What to Know Down Below™
Welcome to What to Know Down Below™ by Tina’s Wish! We’re here to empower you with the knowledge and tools you need to advocate for your own gynecologic health.
Knowledge is power, and we encourage everyone to join us in learning more about what you need to know, down below!
What to Know Down Below™
Vaginal & Vulvar Cancers: An Overview
Moderated by Jennifer Garam, ovarian cancer survivor & advocate and health journalist, and featuring Dr. Melissa Frey, Gynecologic Oncologist at Weill Cornell Medicine.
Welcome to What To Know Down Below by Tina's Wish. We're here to empower you with the knowledge and tools you need to advocate for your own gynecologic health. Knowledge is power, and we encourage everyone to join us in learning more about what you need to know down below.
Speaker 2:Hi everyone. I'm your host, Jennifer Garra , and I'm an ovarian cancer survivor and advocate and a health journalist. I'm back with Dr. Melissa Frey of Weill Cornell Medicine for the final installment of our three part series, A Guide to Gynecologic Cancers. Today we'll be talking about vaginal and vulgar cancers. You can listen to our previous episodes in this series, which focus on uterine and cervical cancer, wherever you get your podcasts. Dr . Frey , thank you again for joining me on this topic. Um, I wanna just start with the basic anatomy as there can be a lot of confusion about the female reproductive system and it's common for some of these terms to be used inaccurately or interchangeably when that's not actually correct. Can you explain the difference between the vagina and the vulva?
Speaker 3:Absolutely. And I think this is a question that , um, most people have or most people don't distinguish between the two. And so I think it's great to start here. So there's the sort of female genitalia , um, and I think you may have a general idea of what that is, but when we say , uh, vulva, we're really talking about the outside part . So the , the visual part of the female genitalia is the vulva and the internal part . So basically between the vulva and leading up to the cervix, where you get really internal, that's called the vagina. So again, sort of vulva is , is more of the external, the part that you can see vagina is the internal part.
Speaker 2:Okay, great. And then in terms of vaginal and vulgar cancers, are these two different diseases? Can someone have one or the other or both? Can you just kind of explain the basics of that?
Speaker 3:There are two different diseases. Um, someone can certainly have both because , um, a disease could spread from, from the vulva to the vagina or from the vagina to the vulva. You can imagine, based on my description, they're really quite close and there's not sort of one absolute line where one begins in the other other end. And so certainly one can spread from, from one site to the other site. And we also know there are some common risk factors. Um, the most common one being HPV that can increase the risk for both vulvar and vaginal cancer.
Speaker 2:Um, are there any other risk factors as well?
Speaker 3:Vulvar cancer , um, probably about 40% are, are due to HPV infection and, and the rest are due to basically chronic inflammatory conditions. So a very common one is called lichens sclerosis. So , and that's sort of an inflammation of the vulvar tissue and that inflammation over time can increase the risk for cancer. So it's a chronic inflammatory and autoimmune processes can also increase one's risk for vulvar cancer.
Speaker 2:Are there any other risk factors for vaginal cancer outside of HPV
Speaker 3:Vaginal cancers? Um, can be HPV driven , but we also can see , um, sort of metastatic disease from other sites, so other, other cancers kind of spreading to the vagina. And then we can see, you know, melanomas of the vagina and the vulva. Vulva actually both. Um, so me melanoma that you would see kind of in any other , uh, body part can also affect the vulva and the vagina. Um, and then we can also see some just rare , um, vaginal tumors that are not attributed to , um, HPV, like sarcomas , um, and other adenocarcinomas of the vagina that sort of arise independent of HPV.
Speaker 2:And what are some of the common signs and symptoms that someone might have a vaginal or a vulgar cancer?
