefully.

Tumor cancer and the treatment of the disease will affect your life in some way. How big the changes will be depends on what treatment you have received, if you have other illnesses and how you feel otherwise.

What you feel and how you feel can also vary. It is different from person to person but can also be changed from one period to another. Some have problems that may be greatest in the immediate time after treatment. Other problems can first be alleviated and then come back.

Tell your contact nurse or other healthcare professional how you are feeling. The vast majority of inconveniences are helpful.

Here are some examples of inconvenience and help available:

Urinary incontinence and bowel incontinence

Radiation treatment can cause incontinence. This means that it is difficult to keep tight. You may have urinary incontinence or bowel incontinence .

A physiotherapist can help you train your muscles so that you can pinch if needed. There are drugs that relieve the hassle.

There are different types of incontinence protection. You can get free incontinence protection through the district nurse.

Sexuality and closeness

The possibility of sexual stimulation may be affected, for example, if all or part of the clitoris has been removed. The illness and treatments can also make you think differently about yourself and your body. Some lose their desire for feeling anxious or depressed.

It can be difficult to talk about the changed situation. You can get help, for example by a psychotherapist or a sexologist. You can get help whether you have a partner or not.

If you have a partner, the help can be about talking support so that you can talk to each other or discover new ways of being together. You can read more in the article  Cancer and Sexuality .

Reportage:  Paula and Thomas: We got to start from scratch

Help that can prevent vomiting problems

Both surgery and radiotherapy can provide scar healing, which results in the opening of the wear. Then it can be more difficult to have intercourse or to be examined.

You can prevent the inconvenience by using a dilator. It is a rod that you insert into the vagina. You get it at the clinic where you have been treated. It is good if a doctor or a nurse helps you try out the dilator so that you get the right size. You may need to resize after a while.

Using a massage stick may work, but it is important that it is the right size for you.

Radiation therapy can lower the levels of estrogen so that the mucous membranes become dry and fragile. It may help with cream or ointment containing estrogen. Taking estrogen in this way does not affect cancer disease.

Lymphedema can be prevented and treated

You may get lymphedema  if the lymph nodes have been removed. This means that lymph fluid is collected. It can feel swollen, tense and heavy in the groin and in the legs or lower abdomen and towards the pubic bone.

Lymphedema can be both prevented and treated, for example with compression stockings, compression pants or massages. You can use a panty that sits tight to relieve the swelling.

Fatigue – fatigue

Many people with cancer feel very tired. It can have different causes. Maybe you don’t get the energy you need, the disease can create substances in the body that make you tired, the treatments can cause fatigue. Anemia , anxiety or depression can also make you feel very tired.

Fatigue means that you will not be rested even though you have slept. You may become more easily irritated and you may not be able to cope with things you usually do. It can affect your relationships.

Tell the health care provider if you are very tired. Make sure you get to know about the fatigue and what it is due to. If you have close relatives, it is good that they also get information. It can help and increase the understanding of the surroundings.

Sometimes exercise in adjusted doses can make you feel less tired. Another thing that can be alleviated is to take several short rest breaks during the day rather than a single, longer rest break. There are also medicines that can help with the fatigue.

Several ways to get support

It is common for the gender to be strongly associated with one’s identity. The illness and treatment can cause feelings of loss and grief.

You have the right to talk to a curator or psychologist about how you feel. Some feel strengthened by contact with other people in the same situation. For example, you can contact any of the patient associations that exist. Here you will find contact information for  advice and support in cancer .

Quality of life

Although it may feel difficult and much can be different, many have a good quality of life after treated vulva cancer.

Getting a cancer message

There are many ways to respond to a cancer message. You may need plenty of time to talk to your doctor and other healthcare professionals about what the message means. If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

You can ask to have the information written down so you can read it peacefully. Ask questions if you don’t understand. You have the right to receive interpreting assistance if you have a hearing impairment .

In many hospitals there are special nurses called contact nurses who can provide support and also help with various practical things.

For many, it usually feels easier once treatment has begun and they know what is going to happen.

You can get support in several places

The contact nurse or the hospital’s curator can help you if you need to talk more or have questions.

You can contact Cancer Counseling or the Cancer Foundation or, for example, a patient association. Beneficial is a compound for people with gynecological cancer. Tumor cancer is a form of gynecological cancer.

Children also need to know

A minor child has the right to receive information and support based on his or her own needs if a relative is ill. It is the responsibility of care. You can get help with what to say if you want to tell the child yourself. Often it is good to make children as involved as possible, regardless of their age. That doesn’t mean you have to tell everything.

You can read more in the text Talking to children when a parent is seriously ill . 

Being related

Sometimes it can be difficult to be close to someone who is ill. You may want to give support to your loved ones while you have a strong concern and feel bad. It is very common to do so.

Try to let other people in your vicinity support you. It can be family members, friends or acquaintances. Often it will be easier for them to help you by telling them how it feels and showing if you are worried and sad.

You can get help from the contact nurse  or a curator at the hospital if you are close and need supportive calls.

Be involved and influence your care

It is important that you are involved in your care as much as possible. The healthcare staff should tell you what treatment options are available. The staff should ensure that you understand what the various alternatives mean, what side effects are available and where you can receive treatment. This way you can help decide which treatment is right for you.

You can make a care plan together with the contact nurse, the doctor and other staff. It should answer questions that are important to you.

New medical assessment

You can get a new medical assessment if you are unsure if you are receiving the care and treatment that is best for you. You will then see another doctor, usually at another specialist clinic. Ask your doctor if you want to know more about how to get a new medical assessment.

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