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Saturday, September 14, 2013

Vulvar Cancer

Posted by Chantel Martiromo, Article By Kyle J. Norton 

Vulva is the external genital organs of the female, including the labia majora, mons pubis, labia minora, clitoris, and vestibule of the vagina.

Vulva cancer is a cancer arises from the abnormal cells growth of the epidermis of the vulvar tissue. The invasive cancer tends to affects women in later life and accounts for approximate 4 % of all female reproductive organs cancers.

Types of vulvar cancer
1. Vulvar squamous cell carcinoma
This cancer begins in the thin, flat cells that line the surface of the vulva and progresses through similar stages as squamous cell carcinoma of the cervix and vagina and tends to spread via the local lymph system. Approximately 90% of vulva cancers are squamous cell carcinomas.
2. Vulvar melanoma.
This cancer begins in the pigment-producing cells found in the skin of the vulva and has a high risk of metastasis. The cancer accounts for an approximate 5% of all cases and tends to be aggressive and affects an younger age group.
3. Basal cell carcinoma
A slow growth type of vulvar cancer, accounts approximately 1-2 % of all cases and affects most ly older women age group.
4. Etc.

Causes and risk factorsThere is no known cause of vulvar cancer but the genetic change cause of mutation of DNA of the cells. Some theories suggested that it is caused by free radical but further studies are needed.
1. Human papilloma virus (HPV) -
Risk of vulvar cancer increases with the infection of HPV.
2. Sexually transmitted diseases
Women who are treated with antibodies due to sexual transmitted diseases such as herpes are at higher risk of vulvar cancer.
3. Lupus
Lupus is a chronic inflammatory diseases due to immune system attacks the body own tissues and organs. Statistic showed that risk of vulvar cancer increases by 5 fold with women with lupus.
4. Smoking
It may be due to cigarette carcinogens.
5. Immunosuppressant drugs
Using immunosuppressant drugs to suppress the immune system for implantation are at high risk to develop vulvar cancer.
6. HIV/AIDs
Increased risk of vulvar cancer for women with HIV/AIDS.
7. Psoriasis
Psoriasis is a chronic immune-mediated disease that appears on the skin, as a result of immune system faulty signals that speed up the growth cycle of skin cells. Higher risk of vulvar cancer if a woman has developed the disease.
8. Etc.


Symptoms
1. Persistent itching
2. Bleeding
It may be caused by tumor has invaded the nearby capillaries.
3. Redness
4. Lump
Due to the growth of malignant cells
5. Painful during urination
It may be caused by cancer has narrow the urinary track
6. Genital warts
Growth of the cancer depends on the types of cells.
7. Painful sexual intercourse
8. Etc.

Grades
The Grade of vulvar cancer are depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Stages
Vulva cancer is classified as 5 stages
1. Stage 0
If the cancerous cell have not penetrated into deeper tissue but on the surface of the the inside lining of the vulvar lining.

2. Stage I
In stage I, the cancerous cells are no longer in the surface but have invaded into deep the inside vulvar limning but still completely inside the vulva.
a. Stage IA
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1:
The spreading is not less than 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2:The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b.Stage IB:
The cancer in this stage have invaded the connective tissue, & less than 5mm (1/5 inch).
b.1. Stage IB1:
Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:
Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (1/5 inch)

3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the vulva.

4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the vulva.

5. Stage IV
In this stage, cancerous cells has spread to the tissue immediately outside of the vulva to distant parts of the body.

Diagnosis and testsAfter recording the family history and physical exam to look for any sign of abnormality, such as lump, in your vagina and cervix with the use of a speculum. The exam also includes a pap test for lab analysis.
1. Biopsy
In vulvar cancer biopsy, a very small tissue sample is extracted and examined under a microscope for the presence of cancer cells by using a thin, tube like medical instrument to look for the grade of abnormal cells growth.

2. Cystoscopy
Cystoscopy is an exam to look inside surface of the bladder via the urethra with a thin, light tube called cystoscope under local anesthesia. If your doctor suspected that the cancer has spread to the bladder.

3. Proctoscopy
Proctoscopy is an visual exam of the rectum using a thin lighted tube. If your your doctor suspected that the cancer has spread to the bowel tissue.

4. Chest x-ray
If your doctor suspected that cancer has invaded the lung tissue.
2. Cystoscopy
Cystoscopy is an exam to look inside surface of the bladder via the urethra with a thin, light tube called cystoscope under local anesthesia. If your doctor suspected that the cancer has spread to the bladder.

3. Proctoscopy
Proctoscopy is an visual exam of the rectum using a thin lighted tube. If your your doctor suspected that the cancer has spread to the bowel tissue.

4. Chest x-ray
If your doctor suspected that cancer has invaded the lung tissue.

5. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details. The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. Unfortunately, CT scan can only review the existence of cancer, but can not tell it is a primary or secondary cancer.

6. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the vulva and surrounding areas.

7. Positron emission tomography (PET)
Positron emission tomography (PET) is a type of nuclear medicine imaging with the uses of small amounts of short-lived radioactive material, either injected into a vein, swallowed or inhaled as a gas which will appear in the area of the body being examined, where it gives off energy in the form of gamma rays detected by a camera of positron emission tomography that produces a three-dimensional image or picture of functional processes of the organ in the body.

8. Etc.

Preventions
A. How to avoid
1. Quit smoking and limited intake of alcohol
In a study of Smoking, alcohol among risk factors for vulvar/vaginal carcinoma by reuter, researchers found that on multivariate logistic regression analysis, statistically significant risk factors for VV-SCCvulva included history of anogenital warts (p<0.001), marital status (p=0.03), smoker status (p<0.001), cumulative alcohol consumption (p=0.01), and years at school (p=0.02). Significant risk factors for VV-SCCvagina were genital washing habits before and after intercourse (p=0.02), history of preinvasive or invasive cervical cancer (p<0.001), smoker status (p=0.02), and cumulative alcohol consumption (p=0.003).

