Vulvar Cancer Diagnosis & Treatment in Singapore

What are the Types of Vulvar Cancer?

Vulvar cancer is a cancer that originates from the vulva. The most common type of vulvar cancer is squamous cell carcinoma, which arises in the squamous cells. These are thin, flat cells that line certain organs and surfaces of the body.

Melanoma is the second most common type of vulvar cancer. As melanoma is a type of skin cancer, vulvar melanomas are often treated the same as regular skin cancer. When it develops in the vulva, it is usually found on the clitoris or the labia minora. Women with melanoma in other body parts may be at higher risk of developing vulvar melanomas. Other less common types of vulvar cancer include:

Adenocarcinoma: Adenocarcinoma begins in the vulvar sweat glands or Bartholin’s glands. These are usually found around the vaginal opening.
Paget’s disease: A rare form of cancer that affects the outermost layer of skin on the vulva. This usually occurs in postmenopausal women and is most often diagnosed in women over the age of 60.
Sarcoma: Vulvar Sarcoma is cancer of the connective tissues beneath the skin of the vulva.
Verrucous carcinoma: This is a slow-growing form of squamous cell carcinoma that has the appearance of a wart.
Basal cell carcinoma (BCC): A slow-growing vulvar cancer that rarely spreads to other parts of the body. Vulvar BCCs are relatively uncommon, making up less than 1% of all BCCs.

What are the Vulvar Cancer Treatments in Singapore?

Once vulvar cancer has been diagnosed, treatment options will be discussed with the patient. Treatment depends on the types of vulvar cancer. The treatment for squamous cell carcinoma and adenocarcinoma differs from the treatment for melanoma, Paget’s disease and sarcomas of the vulva. Vulva melanoma, a type of skin cancer, is treated the same way as melanomas that occur in other parts of the body.

Treatment for squamous cell carcinoma, the most common type of vulvar cancer and adenocarcinoma of the vulva depends on the stage of the cancer. Treatment encompasses various modalities including surgery, radiation therapy and / or chemotherapy.

The specialists at OncoCare in Singapore may suggest one or a combination of the following:

Vulvar Cancer Treatment: Surgery

For most vulvar cancer treatments, surgery is the first step in the treatment plan. Removing the affected tissue surgically may be enough for some patients, but others might need more specialised vulvar cancer treatment, including radiation or chemotherapy. Types of surgery for vulvar cancer include:

Surgical Excision: The surgeon removes the tumour and some healthy tissue around it to ensure that all of the cancerous cells have been removed. For larger tumours, surgery to remove part of the vulva or the entire vulva may be required.
Lymphadenectomy: Vulvar cancer may spread to the nearby lymph nodes, and these lymph nodes may need to be removed to reduce the risk of cancer spreading to more distant areas of the body.

Vulvar Cancer Treatment: Radiation Therapy

Radiation can be used after surgery to kill any cancer cells that might have been left behind. Radiation therapy is sometimes combined with chemotherapy, which can make cancer cells more susceptible to the radiation.

General side effects of radiation might include but are not limited to fatigue, skin reactions, and may cause the vulvar area to become sensitive and sore

Vulvar Cancer Treatment: Chemotherapy

Chemotherapy is a drug treatment to kill cancer cells. A single or a combination of chemotherapy drugs might be given. The drugs used are similar to those used in the treatment of cervical cancer and may comprise of:

Cisplatin
Carboplatin
5-Fluorouracil
Paclitaxel

Side effects include but are not limited to fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhoea.

Vulvar Cancer Treatment: Immunotherapy

Immunotherapy uses your own immune system to fight cancer. Cancer cells can produce proteins that help them hide and prevent detection by the immune system cells. Immunotherapy works by interfering with that process. Immunotherapy is a promising treatment for women with advanced or metastatic vulvar cancer, and may be an option for treating certain types of vulvar cancer.

Oncologists at OncoCare with Clinical Interests in Vulvar Cancers

Early detection of cancer can improve the chances of successful treatment. This means that it is important to be aware of the signs and symptoms of cancer, and to see a doctor if any suspicious symptoms arise. As there are many types of cancer and each person’s case is unique, it is crucial to find a vulvar cancer specialist in Singapore who has the experience and expertise to create a treatment plan that will work for your condition.

OncoCare’s team of oncologists have decades of specialist experience in treating the various types of cancer including vulvar cancer, breast cancer, cervical cancer and liver cancer.

Dr Kevin Tay

Senior Consultant, Medical Oncologist

MBBS (Singapore) – ABIM Int. Med (USA) – ABIM Med Onc(USA) – FAMS (Medical Oncology)

Dr. Tay has been recognised as one of the top cancer doctors doing research. He was awarded the prestigious center grant by the National Medical Research Council of Singapore. He actively collaborates with other leading Asian researchers based in Korea, Taiwan, Hong Kong and USA. Dr Tay has published his findings in numerous journals, including Nature Genetics, the Journal of Clinical Oncology, The Lancet Hematology, American Journal of Medicine, Leukemia & Lymphoma and Seminars in Hematology.

Dr Tay’s subspecialty interest is in women related cancers such as breast cancers & gynaecological cancers, melanoma, brain cancers, soft tissue & bone sarcomas and also hematological malignancies such as lymphoma, multiple myeloma and leukemia.

