Some forms of cancer that affect the reproductive system are more rare than other types of gynecologic cancer, including vulvar cancer and a condition known as gestational trophoblastic disease (GTD). For either of these, your gynecologic oncologist can diagnose and treat you.

Vulvar Cancer

Vulvar cancer is the uncontrolled growth of abnormal cells that begin on the vulva, the outer part of the female genital organs. It may be a skin-related cancer. Your gynecologist will likely notice a change of the vulvar tissue during your regularly scheduled annual gynecologic exam. Following a biopsy, a gynecologic oncologist can make an accurate diagnosis and begin early successful treatment.

Symptoms of vulvar cancer

If you notice any of the following changes, your next step is seeing specialist for a diagnosis:

• A rash or warts
• Changes in the color of the skin of the vulva—redder or whiter than usual
• Sores, lumps, or ulcers on the vulva that do not go away

Risk factors for vulvar cancer

Any of these conditions may you more susceptible to getting vulvar cancer:

• Any condition that weakens your immune system (such as HIV, the virus that can lead to AIDS), making it hard for your body to fight off health problems
• Cervical cancer
• Human papillomavirus (HPV), a common sexually transmitted virus that may cause cell changes and increase your risk of vulvar cancer
• Smoking

Preventing vulvar cancer

Since some vulvar cancers are the result of HPV, it is wise to take preventative measures against HPV, including vaccination. The vaccine is for 11 and 12 year old girls and even girls as young as 9. Teens and young adults 13 through 26, who did not receive the vaccine at an earlier age, are also eligible for vaccination.

Vulvar cancer treatment

Surgery is the most common treatment for cancer of the vulva. Surgery removes the cancer. Your gynecologic oncologist will also try to preserve as much of the vulva as possible to maintain sexual function.

The following surgical procedures treat vulvar cancer:  

• Laser surgery—uses a narrow beam of intense light (laser) as a knife to remove the effected tissue
• Local excision—removes the cancer and some of the normal tissue around the cancer
• Mohs surgery—used for skin cancer, removing one layer at a time until the cancer is removed
• Vulvectomy—removes part or all of the vulva
• Inguinal Lymph node dissection
• Sentinel lymph node mapping and dissection

Non-surgical treatments include chemotherapy for advanced vulvar cancer. You may also need radiation following surgery.

Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a rare form of cancer with tumors that grow abnormally in the uterus where an embryo grows during pregnancy. GTD occurs in about one pregnancy in a thousand in the United States. GTD may occur during pregnancy and have an effect on the pregnancy.

GTD begins in the layer of cells (trophoblast) that surrounds the embryo. The condition develops as cells permeate the placenta that is supposed to nourish and protect the embryo. Most cases of GTD are discovered early in pregnancy through regularly scheduled blood tests and scans.

There are several types of GTD:

• Hydatidiform mole (molar pregnancy)—the most common form of GTD in which a normal pregnancy cannot proceed, and the cells may become cancerous
• Invasive mole—grows in the muscle of the uterus and are tend to grow and spread, but may sometimes disappear on its own
• Choriocarcinoma—a cancerous form of GTD that may spread to other parts of the body. These tumors can develop following a miscarriage, a termination of pregnancy, or during a problematic pregnancy, while some develop after a normal pregnancy
• Placental-site trophoblastic tumor—a rare form of GTD that develops where the placenta attaches to the uterine lining and may spread to other parts of the body
• Epithelioid trophoblastic tumor—an extremely rare form of GTD and difficult to diagnose because it forms in the cervix. It may occur years after a normal pregnancy. If it is cancerous, it can spread to the lungs.

Symptoms of GTD

Since GTD usually occurs around the time of pregnancy, it is essential to report any unusual symptoms to your OB/GYN while you are pregnant or after your pregnancy. Most cases of GTD can be treated early in pregnancy.

Symptoms of GTD during pregnancy may include:

• Irregular vaginal bleeding—typically occurs during the first 13 weeks of pregnancy (the first trimester)
• Anemia—low red blood cell count due to excessive bleeding      
• Abnormal abdominal swelling—the uterus and belly grow bigger and faster than in normal pregnancy
• Ovarian cysts—growths on the ovaries that may cause side effects like swelling and pain
• Vomiting—more frequent and severe than in a normal pregnancy
• Pre-eclampsia—especially problematic during the first or second trimester of the pregnancy and may cause high blood pressure, headaches, exaggerated swelling of hands and feet
• Hyperthyroidism—an overactive thyroid caused by some types of GTD

Risk factors for GTD

Some characteristics may have a risk effect for certain forms of GTD, and most represent only minimal risk. Risk factors include your age, a prior molar pregnancy, one or more miscarriages, blood type, birth control pills, and family history

Preventing GTD

It is important to keep in mind that GTD is rare and is treatable. Not getting pregnant is the only way to avoid GTD, which is not a valid prevention for most women of childbearing age. If you have had a previous molar pregnancy, discuss with your doctor how you can prevent GTD from occurring during future pregnancies.

GTD treatment

The main ways for your gynecologic oncologist to treat GTD are surgery, chemotherapy, and radiation therapy.

• Surgery—dilation and curettage (D&C) is the surgical procedure used to remove the GTD cells. If you are not interested in future pregnancies, a hysterectomy will remove the entire uterus and effected cells within the uterus. If surgery successfully removes the affected cells, that is the only treatment you’ll need
• Chemotherapy—if the GTD cells have spread to other parts of the body beyond the reproductive organs, chemotherapy can treat those areas of the bod

This is a rare and treatable form of cancer. Discuss your risks and ability for a normal full-term pregnancy following treatment with your doctor.