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Vulvar Cancer

Illustration of the anatomy of the female pelvic area
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What is the vulva?

The vulva is the external portion of the female genital organs. It includes:

  • Labia majora - two large, fleshy lips, or folds of skin

  • Labia minora - small lips that lie inside the labia majora and surround the openings to the urethra and vagina

  • Vestibule - space where the vagina opens

  • Prepuce - a fold of skin formed by the labia minora

  • Clitoris - a small protrusion sensitive to stimulation

  • Fourchette - area beneath the vaginal opening where the labia minora meet

  • Perineum - area between the vagina and the anus

  • Anus - opening at the end of the anal canal

  • Urethra - connecting tube to the bladder

What is vulvar cancer?

Vulvar cancer is a malignancy that can occur on any part of the external organs, but most often affects the labia majora or labia minora. According to the American Cancer Society, about 3,9000 cases of cancer of the vulva will be diagnosed in the US in 2010. Cancer of the vulva is a rare disease, which accounts for 0.6 percent of all cancers in women, and may form slowly over many years. Nearly 90 percent of vulvar cancers are squamous cell carcinomas. Melanoma is the second most common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include:

  • Adenocarcinoma

  • Paget's disease

  • Sarcomas

  • Verrucous carcinoma

  • Basal cell carcinoma

  • Bertholin gland

What are risk factors for vulvar cancer?

The following have been suggested as risk factors for vulvar cancer:

  • Age - of the women who develop vulvar cancer, over 80 percent are over age 50, and half are over age 70

  • Infection with the human papillomavirus (HPV)

  • Human immunodeficiency virus (HIV) infection

  • Lichen sclerosus - can cause the vulval skin to become very itchy and may slightly increase the possibility of vulvar cancer

  • Melanoma or atypical moles on non-vulvar skin - a family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer

  • Vulvar intraepithelial neoplasia (VIN) - there is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer

  • Other genital cancers

  • Smoking

What are the symptoms of vulvar cancer?

The following are the most common symptoms of vulvar cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • Constant itching

  • Changes in the color and the way the vulva looks

  • Bleeding or discharge not related to menstruation

  • Severe burning/itching or pain

  • Skin of the vulva looks white and feels rough

The symptoms of vulvar cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

How can vulvar cancer be prevented?

The cause of vulvar cancer is not known at this time, however, certain risk factors are suspected as contributors to the development of the disease. Suggestions for prevention include:

  • Avoid known risk factors when possible

  • Delay onset of sexual activity

  • Use condoms

  • Do not smoke

  • Have regular physical checkups

  • Get vaccinated against HPV

  • Have routine Pap tests and pelvic examinations

  • Routinely check entire body for irregular growth of moles

How is vulvar cancer diagnosed?

Vulvar cancer is diagnosed by biopsy, removing a section of tissue for examination in a laboratory by a pathologist.

Treatment for vulvar cancer:

Specific treatment for vulvar cancer will be determined by your physician(s) based on:

  • Your overall health and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment for patients with cancer of the vulva may include:

  • Surgery, including:

    • Laser surgery - use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells

    • Excision - the cancer cells and a margin of normal appearing skin around the cancer is removed

    • Vulvectomy - surgical removal of part of all of the tissues of the vulvar

  • Radiation therapy

  • Chemotherapy