Vulvar Cancer

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Vulvar Cancer: What You Need to Know

Vulvar Cancer: What You Need to Know

Table of Contents

What is Vulvar Cancer?

Vulvar cancer develops in the tissues of the vulva, the external genital area of women and people assigned female at birth (AFAB). The vulva includes several parts:

  • Labia minora (inner lips): Thin tissue folds around the vaginal opening.
  • Labia majora (outer lips): Larger, fleshy folds that surround the inner lips.
  • Clitoris: The sensitive tissue above the vaginal opening.
  • Vaginal opening: The canal used for sex, childbirth, and menstruation.
  • Urethral opening: The tube that allows urine to exit the body.
  • Mons pubis: The rounded area in front of the pubic bones, covered with hair after puberty.
  • Perineum: The skin between the vagina and anus.

Vulvar cancer typically grows slowly, often starting with precancerous lesions called vulvar intraepithelial neoplasia (VIN).

Types of Vulvar Cancer

Vulvar cancer is classified based on the type of cells where the cancer begins. The most common types are:

  • Vulvar Squamous Cell Carcinoma: Makes up about 90% of cases. It starts in the skin cells.
  • Vulvar Melanoma: Accounts for around 5% of cases and spreads more rapidly.

Other rare types include:

  • Basal cell carcinoma
  • Bartholin gland adenocarcinoma
  • Paget disease of the vulva
  • Sarcoma
  • Verrucous carcinoma

How Common is Vulvar Cancer?

Vulvar cancer is rare, with fewer than 6,500 new cases diagnosed annually in the United States. It is more common in older adults, with 80% of cases occurring in people over 50. The average age of diagnosis is 68.

Symptoms of Vulvar Cancer

Vulvar cancer often doesn’t cause symptoms in its early stages. When symptoms do appear, they may include:

  • Skin changes: Darker, lighter, or white patches of skin.
  • Lumps or growths: These may look like warts, bumps, or sores that don’t heal.
  • Itching or burning: Persistent discomfort that doesn’t go away.
  • Bleeding: Unexplained bleeding unrelated to periods.
  • Pain or tenderness: Especially during sex or urination.

If you notice any of these symptoms, consult a healthcare provider as soon as possible.

What Causes Vulvar Cancer?

Vulvar cancer occurs when cells in the vulva grow uncontrollably. The two main conditions linked to vulvar cancer are:

  • Human Papillomavirus (HPV): A common sexually transmitted infection that can cause changes in cells, increasing the risk of vulvar and other cancers.
  • Lichen Sclerosus: A chronic skin condition that causes itching and skin thinning, which may lead to cancer.

Risk Factors for Vulvar Cancer

Factors that increase the risk of vulvar cancer include:

  • Age: The risk rises after age 50.
  • HPV infection: Certain strains of HPV can lead to cancer.
  • Skin conditions: Chronic conditions like lichen sclerosus.
  • Weakened immune system: HIV or other conditions that lower immunity.
  • Smoking: Smoking raises the risk of vulvar and other cancers.
  • Precancerous lesions: Untreated vulvar intraepithelial neoplasia (VIN) can progress to cancer.

How is Vulvar Cancer Diagnosed?

Diagnosing vulvar cancer involves a combination of tests:

  • Pelvic Exam: A visual and physical examination of the vulva for unusual skin changes, lumps, or abnormalities.
  • Pap Smear and HPV Test: A sample of cells is tested for cancer or HPV infection.
  • Colposcopy: A magnifying device is used to closely examine the vulva, cervix, and vagina.
  • Biopsy: A sample of tissue is removed and tested for cancer cells.

To check if cancer has spread, additional tests may include:

  • Imaging tests (CT scans, MRIs, or PET scans) to check other tissues.
  • Sentinel Node Biopsy: A test to see if cancer has spread to nearby lymph nodes.
  • Scope exams (cystoscopy or proctoscopy) to check for cancer in the bladder, rectum, or anus.

Stages of Vulvar Cancer

Cancer staging helps determine how far the cancer has spread:

  • Stage I: Cancer is confined to the vulva or perineum.
  • Stage II: Cancer has spread to nearby areas like the vagina or anus.
  • Stage III: Cancer has spread to lymph nodes.
  • Stage IV: Advanced cancer has spread to distant organs.

Treatment Options for Vulvar Cancer

Treatment depends on the stage of cancer and overall health. Common treatments include:

1. Surgery

  • Laser Surgery: Removes cancerous cells with a focused laser.
  • Local Excision: Removes the tumor and surrounding healthy tissue.
  • Vulvectomy: Removes part or all of the vulva. Skin grafts may be used to repair the area.
  • Pelvic Exenteration: Removes multiple organs (e.g., bladder, rectum) if cancer has spread widely.

2. Radiation Therapy

Radiation uses high-energy rays to kill cancer cells. It is often combined with chemotherapy and can be given before surgery to shrink tumors or after surgery to eliminate remaining cancer cells.

3. Chemotherapy

Drugs like cisplatin and fluorouracil are used to kill cancer cells. These drugs can be applied as a cream to treat localized cancer or administered through pills or injections for advanced cases.

4. Immunotherapy

Medications like imiquimod cream boost the immune system to fight cancer locally.

Follow-Up Care After Treatment

After treatment, regular check-ups are essential to monitor for recurrence or complications. These check-ups may include pelvic exams, imaging tests, and biopsies.

Conclusion

Vulvar cancer is rare but treatable, especially if caught early. Being aware of the symptoms, understanding risk factors, and seeking timely medical advice can improve outcomes. If you notice any unusual changes in your vulva, don’t hesitate to consult a healthcare provider.

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