Signs and symptoms of vulvar cancer may include: 

• Bleeding or discharge that is not part of a normal menstrual period 
• Growths that look like cauliflower or genital warts 
• Itching or burning sensation 
• Noticeable lump or bump with a raw surface that feels rough 
• Pain on the outside of the vagina 
• Discoloration (skin that is lighter or darker than the skin around it, or that appears more red or pink than usual) 

Risk factors: 

Although the exact cause of vulvar cancer isn't known, certain factors appear to increase your risk of the disease, including: 

• Increasing age.?The risk of vulvar cancer increases with age, though it can occur at any age. The average age at diagnosis is 65. 
• Exposure to human papillomavirus (HPV).?HPV?is a sexually transmitted infection that increases the risk of several cancers, including vulvar cancer and cervical cancer. Many young, sexually active people are exposed to?HPV, but for most the infection goes away on its own.  
• Smoking. Smoking raises your risk of developing multiple cancer types, including vulvar cancer. 
• Having a weakened immune system.?People who take medications to suppress the immune system, such as those who've undergone organ transplant, and those with conditions that weaken the immune system, such as human immunodeficiency virus (HIV), have an increased risk of vulvar cancer. 
• Having a skin condition involving the vulva.?Lichen sclerosis, which causes the vulvar skin to become thin and itchy, increases the risk of vulvar cancer. 

Diagnosis: 

The best way to diagnose vulvar cancer is by having regular wellness exams with a primary care doctor or a gynecologist. During these exams, the doctor will look for common signs and symptoms of vulvar cancer and may order tests if something looks suspicious. 

Tests and procedures used to diagnose vulvar cancer include: 

• Examining your vulva.?Your doctor will likely conduct a physical exam of your vulva to look for abnormalities. 
• Colposcopy:?During a colposcopy, a magnifying device is used to get a better look at the skin cells around the vulva to spot signs of cancer. If an area appears suspicious, a biopsy will be performed. 
• Biopsy:?The vulva area is numbed, and a small sample of tissue is removed and sent to a lab, where a pathologist determines if cancer is present. A biopsy is required to confirm a diagnosis of vulvar cancer. 
• Imaging:?Imaging tests may be ordered if your doctor thinks your vulvar cancer may have spread to other areas of the body. Tests include?CT scans,?MRI?or?positron emission tomography (PET) scans. 

The stages of vulvar cancer are indicated by Roman numerals that range from I to IV, with the lowest stage indicating cancer that is limited to the vulva. By stage IV, the cancer is considered advanced and has spread to nearby structures, such as the bladder or rectum, or to distant areas of the body. 

Treatment: 

Treatment options for vulvar cancer depend on the type, stage and location of your cancer, as well as your overall health and your preferences. 

Surgery 

Operations used to treat vulvar cancer include: 

• Removing the cancer and a margin of healthy tissue (excision).?This procedure, which may also be called a wide local excision or radical excision, involves cutting out the cancer and a small amount of normal tissue that surrounds it. Cutting out what doctors refer to as a margin of normal-looking tissue helps ensure that all of the cancerous cells have been removed. 
• Removing part of the vulva or the entire vulva (vulvectomy).?Surgery to remove part of the vulva (partial vulvectomy) or the entire vulva, including the underlying tissue (radical vulvectomy), may be an option for larger cancers. People with larger cancers may also consider treatment that combines radiation therapy and chemotherapy to shrink the tumor before surgery, which may allow for a less extensive operation. 
• Removing nearby lymph nodes.?To determine whether cancer has spread to the lymph nodes, the surgeon may use a procedure called sentinel node biopsy. And?If the cancer already has spread to the lymph nodes, many lymph nodes may be removed to reduce the risk that cancer will spread to distant areas of the body. 

Radiation therapy 

Radiation therapy?uses X-rays or other high-energy sources to kill cancer cells. The most common delivery method for vulvar cancer treatment is external beam radiation therapy (EBRT). EBRT uses a machine to deliver radiation through your skin to the targeted cancer site. 

