Tumors of the vulva

Pathology

Vulvar cancer is a relatively rare cancer that accounts for about 3-5% of cancers of the female genital tract. About 1,200 new cases are reported in Italy each year, most of them in women of mature age. In fact, the incidence increases with age: about 9 out of 10 women receive the diagnosis after age 60.

The vulva is the outermost part of the female genital tract and includes the labia majora and labia minora, the vestibule (i.e., the vaginal opening), the clitoris, and the perineum, the area of skin between the vagina and anus. The tumor most frequently affects the labia majora, but can develop in all areas of the vulva.

Vulvar cancer is a disease that generally takes many years to develop. It is often preceded by pre-invasive lesions, i.e., tissue changes that are not yet cancer, but can develop into malignant forms over time. These lesions can be caused by human papillomavirus (HPV) infection or by chronic vulvar dermatoses, such as lichen sclerosus.

Early detection is critical for a more favorable prognosis: in fact, if identified in the early stages, vulvar cancer can be successfully cured, and about 3 out of 4 women no longer show signs of the disease after 5 years.

Types

  • Squamous cell carcinoma (85-90% of cases): derived from the squamous cells lining the vulva;
  • Malignant melanoma (2-5% of cases): dark mole-like pigmented tumor;
  • Adenocarcinoma (1-3% of cases): develops from Bartolini’s glands;
  • Other rare tumors: stem such as sarcoma or Paget’s carcinoma.

Symptoms

In the early stages, the tumor may be asymptomatic or confused with benign conditions. At first it may manifest with changes in the skin, which may appear thinner, redder, or darker than nearby areas.

Over time, a white or red lump with an irregular surface may appear, sometimes accompanied by itching, pain, burning, or small wounds that tend not to heal.

Risk factors

Usually this type of neoplasm arises on precancerous lesions related to human papilloma virus (HPV) infection or chronic inflammatory conditions (such as genital lichen sclerosus). The main known risk factors are:

  • Age (above 60 years);
  • Human papillomavirus(HPV) infection;
  • Cigarette smoke ;
  • presence of lichen sclerosus or other chronic inflammatory conditions (e.g., Paget’s disease).

Other factors that may predispose to higher risk are:

  • weakened immune system;
  • presence of precancerous lesions (dysplasia) or tumors in other areas such as the cervix, vagina, or anus;
  • chronic granulomatous disease.

Diagnosis and examination

The diagnostic pathway for vulvar cancer begins with a specialist gynecological examination, during which the doctor collects the patient’s personal and family history, assesses symptoms, and proceeds with a thorough inspection of the genital and inguinal area, as well as a complete gynecological examination. If a cancerous lesion is suspected during the evaluation, a biopsy, which is the taking of a small fragment of tissue for microscopic analysis, is performed. This examination is critical because it allows the presence of the tumor to be confirmed or excluded with certainty. In some situations, when the lesion is very small or inconspicuous, the specialist may use vulvoscopy, an investigation that allows a better look at the affected area and guides the eventual sampling.

To accurately determine theextent of the disease and any involvement of the inguinal lymph nodes, imaging tests such as:

  • Magnetic resonance imaging (MRI)
  • PET/TC
  • Computed tomography (CT) scan

Early diagnosis and early care are key: the earlier the disease is identified, the more effective and targeted the available treatments can be.

Staging

Vulvar cancer is divided into four stages according to the criteria established by the International Federation of Gynecology and Obstetrics (FIGO):

  • Stage IV: The tumor is more advanced, can reach deeper structures such as bladder or rectum, attach to the pelvic bone or give distant metastasis;
  • Stage I: The tumor is located exclusively in the vulva or perineum and has not reached the lymph nodes;
  • Stage II: The tumor may extend to nearby tissues, such as the lower part of the urethra, vagina or anus, but without lymph node involvement;
  • Stage III: The disease involves lymph nodes in the inguinal or femoral region and may invade surrounding tissues.

This classification is very important because it allows the physician to understand how extensive the disease is and to choose the most appropriate treatment.

Therapies

To select the appropriate treatment for this condition, it is essential to take into consideration the patient’s age, pathology, type of disease, location, and extent of disease.

Pre-cancerous lesions

When dealing with precancerous lesions, conservative intervention such as laser surgery may be sufficient to remove or vaporize the altered cells without removing excess tissue.

Surgical intervention

In cases of invasive cancer, vulvar surgery is the main treatment and has both a therapeutic and symptomatic function. The surgery may be more or less extensive depending on the size and spread of the tumor. Inguinal lymph nodes also often need to be removed, as they are the first site where the tumor could spread.