MEDICAL PROFILE

Graduated from the National University of Singapore in 1998.
Board Certified, Internal Medicine, American Board of Internal Medicine, 2006
Board Certified, Medical Oncology, American Board of Internal Medicine, 2009
Chief Resident, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 2006
Chief Fellow, Medical Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, 2008

Dr Lim Sheow Lei

Senior Consultant, Medical Oncologist

MBBS (Australia, Honours), MRCP (United Kingdom), MD (United Kingdom)

Dr Lim specialises in the treatment of gynaecological cancers, such as cancer of the ovary, uterus, cervix and vulva. She trained under several renowned oncologists, including Professor Hani Gabra, a world renowned expert on ovarian cancer.

Dr Lim joined the Department of Gynaecological Oncology at KK Women’s and Children’s Hospital, specialising in the treatment of gynaecological cancers (cancers of the ovary, uterus, cervix and vulva). She also led the Chemotherapy Centre at KK Hospital and served as chairperson of the Singapore Cancer Network (SCAN).

MEDICAL PROFILE

Graduated from Monash University, Australia (Honours) in 1996
MRCP (UK), Royal College of Physicians of the United Kingdom, 2001
Certification in Medical Oncology by the United Kingdom Postgraduate Medical Education Training Board in 2008
Doctor of Medicine (MD) , United Kingdom in 2009
Executive Committee Member of the GyneCologic Cancer Group Singapore (GCGS) since 2018
Former Senior Consultant Medical Oncologist at the Department of Gynaecological Oncology at the KK Women’s and Children’s Hospital (KKH), Adjunct Associate Professor at DUKE-NUS Medical School
Visiting Consultant at KK Women’s and Children’s Hospital

What are the Signs and Symptoms of Vulvar Cancers?

Specialists can use the signs and symptoms of vulvar cancer to diagnose cancer. Different types of vulvar cancer can have other signs and symptoms. As a general guide, any changes should be checked by a doctor. Early diagnosis will result in the best treatment and prevention of vulvar cancer. Signs are something that other people can identify and measure, whereas symptoms are what the patient can identify and describe. Self-examination will help you find the warning symptoms early.

Signs and symptoms may include:

A lump or growth in or on the vulvar area;
A patch of skin that is different in colour or texture to the rest of the vulvar area;
Itching that doesn’t go away;
Pain and tenderness in the vulvar area;
Bleeding or discharge that is not from menstruation;
Open sores or wart-like bumps that persist for more than a month;
Painful urination.

To diagnose vulvar cancer, colposcopy may be used during the examination. A colposcope is an instrument with a magnifying lens. It allows the doctor to see the surface of the vulva clearly. The vulva is treated with a diluted solution of acetic acid that causes areas where vulvar cancer has formed to turn white. Once such areas are identified, a biopsy will be done to determine the type and stage of vulvar cancer diagnosed. Imaging scans will then be done to determine the extent of the tumour before treatment is discussed.

What are the Causes and Risks of Vulvar Cancer?

The biggest risk factors for vulvar cancer are:

Age – In Singapore, reported cases of vulvar cancer occur in women between the age range of 50 to 70 years old.
Human Papillomavirus (HPV) – Women infected with HPV may have a higher risk of developing vulvar cancer.
Vulvar Intraepithelial Neoplasia (VIN) – VIN is the general term for a precancerous state where the vulvar cells have a range of low-grade cancerous cells. During this period, a tumour has yet to form. Women with VIN have a very high risk of developing vulvar cancer.
Lichen Sclerosus et atrophicus (LSA) – LSA can result in the skin becoming thin and itchy. This may increase the susceptibility to vulvar cancer.
Melanoma – Personal or family history of melanoma in other parts of the body puts the woman at high risk for developing vulvar cancer.
Sexually Transmitted Infections (STIs) – Women with a high level of antibodies to herpes type 2 have a higher risk of developing vulvar cancer.
Smoking – Women who smoke regularly have a higher risk of developing vulvar cancer. When combined with HPV, the chances are much higher still.
Human Immunodeficiency Virus (HIV) – People with HIV or AIDS are more susceptible to developing vulvar cancer due to compromised immune systems.

The following factors might help prevent vulvar cancer:

Try to delay the first sexual intercourse experience as long as possible to avoid contracting HPV or STIs.
Avoid having sexual intercourse with multiple partners.
Avoid having sexual intercourse with someone who has had many partners.
Abstaining from sexual intercourse is the only effective way to prevent HPV infection, as condoms do not protect effectively.
Regular gynaecological exams will assist in detecting precancerous conditions.
Quit smoking where possible.

What are the Stages of Vulvar Cancer?

Cancer staging helps the oncologist determine prognosis and treatment. There are four stages of vulvar cancer:

Stage 1

The tumour is limited to the vulva or perineum (the area between the rectum and the vagina).

Stage 2

The tumour has reached the lower part of the vagina, urethra or the anus.

Stage 3

The tumour has spread to the nearby lymph nodes.

Stage 4

The tumour has spread to the bladder, rectum, pelvic bone, upper part of the urethra or vagina or to distant organs such as lung or bone.

To learn more, be sure to check our FAQ page or chat with our specialists at OncoCare for further advice.