Vulvar Cancer Services at Hoag Gynecologic Oncology

Vulvar cancer is cancer that occurs in the vulva, which is the external female genitalia that surrounds the vaginal opening and urethra and includes the clitoris, labia minora and labia majora. Vulvar cancer is one of the rarest types of gynecologic cancer, diagnosed in only around 5,500 women in the U.S. every year.

There are two main types of vulvar cancer:

• Vulvar squamous cell carcinoma, the most common kind of vulvar cancer, which begins in the flat cells that cover the surface of most of our bodies, including the vulva.

• Vulvar melanoma, which begins in the cells that produce pigment in the vulva.

In its early stages, vulvar cancer often produces no symptoms, making regular gynecological screening especially important.

Symptoms of vulvar cancer can include:

• Finding a lump in your vulva

• Sores or ulcers on the vagina that don’t heal

• Unexplained color changes or thickening in the skin of the vulva

• Persistent and unexplained itching, pain or tenderness in the vulva

• Unexplained bleeding

Like cervical cancer, vulvar cancer can sometimes be caused by an infection by the Human Papilloma Virus (HPV) a common sexually-transmitted condition. Most people who carry HPV will never develop vulvar cancer. Other risk factors for vulvar cancer can include:

• Being older, with most cases of vulvar cancer diagnosed in women over age 65

• Chronic irritation of the vulva

• Being diagnosed with vulvar intraepithelial neoplasia (VAIN), which is considered a precancerous condition of the vulva. While most people with VAIN don’t develop cancer, a small percentage do.

• Being infected with HPV, or not receiving the HPV vaccine before becoming sexually active as a young person

• Smoking

• Treatment or a condition that results in a weakened immune system.

Ways to reduce your risk of developing vulvar cancer include:

• Get vaccinated against HPV before beginning sexual activity

• Get screened for infection with HPV

• Don’t smoke

• Eat a healthy diet and get plenty of exercise to keep your immune system healthy

• Use condoms during sexual activity

If you have symptoms that might suggest vulvar cancer, your doctor will talk to you about the issues you’re experiencing, followed by a pelvic exam or Pap test to check for infection with HPV, which can cause cancer in the vagina or vulva.

If initial tests suggest further investigation, the doctor may refer you for additional tests, including:

• Colposcopy: an exam in which the doctor uses a special kind of magnifying device called a Colposcope to closely examine the skin of your vulva.

• Biopsy: in which a small sample of tissue is removed so it can be checked for cancer

• Imaging tests: Which may include x-rays, CT scans, PET scans or MRI.

As a leading provider of advanced gynecologic care, Hoag treats more women than any other hospital in Orange County. Trust Hoag for your gynecologic cancer treatment.

Our gynecologic cancer specialists and support staff with Hoag Oncology and The Hoag Women’s Health Institute will be there for you following your diagnosis to help you find resources, review your options and make informed decisions at every step of your cancer treatment and recovery.

Treatment options for vulvar cancer depend on many factors, including how advanced the cancer is when detected, your age, other health issues you may have, the size and location of the tumors and whether you wish to have children in the future. Some treatment options Hoag offers for vulvar cancers include:

• Radiation therapy/radiotherapy. Learn more about Hoag Radiation Oncology.

• Local excision surgery, which involves removal of small tumors or lesions on the surface of the vulva.

• Pelvic exenteration, which involves removal of most of the pelvic organs. This surgery is rare, and only performed in advanced cases

• Partial or radical vulvectomy, which involves removing some or all of the vulva

• Lymph node surgery, if the cancer has spread to lymph nodes in the groin

• Chemotherapy Brachytherapy, also known as “internal radiation therapy,” is a radiation treatment in which a small radioactive source is temporarily placed inside the body. Because of the high dose rate, brachytherapy treatments are usually delivered on an outpatient basis or with a minimal hospital stay. Explore advanced treatment options at Hoag.

Robotic-assisted surgery from Hoag, the unmatched leader on the West Coast in the field of robot-assisted, minimally-invasive surgery to help treat gynecologic cancers. Explore robotic surgery at Hoag. There are many conditions and patients that can benefit from Minimally Invasive Gynecology Surgery including:

• Hysterectomy

• Cancers of the uterus, cervix, and ovary

• Endometriosis

• Patients at high risk of gynecologic cancers who want preventative surgery

• Patients with a history of surgery complications

• Obese patients at a high risk for surgical complications

• Ovarian masses

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many gynecologic cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained oncologists who utilize the latest techniques and technology in the surgical management of many different cancers found in women, including vulvar and vaginal cancers.

Radical cancer surgery is a surgical procedure in which physicians remove the entire tumor, a margin of normal tissues, and in some cases, nearby lymph nodes. At Hoag, our surgeons have undergone extensive training in radical gynecologic cancer surgery and procedures, including in the areas of:

• Debulking surgery: In cases where the cancer has spread, as much of the cancer is removed as possible. This can often involve extensive surgery including removal of sections of the small or large intestine, as well as tumors from the liver, diaphragm and pelvis.

• Radical hysterectomy

• Excision of vulvar and vaginal cancers

At Hoag, our team applies a multidisciplinary approach to cancer surgery. Our physicians work together on your care, consulting with colleagues in plastic surgery, anesthesia and other specialties to help patients achieve better outcomes, maintain sexual and urinary function and preserve overall quality of life. Hoag surgeons utilize the Enhanced Recovery After Surgery (ERAS) pathway, an approach focused on understanding a patient’s specific biology to improve recovery time and pain management. With ERAS, patients become an active participant in their recovery in four key areas:

• Planning and preparing before surgery

• Reducing the physical stress of surgery

• Post-surgery pain relief planning

• Early feeding and movement after surgery

With ERAS, post-surgical patients require fewer narcotics, suffer from less constipation, are able to return to eating normally sooner and have a recovery period that is, on average, two days faster.

Hoag’s non surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag Newport Beach was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California — San Francisco.

Explore advanced treatment technologies for gynecologic cancers available at Hoag.

Treatment for gynecologic cancer can sometimes impact a person’s ability to conceive and bear a child. If you are considering having children in the future, you can discuss fertility options with your doctor. These may include:

• Egg freezing

• Embryo freezing

• Fertility-preserving surgery

• Gestational surrogacy

Fertility preservation works best if initiated prior to your cancer treatment. These options, such as egg or embryo freezing, can be completed within approximately two weeks of diagnosis so as not to compromise initiation of your cancer treatment.

To help patients understand the impact of gynecological cancer treatment on their fertility, Hoag has developed a series of questions you can ask your oncologist or fertility specialist.