Cancer occurs when abnormal tissue cells reproduce uncontrollably. Cancer can develop anywhere in the body, and the symptoms and treatment depend on the type of cancer and its location. There are various types of cancer that can affect the female reproductive organs, including vulvar cancer.
Vulvar cancer is a cancer of the vulva, or a female’s external genitals. The vulva includes the inner and outer lips of the vagina, the clitoris, and the opening of the vagina, which is called the introitus. Glands near the vaginal opening are also part of the vulva. Vulvar cancer typically affects the outer lips of the vagina, but other parts of the vulva may also be affected, especially as the cancer enlarges.
This type of cancer usually develops slowly. It often begins as vulvar intraepithelial neoplasia, which occurs when healthy skin cells around the vulva undergo abnormal changes. Without treatment, the abnormal cells can turn into cancer.
In its early stages, vulvar cancer may not cause any symptoms. When symptoms do occur, they can include:
- abnormal bleeding
- itching in the vulvar area
- a discolored patch of skin
- pain with urination
- pain and tenderness in the vulvar area
- a lump or wart-like sores on the vulva
Call your doctor right away if you’re having symptoms of vulvar cancer. Early detection and treatment may help prevent the cancer from progressing and becoming more advanced.
Although the exact cause of vulvar cancer isn’t known, there are certain risk factors associated with the condition. These include:
- being 55 or older
- having vulvar intraepithelial neoplasia
- having HIV or AIDS
- having a human papillomavirus (HPV) infection
- having a history of genital warts
- having a skin condition that can affect the vulva, such as lichen planus
Your doctor will perform a physical exam and closely examine the vulva. They’ll also review your medical history and ask you questions about your lifestyle.
Your doctor will likely also do a biopsy. This involves taking small samples of tissue from the vulva for analysis. The procedure may be done with a local anesthetic, which will numb the area so you don’t feel any pain.
If the biopsy results indicate vulvar cancer, your doctor may refer you to a gynecologic oncologist. A gynecologic oncologist is a doctor who specializes in cancers of the female reproductive system. They will review your biopsy results and run more tests to stage the cancer.
Staging helps your doctor classify the severity of the cancer. This allows them to create an effective treatment plan for you. The factors used in staging include the location of the primary tumor, the spread of cancer to nearby lymph nodes, and the size and number of tumors.
The stages of vulvar cancer typically include 0 through 4. The higher the stage is, the greater the severity:
- Stage 0 cancer refers to very early cancer that’s confined to the surface of the skin of the vulva.
- Stage 1 cancer only affects the vulva or the perineum. The perineum is the area of skin between the vaginal opening and anus. The tumor hasn't spread to the lymph nodes or other areas of the body.
- Stage 2 cancer has spread from the vulva to nearby structures, such as the lower portions of the urethra, vagina, and anus.
- Stage 3 cancer has spread to nearby lymph nodes.
- Stage 4A cancer has spread more extensively to the lymph nodes or the upper portions of the urethra or vagina. In other cases, the tumors have spread to the bladder, rectum, or pelvic bone.
- Stage 4B cancer has spread to distant organs or lymph nodes.
There are a number of tests that help your doctor stage the cancer, including the following:
- A pelvic examination is done under general or regional anesthesia so your doctor can examine the area more thoroughly.
- A CT scan can help your doctor identify enlarged lymph nodes in the groin area.
- An MRI scan can help your doctor find pelvic tumors and tumors that have spread to the brain or spinal cord.
- A cystoscopy and proctoscopy can help your doctor determine whether the cancer has spread to your bladder and rectum.
Your treatment plan will depend on the stage of your cancer. However, there are four types of standard treatments:
Laser therapy uses high-intensity light to kill cancer cells. The light beams through a thin tube called an endoscope, which is used to target and destroy the tumors. Laser therapy tends to cause less scarring and bleeding than other forms of treatment. It can often be performed on an outpatient basis, which means you can leave the hospital on the same day as treatment.
Surgery is the most common treatment for vulvar cancer. There are many different surgeries that can be performed. The type of surgery chosen will depend on the stage of your cancer and your overall health.
A local excision may be done if the cancer hasn’t spread to distant nodes or organs. The procedure involves the removal of the affected area and a small amount of normal tissue surrounding it. Lymph nodes may also be removed.
A vulvectomy is another surgical option. During this procedure, your surgeon will either remove the entire vulva during a radical vulvectomy or a portion of the vulva during a partial vulvectomy.
For advanced or severe vulvar cancer, pelvic exenteration may be performed. Depending on where the cancer has spread, your surgeon may remove the:
- lower colon
- lymph nodes
If your bladder, rectum, and colon are removed, your surgeon will create an opening called a stoma so that urine and stool can leave your body.
Radiation therapy uses high-energy radiation to shrink tumors and kill cancer cells. This type of treatment may be administered externally, which means the rays are aimed at the cancerous area from a machine. In other cases, radiation therapy may be given internally through the insertion of radioactive seeds or wires.
Chemotherapy is an aggressive form of chemical drug therapy that helps slow down or stop cancer cells from growing. It’s the preferred treatment option when the cancer is more advanced and has spread to other organs in the body. Depending on the type of medication being given, you can take the medicine orally or through your vein (IV). You can also get it as a topical cream.
In some cases, you may be able to participate in a clinical trial. Clinical trials are part of scientific research. People are chosen to receive new treatments and are monitored very carefully to evaluate the treatment’s effectiveness. Talk with your doctor about whether a clinical trial is appropriate for you.
Once you get treatment, you’ll need to go to your doctor for regular follow-up appointments. These appointments involve exams to make sure your body is healing from any procedures, to monitor for the recurrence of cancer, and to check for side effects from treatment.
Your long-term outlook depends on the stage of the cancer and the size of the tumor. The survival rate is quite high when vulvar cancer is diagnosed and treated early. In fact, the relative five-year survival rate is approximately 86 percent if the cancer is classified as stage 1. This means that 86 percent of people who are diagnosed with stage 1 vulvar cancer live for at least five years after their cancer is diagnosed. However, once vulvar cancer is more advanced and classified as stage 4, the five-year survival rate drops to about 16 percent.
It’s important to note that survival rates vary depending on:
- the type of treatment used
- the effectiveness of the treatment
- your age
- your overall health
It’s important to have a strong support network that can help you deal with the challenges that come along with a cancer diagnosis. You should speak with a counselor, family member, or close friend about any stress and anxiety you may be feeling. You might also want to consider joining a cancer support group, where you can discuss your concerns with others who can relate to what you’re experiencing. Ask your doctor about support groups in your area. You can also find information about support groups on the American Cancer Society and National Cancer Institute websites.