Vulvar cancer occurs in women on the vulva— the area of skin that surrounds the urethra and vagina, including the clitoris and labia. Vulvar cancer is a type of gynecologic cancer that most often affects the vaginal lips or the sides of the vaginal opening; however, other parts of the vulva may also be affected, especially as the cancer enlarges.
Vulvar cancer is named for the type of tissue where the cancer started. The most common type of vulvar cancer is squamous cell carcinoma. Other, less common vulvar cancer types include:
Vulvar cancer is rare, representing only 0.3% of all new cancer cases in the United States. Because this type of cancer usually develops slowly, it's advisable to keep an eye for physical symptoms and have a gynecologic exam every year to detect any abnormalities as early as possible.
As with most other cancers, vulvar cancer may not cause any symptoms in its early stages. When symptoms do occur, they can include:
Some of these symptoms can be signs of other non-cancerous conditions. If you notice any of these it’s best to schedule an appointment with your gynecologist.
Although the exact cause of vulvar cancer isn't known, certain factors appear to increase your risk of the disease. These include:
Other possible risk factors for developing vulvar cancer include the following:
Reducing your risks of vulvar cancer means reducing your risk of the sexually transmitted infection HPV. To do this, take preventative measures such as:
Your doctor may use many tests to detect or diagnose vulvar cancer. The most common way vulvar cancer is detected is through a gynecologic examination, which usually screens for cervical and other types of gynecologic cancers and includes a pelvic exam. Your doctor or nurse will inspect your uterus, vagina, rectum, ovaries, and cervix during a pelvic exam to check for abnormalities such as lumps.
In addition to a physical examination, the following tests may be used to diagnose vulvar cancer:
Staging is the process to find out if cancer has spread within the vagina or to other parts of the body. The gynecologic oncologist can determine the current stage of the disease and come up with an appropriate cancer treatment plan from the information gathered. The following is one way of determining the stage and, therefore, the types of treatment needed.
Stage I: The tumor has not spread past the vulva or the vulva and perineum.
IA: The tumor is only in the vulva or the vulva and perineum, is 2 cm or smaller, has not spread, and is no deeper than 1 mm.
IB: The tumor is larger than 2 cm or is deeper than 1 mm, but is contained to the vulva or the vulva and perineum.
Stage II: The tumor is of any size and has spread to nearby structures, including the lower part of the urethra, vagina, or anus. The lymph nodes or other parts of the body have not been affected.
Stage III: The cancer has spread to nearby tissue, such as the vagina, anus, or urethra. It has also spread to the groin lymph nodes. There are no distant metastases.
IIIA: The cancer has spread to nearby tissue (the vagina, anus, or urethra). There are 1 or 2 metastases to lymph nodes, but they are smaller than 5 mm, or there is 1 metastasis that is 5 mm. There are no distant metastases.
IIIB: The cancer has spread to nearby tissue (the vagina, anus, or urethra). There are 3 or more metastases to lymph nodes, but they are smaller than 5 mm, or there are 2 or more metastases that are 5 mm. There are no distant metastases.
IIIC: The cancer has spread to nearby tissue (the vagina, anus, or urethra) and to 1 or more lymph nodes and their surrounding lymph node capsule or covering. There are no distant metastases.
Stage IV: The cancer has spread to the upper part of the vagina or upper part of the urethra or spread to a distant part of the body.
IVA: The tumor has spread to the upper part of the urethra, vagina, or anus; the cancer has spread to regional lymph nodes and caused ulceration, or it has attached the lymph node to the tissue beneath it. There are no distant metastases.
IVB: Cancer has spread to a distant part of the body.
Your choice of treatment options may depend on the stage and type of cancer, your current health condition, and your care goals. Currently, three standard treatment methods are being used to treat vulvar cancer patients:
Surgery is used to remove the tumor and some surrounding healthy tissue. Surgical options for invasive vulvar cancer include a vulvectomy, which removes part or all of the vulva, depending on the size and spread of the primary tumor. If the cancer has spread to regional lymph nodes, a surgical procedure, called lymphadenectomy, may be necessary to remove them. This surgery is typically performed by a gynecologic oncologist who will follow you through your entire cancer treatment process.
During radiation therapy, high-energy x-rays are used to kill cancerous cells or prevent them from growing. Your gynecologic oncologist might recommend a combination of external beam radiation and brachytherapy.
Chemotherapy drugs are used to stop the growth of vulvar cancer. It might be given along with radiation after surgery is complete. The type and amount of chemo needed will depend on the stage of cancer.
Vulvar cancer can come back to the vaginal area or other parts of the body after being treated; therefore, it's essential to carry out regular follow-up tests after cancer treatments conclude.