Disease Description (Causes and Symptoms)

Definition and pathophysiology: Vulvar cancer is a malignant tumor occurring in the vulva, including the labia (labia majora and labia minora), clitoris, and vaginal opening; most cases are squamous cell carcinoma. Some cases are melanoma, Bartholin gland cancer, or basal cell carcinoma. In some cases, precancerous lesions (vulvar intraepithelial neoplasia) progress to invasive cancer.
Causes and risk factors: The exact cause is unknown, but human papillomavirus (HPV) infection is observed in 20–60% of patients and is an important associated factor. Age (mean age at diagnosis approximately 65 years), smoking, and immunosuppression increase the risk.
Main symptoms: Vulvar itching (pruritus), a mass or raised lesion, bleeding, discharge, pain, and difficulty urinating. Lesions may appear raised, ulcerated, as leukoplakia (white lesions), wart-like, or with pigment changes (darkening or reddening).
Summary of diagnostic elements: Diagnosis is confirmed through visual examination and colposcopy, together with a biopsy of the lesion. Imaging tests such as CT, MRI, and ultrasound, as well as lymph node evaluation, are performed to assess metastasis and staging.

Treatment Methods

Surgical treatment (standard): Depending on the size, location, stage, and lymph node status of the lesion, local excision, partial or total vulvectomy, and lymph node dissection (pelvic and inguinal) are performed. The goal is to preserve the urethra, anus, sexual function, and bowel and urinary functions as much as possible while leaving as much normal tissue as possible. Recently, sentinel lymph node biopsy has been used in an attempt to reduce unnecessary lymph node dissection.
Radiation therapy: Used for locally advanced disease, to shrink the lesion before surgery, or as adjuvant therapy when the risk of local recurrence is high after surgery. It may be considered for preservation purposes in some small lesions, particularly those around the clitoris.
Chemotherapy: Used alone or selectively in combination with radiation therapy for distant metastasis or recurrent lesions that cannot be treated surgically. Standard medications vary depending on the stage and condition.
Conservative and rehabilitative care: Wound care after surgery and rehabilitation of urinary, bowel, and sexual function (physical therapy and sex therapy when necessary), as well as pain and psychological support, are important.
Points to note during treatment: Manage wound infections and lymphedema, do not smoke, and take preventive measures related to HPV (consultation about vaccination is recommended depending on age and condition).

Items to prepare (before examination and treatment)

A list of all medications currently being taken, including prescription drugs, OTC medications, and supplements
Past medical history, surgical history, and relevant findings (copies of previous biopsy and pathology reports and imaging results)
The time of symptom onset and course of symptoms (itching, pain, bleeding, discharge, etc.), along with a record of changes
Smoking history, sexual history (number of sexual partners, condom use, etc.), and whether the HPV vaccine was received
Bringing photographs of the lesion (its appearance and changes) may help with comparison
Example questions (questions to ask during the consultation)
"Please explain in detail when you first noticed the symptoms and how they have changed."
"Do you have records of any previous biopsy or pathology findings or imaging tests?"

"What do my cancer stage and prognosis (survival rate) mean?"
"What are the advantages, disadvantages, and side effects of the recommended treatment options?"
"What is the risk of sexual, urinary, or bowel dysfunction caused by surgery? How will rehabilitation proceed?"
"Is lymph node evaluation absolutely necessary? Is sentinel lymph node biopsy possible?"
"What lifestyle changes should I make to reduce the risk of recurrence?"

"In my case, how will the extent of surgery (partial excision versus total vulvectomy) be determined, and is it possible to preserve the clitoris, urethra, and anus?"
"Am I eligible for sentinel lymph node biopsy (SLN biopsy), and if it is not performed, what is the risk of complications from lymph node dissection, such as lymphedema?"

Additional Information

The presence or absence of lymph node metastasis is the most important prognostic factor (the 5-year survival rate is >90% when the lymph nodes are negative, decreasing to approximately 55% when they are positive; it may decrease to as low as 30% in advanced disease).
Prevention: Regular gynecological examinations and vulvar self-examinations, smoking cessation, safe sexual practices and HPV vaccination, and hygienic care (wiping from front to back after urination and bowel movements, wearing breathable cotton underwear, and limiting tight-fitting clothing) are recommended.