Often, people receive radiation therapy and chemotherapy together (chemoradiation). You may receive radiation before surgery to shrink a tumor or after surgery to destroy any remaining cancer cells. 

Chemotherapy 

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. For those with advanced vulvar cancer that has spread to other areas of the body, chemotherapy may be an option. 

Chemotherapy is sometimes combined with radiation therapy to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Chemotherapy may also be combined with radiation to treat cancer that has spread to the lymph nodes. 

 

Targeted drug therapy 

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Targeted therapy might be an option for treating advanced vulvar cancer. 

Immunotherapy 

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process. Immunotherapy might be an option for treating advanced vulvar cancer. 

Vulvar cancer care at Shefa-El Orman Hospital 

• ?At Shefa-El Orman, gynecologic oncologists, radiation oncologists, medical oncologists and plastic surgeons work as a team to create a comprehensive treatment plan that ensures all of your individual needs are met. 
• Our doctors have extensive experience diagnosing and treating rare cancers, including vulvar cancer. Each year, more than 240 people with vulvar cancer. 
• ?You and your care team can carefully consider all of the available treatment options for your cancer. The range of treatments offered for vulvar cancer includes?chemotherapy,?radiation therapy?and many types of surgical procedures, such as wide local excision, partial vulvectomy, radical vulvectomy, lymph node removal,?sentinel node biopsy?and reconstructive surgery. 
• Shefa-El Orman surgeons work to ensure your vulvar cancer treatment preserves the cosmetic appearance and function of your vulva. Surgery involves removing the smallest amount of tissue necessary to successfully remove the cancer.  
• Our radiation oncologists use the latest techniques in treatment planning and delivery to carefully shape radiation beams. This ensures that the maximum dose of radiation treatment reaches the target area, while sparing nearby healthy tissue. Advanced technology including IMRT.  

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The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical blood test
  • inflammation markers (CRP, ESR)
  • blood coagulation analysis (aPTT, PT, INR)
  • tumor markers (CEA, CA19-9, AFP, CA125)
• gynecological examination:
  • colposcopy
  • vaginal swab
  • biopsy with histological study (if clinically indicated)
  • pelvic ultrasound
  • transvaginal ultrasound
• ultrasound of the abdomen or pelvic, CT/MRI of the abdomen and pelvic organs (if clinically indicated)
• nursing services
• consultation of related specialists
• treatment by chief physician and all leading experts
• explanation of individual treatment plan
    

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

________________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • inflammation indicators (CRP, ESR)
  • indicators blood coagulation
  • tumor markers (CEA, CA19-9, CA125)
• gynecological examination
• ultrasound examination: pelvis, abdomen, CT/MRI scans (if indicated clinically)
• preoperative care
• operative:
  • radical vulvectomy and lymphadenectomy
  • partial vulvectomy.
• histologically and immunohistochemically examination of the remote tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: 

Type of program: Inpatient

Expected duration of the program: 10 days

 

___________________________________________________________________________

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI scan (if indicated clinically)        
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • inflammation indicators (CRP, ESR)
  • indicators of blood coagulation
  • tumor markers (CEA, CA19-9, CA125)
• CT and MRI planning of radiation therapy
• Physics calculation  
• full course of conventional radiation therapy or brachytherapy separate or together (sequential) depending on your cancer stage and your treatment options will be explained by treating physician  
• chemotherapy weekly with radiotherapy (if indicated clinically), the cost of medicines is included  
• symptomatic treatment
• cost of essential medicines and materials including masks and mattress used for fixation.
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation in order to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

During the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

 

 

_____________________________________________________________________________

4-chemotherapy: 

The program includes: 

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • biochemical analysis of blood
  • tumor markers
  • inflammation indicators
  • indicators of blood coagulation
• ultrasound scan of the abdomen (if indicated).
• CT / MRI scan of the abdomen (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the inpatient procedure or outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• Any radiological images (not older than 3 months)
• Biopsy results 
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: Inpatient or outpatient (regarding chemotherapy protocol)

Expected duration of the program: from 1 to 4 days per cycle (regarding chemotherapy protocol)