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Vulvar Cancer

Vulvar Cancer

The vulva is a woman’s external genitalia and includes:

  • Inner and outer lips of the vagina
  • Clitoris (sensitive tissue between the lips)
  • Opening of the vagina and its glands
  • Mons pubis (the rounded area in front of the pubic bones that becomes covered with hair at
    puberty)
  • Perineum (the area between the vulva and the anus

 

Risk factors:

  • Older age
  • Having HPV
  • History of genital warts
  • High number of sexual partners
  • First sexual encounter at a young age
  • History of abnormal pap smears
  • History of other cancers (melanoma, cervical)
  • Lichen sclerosis
  • HIV
  • Smoking

 

Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the vulva. Vulvar cancer often does not cause early signs or symptoms. The most common complaints may also be caused by other conditions and it is important to check with a doctor if you have any of the following:

  • Vulvar tissue that is thickened, lighter or darker than surrounding tissue.
  • Itching in the vulvar area that does not go away.
  • A lump or growth on the vulva that looks like a wart or ulcer.
  • Bleeding not related to menstruation (periods).
  • Pain in the vulvar area

Testing used to diagnose vulvar cancer include:

  • Health history of any reported symptoms.
  • Physical exam to examine the vulva for abnormalities.
  • Biopsy of abnormal vulvar tissue, sent to pathology for diagnosis.
  • Imaging tests take pictures inside the body to see if there is a tumor. They can also show if and how
    far the cancer has spread. This may include an ultrasound, CT scan, PET scan or MRI.

Treatment for vulvar cancer will be individualized and based on physical exam, pathology results and imaging.
Treatment may include:

  • Surgical resection to remove the abnormal tissue without any loss of the woman’s sexual function, but is based on location. May require more than one surgery, depending on margin status and depth of invasion.
  • Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
  • Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.

Ways you can reduce your risk of developing vulvar cancer:

  • Obtain routine health screenings including well women exams and pap smears.
  • Don’t smoke or stop smoking.
  • Practice safe sexual practices by limiting partners and using condoms.
  • Get the HPV vaccine – This vaccine is available for all boys and girls aged 9 and 26 and is
    approved by the FDA &CDC for adults aged 27-45.
  • The HPV vaccine is not recommended for everyone older then 27 and is most
    effective when given at a young age, before exposure to HPV.
  • However, older individuals at risk for acquiring a new HPV infection in the future with new partners, might benefit from vaccination.

Staging is based on:

  • The size of the tumor : How large and deep has the cancer grown? Has the cancer reached nearby structures or organs like the bladder or rectum?
  • The spread to nearby lymph nodes
  • The spread to distant lymph nodes or distant organs

Staging can be complex and further explanation will be provided by your physician.

FIGO stage Stage description
IA The cancer is in the vulva or the perineum (the space between the rectum and the vagina) or both and has grown no more than 1 mm into underlying tissue (stroma) and is 2 cm or smaller (about 0.8 inches)

It has not spread to nearby lymph nodes or to distant sites .
IB The cancer is in the vulva or the perineum or both and is either more than 2 cm (0.8 inches) or it has grown more than 1 mm (0.04 inches) into underlying tissue (stroma)

It has not spread to nearby lymph nodes or to distant sites .
II The cancer can be any size and is growing into the anus or the lower third of the vagina or urethra (the tube that drains urine from the bladder).

It has not spread to nearby lymph nodes or to distant sites .
IIIA Cancer is in the vulva or perineum or both  and may be growing into the anus, lower vagina, or lower urethra.

It has either spread to a single nearby lymph node with the area of cancer spread 5 mm or more OR it has spread to 1 or 2 nearby lymph nodes with both areas of cancer spread less than 5 mm.

It has not spread to distant sites.
IIIB Cancer is in the vulva or perineum or both and may be growing into the anus, lower vagina, or lower urethra

The cancer has spread either to 3 or more nearby lymph nodes, with all areas of cancer spread less than 5 mm ; OR the cancer has spread to 2 or more lymph nodes with each area of spread 5 mm or greater.

It has not spread to distant sites.
IIIC Cancer is in the vulva or perineum or both and may be growing into the anus, lower vagina, or lower urethra .

The cancer has spread to nearby lymph nodes and has started growing through the outer covering of at least one of the lymph nodes (called extracapsular spread.

It has not spread to distant sites.
IVA Cancer is in the vulva or perineum or both  and may be growing into the anus, lower vagina, or lower urethra.

The cancer has spread to nearby lymph nodes and has become stuck (fixed) to the underlying tissue or has caused an ulcer(s) to form on the lymph node(s)(ulceration) .

It has not spread to distant sites .
IVA The cancer has spread beyond nearby tissues to the bladder, rectum, pelvic bone, or upper part of the urethra or vagina .

It might or might not have spread to nearby lymph nodes. It has not spread to distant sites.
IVB The cancer has spread to distant lymph nodes (pelvic) or organs such as lung or bone . The cancer can be any size and might or might not have spread to nearby organs.

It might or might not have spread to nearby lymph nodes.

For more information on Vulvar Cancer Stages: 

https://www.cancer.org/cancer/vulvar-cancer/detection-diagnosis-staging/staging.html

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