2. Safe sex practice
To reduce the risk of development of sexually transmitted diseases such as HPV infection.

3. Detecting pre-cancerous conditions
Pre-cancerous vulvar conditions can be prevented, if the vulva is examined at the same time when a woman has a pap test and pelvic examination.

4. Etc.

B. Diet
1. Cranberries
Cranberries contains high amount of cyanidin and delphidin which inhibit vulvar cancer in vitro.

2. Green tea
Green tea contain low levels of oxalate and some researchers believe that the amount of oxalate may already absorbed by the digestive system, before it has the change to enter the body . In some clinical studies researchers suggested that the polyphenols in green tea, may play an important role in the prevention of cancer by killing cancerous cells and stopping their progression.

3. Modified citrus pectin
In a study, researcher found modified citrus pectin may help block the growth and metastasis of solid tumors.

4. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.

5. Cabbage
Cabbage beside contains high amount of antioxidants, but also phytonutrients that have been shown to help prevent the onset and halt the progression of certain cancers.

6. Etc.


C. Nutritional supplements
1. Antioxidants - free radical scavengers
Vitamin A, C, E are free radical scavengers enhanced the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth. For more information of how antioxidants help to treat cancer, click here

2. Cyanidin and delphidin
In a study of A study by Susanne Meiers and a team of researchers at the University of Regensburg in Germany, published in the Journal of Agriculture and Food Chemistry in February 2001. researchers found that cyanidin and delphidin inhibits vulva cancer cells in vitro.

3. Beta -carotene
In some laboratory, animal, and human studies, researchers found that vitamin A, certain retinoids may also inhibit cancer development.

4. Phytochemicals
Phytochemicals are under active research for possible benefits immune system, and as anti-cancer agents. Flavonoids found abundant in berry, inhibit caner cell in vitro study.

5. Lycopene
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibit apoptosis, causing cell death.

6. Etc.

Treatments
A. In conventional medicine
1. Surgery
The aim of the surgery is to cure. If the tumor is small and has not spread deeply, surgery may be the only treatment. Otherwise, the combination of radiotherapy and chemotherapy may be necessary, depending to the stage and grade of the cancer. In some case, dissection of the lymph nodes in the groin may be necessary if extensive surgery is needed to cure.
b. Risks and side effects
Surgical and anesthesia risks

2. Radiotherapy
a. Sometime doctors give radiation for vulva cancer after surgery and before chemotherapy. In vulva cancer, radiation may be used to kill the cancer cells and keep them from growing or regrowing.
b. Side effects
b.1. Fatigue
b.2. Chest pain
b.3. Heart problem
b.4. Short of breath
b.5. Skin discoloration or pinkness, irritation.
b.6. Etc.

3. Chemotherapy
a. If the cancer has spread, chemotherapy with use of drugs to cure vulva cancer even the cancer has spread to distant part of the body. Chemotherapy is most use to treat with advance stage of cancer combined with radio therapy.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

4. Laser Therapy
a. Laser therapy is a treatment for patients with a low grade and stage of vulva cancer by using a laser beam concentrated to kill off the cancer cells.
b. Risks and side effects
b.1. burning and/or swelling to the treated area
b.2. Itching,
b.3. Redness
b.4. Etc.


5. Etc.

B. Herbal medicine
1. Asparagus Cochinchinensis
In vitro studies researchers found that curcumin acts as a weak phytoestrogen, exhibits neuroprotective, antiproliferative and preventative effects against cancer.

2. Celandine
Celandine is a herbaceous perennial plant, genus Chelidonium, belonging to the family Papaveraceae, native to Europe and western Asia and introduced widely in North America.
In a study of Ukrain (Ukrain is an anticancer drug based on the extract of the plant)– a new cancer cure? A systematic review of randomised clinical trials, researcher suggested, according to the data from randomised clinical trials that Ukrain to have potential as an anticancer drug. However, numerous caveats prevent a positive conclusion, and independent rigorous studies are urgently needed.

3. Fenugreek
Fenugreek is used both as a herb (the leaves) and as a spice (the seed), genus Trigonella, belonging to family Fabaceae. Vitro studies have shown that fenugreek exhibits chemopreventive properties against certain cancers.

4. Aloe
in some studies, researchers suggest that some chemical compounds of aloe, such as acemannan, aloeride, and di(2-ethylhexyl)phthalate (DEHP) may have immunomodulating and anticancer effects.

5. Etc.


C. Traditional Chinese medicine
1. Dang qui
Dang qui is also known as Chinese engelica root. A study published in the journal Life Sciences in August 2004 showed that an extract of Dang qui was able to slow the proliferation of several different types of cancer cells in vitro.

2. Huang Qi
In study of Astragalus-Based Chinese Herbs and Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Meta-Analysis of Randomized Trials, researchers found that astragalus may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. These results require confirmation with rigorously controlled trials.
According to the American Cancer Society, the substances, licochalcone-A, licocoumarone and glabridin, which are present in licorice root, may prevent mutations in the DNA and kill existing cancer.

3. Pu Kong Yin (Dandelion Root)
In a study of the efficacy of dandelion root extract in inducing apoptosis in drug-resistant human melanoma cells, researchers found that treatment with this common, yet potent extract of natural compounds has proven novel in specifically inducing apoptosis in chemoresistant melanoma, without toxicity to healthy cells.

4. Gan Cao
Gan Cao is also known as Licorice root. In-vitro, researchers found that saponins in Gan Cao stimulate the immune system and inhibit Epstein-Barr virus expression and possess anti-cancer activities.

Etc.

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