Speaker 3:Sure. So I'll start with , um, vulgar cancer because this is something that's often visible to someone. And so if somebody has any lesion or any ulcer, anything on the vulva that does not look right, that is something that someone should see their doctor for and have a biopsy. Other common presenting symptoms for vulvar cancer would be , um, itching, like feeling like a chronic vulvar itching 'cause that can be , um, you know, caused by some of those chronic inflammatory and autoimmune disorders. So kind of any symptoms that are new and, and should be evaluated by a doctor. Um, any abnormal bleeding or pain in the vulva should also be evaluated. Um, we know that , um, vulvar cancer , um, if someone develops cancer, it can spread to lymph nodes in the groin. And so if someone notices that their groin feels swollen or tender, that can be the sign of a vulvar cancer that's spread to that lymph node. And that can also cause swelling of the leg . So if someone has sort of, kind of new but really kind of chronic swelling of one or both of their legs, that can be due to sort of a vulvar cancer that's spread to the lymph nodes that it's affecting the normal lymphatic drainage of the leg now kind of going on to vaginal cancer. So we can't, you can't see the vagina in the same way that you see a vulva. So it's not gonna be sort of that presenting ulcer or a new lesion that someone sees. Um, and so more commonly it's bleeding. And so if someone has bleeding , um, after menopause, so when we should not be seeing bleeding after someone goes through menopause, so that should be evaluated. Or if someone's having bleeding after intercourse, we call that postal bleeding, that is something that should be evaluated. If someone notices any kind of mass in their vagina that should be evaluated. Um, vaginal cancers can spread to the bladder, they can spread to the intestines or their the bowel. And so if someone has changes in the way they're urinating or changes in the way they're having bowel movements, that also should be something that's evaluated. And then finally, kind of any pain in the , in the pelvic area should lead to a workup for either vulva or vaginal cancer.
Speaker 2:And at what point should someone see their doctor if they're experiencing these symptoms?
Speaker 3:I would recommend right away. I mean, I think if someone is having a symptom that doesn't, you know, go away after a day or two that is new, that's something that should , uh, that that is something that warrants evaluation by a doctor
Speaker 2:And who is at risk for vaginal or vulvar cancer. And is there any way that someone could reduce their risk?
Speaker 3:Unfortunately, everyone's at risk for , uh, vulvar and vaginal cancer. And I think the, the best way to reduce risk is HPV vaccination. We talked a lot about HPV vaccination on the cervical cancer podcast, but because many vulvar and vaginal cancers are caused by HPV or the best things we can do is, is vaccinate to prevent someone from ever acquiring the HPV vaccine. And then sort of the next thing is just really , um, follow up of any symptoms. So any, any abnormalities, any new complaints should be evaluated so that we can diagnose something at the earliest possible stage.
Speaker 2:And how does someone get screened for vaginal or vulva cancer? Are these diseases detected on a pap smear like a cervical cancer , um, would be detected on pap smear.
Speaker 3:These diseases can be found on a pap smear because they can be HPV driven . Um, and so we can either see abnormal cells , um, as part of the PAP or HPV as part of the HPV test, but also what is critical is , um, physical exam. And so I think there , you know, as we're doing , uh, cervical cancer screening less frequently, there's always the question of whether or not you have to see your gynecologist or can you wait five years? One of the reasons to see a gynecologist, even if you're not due for a pap , is to have a physical exam. Usually people are not evaluating their , um, vulva and certainly can't see into the vagina on a regular basis. And so really the best way to determine if something abnormal is happening is to have a pelvic exam. And so this is the speculum exam and the external exam that's done by a gynecologist. And that is a really important way to find these cancers or precancerous.
Speaker 2:This is sort of a side note, but is there, do you happen to know, or is it common for people to not have a regular gynecologist? Or do you , do you , or even anecdotally, do you , do you think there's a need for more people to have a regular gynecologist who sees them on a regular cadence to catch anything like any irregularities?
Speaker 3:Yes, I think unfortunately there's a lot of , um, drop off after child bearing. Often people have an obstetrician and then sort of after having children don't have regular follow-up with the gynecologist. And I think this is the reason why regular follow-up is, is very important so that you can have a screening exam and then also if you have symptoms, if you have sort of notice , you know, a new kind of lesion on the vulva or if you have new sort of, of itching or burning or any kind of symptoms, that can be worked up quickly because really the gynecologist is the best person for that kind of evaluation.
