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Vulvar Cancer

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:

  • Adenocarcinoma
  • Melanoma
  • Sarcoma
  • Basal cell carcinoma

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.

Signs & Symptoms of Vulvar Cancer

As with most other cancers, vulvar cancer may not cause any symptoms in its early stages. When symptoms do occur, they can include:

  • A lump or growth on the vulva that looks like a wart or ulcer
  • Itching in the vulvar area that does not go away
  • Bleeding not related to menstruation (periods)
  • Pain or tenderness in the vulvar area

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.

Risk Factors and Prevention

Although the exact cause of vulvar cancer isn't known, certain factors appear to increase your risk of the disease. These include: 

  • Older age. Most vulvar cancers are found in women over the age of 50.
  • Smoking. Smoking tobacco may increase a woman’s risk of developing vulvar cancer.
  • Having human papillomavirus (HPV) infection. HPV may be responsible for about one-third to two-thirds of all vulvar cancers. 
  • Having vulvar intraepithelial neoplasia (VIN). VIN is a premalignant growth of cells on the vulva and is treated differently from invasive cancer.
  • Having a deficient immune system. Women with lowered immune systems have a higher risk of developing vulvar cancer. 

Other possible risk factors for developing vulvar cancer include the following:

  • Having many sexual partners
  • Having first sexual intercourse at a young age
  • Having a history of abnormal Pap tests (Pap smears)

Reducing your risks of vulvar cancer means reducing your risk of the sexually transmitted infection HPV. To do this, take preventative measures such as: 

  • Limiting your number of sexual partners. The more sexual partners you have, the greater your risk of exposure to HPV.
  • Using a condom during sex. Condoms can’t fully protect against HPV, but they may reduce your risk of contracting it. 
  • Getting the HPV vaccine. The HPV vaccine may protect against the strains of the virus most associated with vulvar cancer.

Detecting & Diagnosing Vulvar Cancer

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:

  • Biopsy. The removal of cells or tissues from the vulva so they can be viewed under a microscope by a pathologist to check for signs of cancer.
  • Colposcopy. A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for disease signs.
  • CT scan (CAT scan). This procedure makes a series of detailed pictures of areas inside the body taken from different angles. The images are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan (positron emission tomography scan). A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • MRI (magnetic resonance imaging). A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Vulvar Cancer Staging 

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.

Types of Treatment for Vulvar Cancer

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:

Gynecologic Cancer Surgery

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.

Radiation Therapy

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.

  • External radiation therapy uses a machine outside the body to send radiation to the intended area.
  • Internal radiation therapy involves placing hollow tubes in the vagina next to the tumor. A precise dose of radiation can be inserted into the tubes and directly applied to the cancer. The radioactive substance is left in place in the vagina for several minutes, and patients must stay in bed during this time. These are most often done as outpatient procedures.

Chemotherapy

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.

Compass Oncology - The US Oncology Network