In particular:

    • The sentinel ly mph node is the first lymph node to receive lymphatic drainage from the tumor-affected area. Its removal makes it possible to check whether the tumor has spread without having to remove all the lymph nodes in the region, reducing the risk of complications such as lymphedema;

    • depending on the stage of the disease and location of the tumor, it may be necessary to remove all inguinal lymph nodes, unilaterally or bilaterally.

Post-surgical reconstruction

After vulvectomy (total or partial removal of the vulva), vulvar reconstruction is extremely important, both for psychological reasons and to improve quality of life. When the removal involves a significant portion of tissue, the intervention of a plastic surgeon can ensure a more functional and aesthetic reconstruction.

Radiotherapy, chemotherapy and other therapies

Surgery in some cases is combined with radiotherapy or chemotherapy treatment depending on the stage of disease.

Finally, new targeted therapies, designed to hit specific targets on cancer cells, andimmunotherapy, which aims to stimulate the immune system against the tumor, are being investigated. These options are currently available only in experimental settings and may expand treatment options in the future.

Ongoing support

At our institute, we ensure constant support before, during and after treatment to accompany each patient throughout the entire course of treatment and recovery.

Psychological support

The impact of cancer in a person’s life also affects the psychological sphere: falling ill with cancer is in fact always a traumatic event that affects all dimensions of the person and can generate anxiety, fear, anger, depression.

At the Candiolo Institute, alongside cutting-edge therapies, the treatment and care pathway always includes a qualified psycho-oncological support that helps the patient cope positively not only with treatment but also with the delicate phase of physical and psychological recovery.

It is also possible to participate in support groups psychological to compare with other people who have gone through or are going through the same experience.

Management of emergencies and side effects

The cancer patient is often a fragile patient, who needs help and support in her disease journey: when she experiences discomfort, whether related to the disease or a side effect of therapy, she needs to be able to receive a specialist’s opinion quickly, through a “fast track.”

For this reason, at the Candiolo Institute there is an assistance service every day, Monday through Friday from 8 a.m. to 5 p.m.: just call the secretary of the Oncology Day Hospital (011 993 3775) reporting the need for an urgent consultation, and the patient is quickly contacted by his or her specialist doctor.

Continuing and palliative care

The cancer patient is a person with complex needs that requires multidisciplinary support not only for the cancer disease, but also for all related issues.

At the Candiolo Institute, patients who need or require it have access to specialists in different areas to receive nutritional support, physical therapy, pain therapy and management of other associated conditions.

Follow-up

After completion of treatment, follow-up is essential to monitor the patient’s health and detect any recurrence early. European gynecologic oncology guidelines (ESGO society) recommend:

  • Gynecological visits: every 3-6 months in the first two years, then every 6 months for the next three years;

  • Pap test: once a year to check the health of cervix cells;

  • Instrumental and blood tests: such as ultrasound, CT scan, or MRI, to be performed only if indicated by the physician, as needed and according to the stage of the disease.

Personalized follow-up enables early intervention in case of new signs and ensures careful and safe monitoring over time.

Social work

The Social Service Department of the Candiolo Institute conducts information and orientation interviews to patients and their families on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).

The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. (phone: 011 9933059)

Interdisciplinary Group

Every cancer requires, in all phases of disease management, a multidisciplinary approach that at the Candiolo Institute is guaranteed by a team of different specialists, belonging to the various clinical and surgical departments of the Institute: this team is called GIC (Interdisciplinary Care Group). The GIC ensures that each patient is taken care of throughout the diagnostic-therapeutic process, including prescribing and booking examinations and communicating with the patient and his or her family members. The GIC defines and shares a personalized care pathway for each patient, based not only on the type and stage of the tumor, but also on the patient’s own characteristics. The goal is to ensure that he or she has the best outcome both oncologically and functionally and the maintenance of a good quality of life.The Group also works closely with researchers at the Institute to ensure that patients have rapid access to the latest research-produced innovations in screening, diagnosis and treatment.

Clinical divisions

The diagnostic and therapeutic pathway for vulvar cancer at Candiolo involves several clinical divisions, including:

Clinical studies

Researchers at the Candiolo Institute are currently involved in several national and international projects on gynecological cancers.

The main ones involve clinical, translational, and molecular research, as well as numerous experimental clinical trials on new chemotherapeutic drugs and immunotherapy.

In addition, experimental surgical protocols on lymph node staging for cervical cancer and sentinel lymph node are active.

Why choose us

At Candiolo IRCCS Institute, every patient with vulvar cancer is followed according to highly specialized standards, thanks to the synergistic work of a dedicated Interdisciplinary Care Group (ICG) .

Clinical experience and tailored approach

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Imaging technologies and advanced diagnostics

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

Minimally invasive surgical techniques and multidisciplinarity

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

Clinical research and access to trials

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

Care and support every step of the way

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.