Speaker 2:Um, and also just to kind of go off of that point that you just made, is that seeing a gynecologist, you know, if you have an obstetrician gynecologist beyond childbirth, there are so many other issues that could come up with your gynecologic health and that there , it's important to really before childbirth and then if you have children or you may not, and then to continue on with it because there are so many other issues that could be potentially evaluated. And that , um, just in my experience in looking around for gynecologists, certain gynecologists specialize in menopausal women or, you know, different things. So it's like if you, you know, you can still find the right provider even if you're not just , um, there for childbirth.
Speaker 3:And I would add to that also, many women, if they have a hysterectomy for something benign, for example, fibroids, they're very common. There's a thought that if the uterus and the cervix and maybe the ovaries and fallopian tubes have been removed, there's no need for a gynecologist. But, you know , I would just point out that , um, uh, women still have a vulva and a vagina and having a gynecologist involved in routine care is still critical. And vulva and vaginal cancer and pre-cancer is just one example of something that can happen even if someone's had some of their other gynecologic organs removed.
Speaker 2:Great . And this goes beyond , um, sexual identity as well. Just anyone who has vagina and a vulva should really have this sort of routine care
Speaker 3:Absolutely. Beyond sexual identity, beyond , um, whether or not someone's sexually active. So even if someone's had never been sexually active or have had many years since their last sexual , um, activity, this is still something that should be evaluated.
Speaker 2:And gynecologic health and vaginal health in particular can be very taboo. It can be an embarrassing topic for , um, women to bring up , um, whether to friends and family, whether to their doctor. Do you have any advice for overcoming this taboo and just normalizing this conversation? I mean, obviously it's so taboo in our society when a , a large amount of people don't dunno the difference between a , a vuln a vagina like we have worked to do, and what are some ways we can normalize these conversations?
Speaker 3:I agree with you 100% , and I think that exactly because it's taboo. You know, I often see women who had, you know, vaginal bleeding that was irregular for over a year before they sort of had the courage to come in, or for women who had, you know, a , a growing mass on her vulva and was just too embarrassed to talk about it or to tell family, or to tell her doctor. And what I would say is, you know, I think we have to work to negate that taboo. And really as patients, we have to be our, our best, our own best advocate because for all of these , um, diseases, early diagnosis and early treatment results in better outcomes, better survival, better , um, quality of life. And so I think if you have any symptom, just remember, this is what the gynecologist is here for. You do not have to be be embarrassed. Um, you know, if you don't wanna share this with relatives, that's okay, but share this with your , uh, gynecologist.
Speaker 2:Great . Thank you so much. Is there anything else you feel is important to add on this topic that we haven't covered so far?
Speaker 3:I would just emphasize again, the importance of the HPV vaccination and the importance of following with a gynecologist. Even if you finished having children, even if you've had hysterectomy, even if you think you don't have needs, I think having a routine , um, exam and having , uh, a doctor that you can check in with if you need anything is really critical to maintaining overall health.
Speaker 2:Great. Thank you so much. And I'm, I'm glad that we could talk about that and touch on that, that gynecologic health is part of your healthcare and that needs to be included and paid attention to throughout your whole entire life, regardless of age circumstances. It's something that needs to be taken care of without stigma.
Speaker 3:Absolutely.
Speaker 2:Thank you so much Dr. Frey , um, for being our subject matter expert for our Guide to Gynecologic Cancer series. We are so appreciative of your time and your expertise and all you do to improve women's health and a huge thank you to everyone listening. We hope you will continue to share the information you learn from this podcast with those around you, and encourage everyone to be empowered when it comes to your own health. Please tune into our previous podcast episodes focused on ovarian cancer, uterine cancer, and cervical cancer, as well as additional gynecologic health topics.
Speaker 1:For more information about gynecologic health, visit tina's wish.org/what to know . That's tina's wish.org/w H-A-T-T-O-K-N oow. And like follow or subscribe wherever you listen to your favorite podcasts.