Labia / vulvar cancer
In Switzerland, an estimated 200 women are newly diagnosed with vulvar cancer every year, unfortunately there are no exact numbers.
How many women die as a result of the disease is unknown, one can only assume that the situation is similar to that in neighboring countries and that the prognosis has improved significantly over the past 15 years. The cancer statistics from Holland, Australia and Germany know that vulvar cancer has more than doubled in the last 20 years, with the diagnosis increasingly being made in younger women in particular, which used to be extremely rare. Unfortunately, there is no established early detection program for the vulva, although the cancer and its precursors are relatively easy to identify.
There are two ways of developing cancer. On the one hand, vulvar cancer, similar to cervical cancer, is caused by human papillomaviruses (HPV). The precancerous stage is often easy to recognize, often causes symptoms such as itching or is felt by the patient themselves, and it is also relatively easy to treat. HPV-associated vulvar cancers mostly affect younger women between 35 and 45 years of age and have a very good prognosis. On the other hand, there are also HPV-independent vulvar carcinomas that usually develop on the basis of a lichen sclerosus. Although lichen sclerosus is not a precancerous stage, it is unfortunately not infrequently recognized late and makes changes such as cornification, cracks or open areas that mask a precancerous stage. This is therefore rarely diagnosed and an invasively growing vulvar carcinoma usually already exists at the time of diagnosis. Affected women with lichen sclerosus-associated vulvar cancer are usually over 60 years old, the prognosis is less good and the tumor is at high risk of recurrence. Both tumor variants are diagnosed with about the same frequency.
Therapy of vulvar cancer
The primary therapy for vulvar cancer is surgical removal and surgical examination of the lymphatic drainage pathways. The sentinel lymph node method can be used for smaller tumors, but the surgeon should have sufficient experience. In the case of affected lymph nodes, the groin must be operated on completely on the affected side, which unfortunately always goes hand in hand with problems. These are nasty infections, lymph cysts, and chronic lymphatic congestion. If more than one lymph node is involved, the area should also be irradiated afterwards, which increases the risk of long-term effects.
Surgery of the vulva is technically demanding, because functional organs come together here and women just sit on their external genitals. Therefore tension-free techniques for the reconstruction of the external genitals are necessary, which must be mastered. Otherwise, long-term sitting alone will lead to considerable discomfort. The impairment of sexuality is almost always a problem, because even if everything seems functionally normal, the &quout;mutilation&quout; practically always has subjective effects. Women with vulvar cancer should always be treated in a team with trained GynOnc nurses who can provide assistance with processing and care. If the tumor is close to the perineum, an artificial anus should sometimes be created for a few weeks for better wound healing, otherwise severe wound healing disorders can be expected.
In the case of very extensive tumors, or in patients who cannot be operated on for other reasons, it can make sense to irradiate primarily with the aim of being able to operate better later.
Advanced and metastatic vulvar cancer
Unfortunately, the options for advanced vulvar cancer are extremely limited and often frustrating. However, more recent data show that if a relapse is detected early using combined therapy approaches consisting of surgery with radiation therapy can lead to long-term survival. In the case of distant metastases to other organs, the response rates of the available therapies are unfortunately not particularly good up to now.
Outlook
By increasing the vaccination rate against HPV, at least one variant of vulvar cancer could be reduced. Fortunately, gynecology is increasingly aware of the vulva, the problem is increasingly being addressed, and training and continuing education are increasingly focused on this neglected organ. Lichen sclerosus is recognized increasingly earlier and it is very likely that adequate therapy, e.g. with ointments containing cortisone, will counteract the development of cancer.
