Quilting is a special hobby for Liz Lancaster. The projects are more than just blankets or bed covers, quilts mark important life events. One in particular has been at her side through a taxing journey.
"In my normal routine showering, I felt this tiny lump," Lancaster, 59, said from her home in Carrollton.
The lump wasn't on her breast. It was more intimate than that.
"It was the size of a pencil eraser," Lancaster said. "As I went on long walks, that area would become irritated, and so I thought something's not right."
Curious about this lump that wasn't going away, Lancaster scheduled a doctor's appointment.
"She actually probably came in much earlier than many women would," said gynecologic oncologist Dustin Manders, who added that it's possible Lancaster's diligence saved her life.
"Five days later, [doctors] called me and said, 'You have vulvar cancer.' I'm like, I have what?" Lancaster said.
Vulvar cancer is relatively rare. About 6,000 women are expected to be diagnosed this year. Compare that to between 12,000 and 14,000 women who will be diagnosed with cervical cancer in 2019 and upward of 22,000 women who will be diagnosed with ovarian cancer.
"Women sometimes don't want to go get it checked out so there's a lag time of many months before it's identified," said Dr. Manders, who sees about one woman every month with vulvar cancer at Texas Oncology.
Mostly, Dr. Manders said, the women referred to him are in their mid- to- late 60s.
"The most common symptoms of vulvar cancer would be things like vulvar irritation, itching, burning, sometimes bleeding, and almost always some type of knot or bump," Dr. Manders said, noting that oftentimes women are either misdiagnosed or under the assumption that they are experiencing a yeast infection.
Lancaster caught her cancer early. In her case, surgery wasn't recommended because of the location of her tumor. Instead, she went through six weeks of chemotherapy and radiation and is now considered cancer free.
"I'm good," Lancaster said. "I feel great."
With scientists still navigating this field what's still a bit of a mystery is how this type of cancer develops and why in older women.
"Part of it was like, what did I do? What did I not do?" Lancaster said, recalling questions that have replayed in her mind for months.
One of the factors that can lead to vulvar cancer is an infection millions of Americans have: the Human Papillomavirus, or HPV. According to the CDC, an estimated 79 million Americans are infected with HPV.
Typically, an HPV infection has no symptoms, unless it's an HPV type that causes genital warts. In most people, their immune system attacks the virus and clears the HPV infection, typically within two years. Symptoms can develop years after being originally infected.
"Not every vulvar cancer is going to be an HPV-related cancer, but it is a risk factor," Dr. Manders said, highlighting the argument for the HPV vaccination.
"We think that it can be protective against about 70 percent of cervical cancer and certainly I think it would reduce the risk of vulvar cancer as well," Dr. Manders said.
The HPV vaccine has been on the market since 2006. More than 270 million doses of the HPV vaccine have been given worldwide, including 100 million doses in the U.S.
Vaccines are approved by the U.S. Food and Drug Administration for use in females ages 9-26 depending on the vaccine. In October 2018, the U.S. Food and Drug Administration approved Gardasil 9 for women ages 27-45.
Lancaster, who has been married for 34 years and works at a district office of the North Texas Conference of the United Methodist Church, isn't a loud person. But her cancer diagnosis inspired her to get vocal about the HPV vaccination.
"Why would you not do that for your child?" Lancaster said. "You have the opportunity to make a wise health decision. Why wouldn't you do it?"
With cancer behind her, there was one thing left to do to complete this part of her journey: finish the quilt that she started before her diagnosis. And following her final chemo treatment, she did.
"My symbol that it really is all good," Lancaster said.