Vulvar Cancer

The risk of developing vulvar cancer is increased by the following:

Most vulvar cancers are caused by persistent human papillomavirus (HPV) infection Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) can be sexually transmitted and causes changes in cells, which can lead to genital warts or to precancer or cancer of the cervix, vagina, vulva, anus, or throat. Different... read more .

Redness or a change in skin color of the vulva may be precancerous (indicating that cancer is likely to eventually develop).

Vulvar cancer usually causes unusual lumps or flat, smooth or rough, red, or flesh-colored sores that can be seen and felt and that do not heal. Sometimes the flat sores become scaly, discolored, or both. The surrounding tissue may contract and pucker. The sores may bleed. Melanomas may be bluish black or brown and raised. Some sores look like warts.

Many women have had itching in the vulvar area for a long time.

Typically, vulvar cancer causes little discomfort, but itching is common. Eventually, the lump or sore may bleed or produce a watery discharge (weep). These symptoms should be evaluated promptly by a doctor.

Doctors diagnose vulvar cancer by taking a sample of the abnormal skin and examining it (biopsy). The biopsy enables doctors to determine whether the abnormal skin is cancerous or just infected or irritated. The type of cancer, if present, can also be identified, helping doctors develop a treatment plan. If the skin abnormalities are not well-defined, doctors apply stains to the abnormal area to help determine where to take a sample of tissue for a biopsy. Alternatively, they may use an instrument with a binocular magnifying lens (colposcope Colposcopy Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more ) to examine the surface of the vulva—a procedure called colposcopy.

If vulvar cancer is detected and treated early, about 3 of 4 women have no sign of cancer 5 years after diagnosis. The percentage of women who are alive 5 years after diagnosis and treatment (5-year survival rate) depends on whether and how far the cancer has spread. Overall, the 5-year survival rate is about 70%.

Melanomas are more likely to spread than squamous cell carcinomas.

All or part of the vulva is surgically removed (a procedure called vulvectomy). Nearby lymph nodes are usually also removed. But sometimes doctors can instead do a sentinel lymph node What Is a Sentinel Lymph Node? dissection (removal of the first lymph node that would be affected by the cancer). Because basal cell carcinoma of the vulva does not tend to spread (metastasize) to distant sites, surgery usually involves removing only the cancer. The whole vulva is removed only if basal cell carcinoma is extensive.

To identify sentinel lymph nodes, doctors inject a blue or green dye and/or a radioactive substance into the vulva around the tumor. These substances map the pathway from the vulva to the first lymph node (or nodes) in the pelvis. During surgery, doctors then check for lymph nodes that look blue or green or that give off a radioactive signal (detected by a handheld device). Doctors remove this lymph node and send it to a laboratory to be checked for cancer. If it is cancer-free, no other lymph nodes need to be removed (unless they look abnormal). For early-stage cancers, such treatment is usually all that is needed. Doctors may remove sentinel lymph nodes on one or both sides of the vulva, depending on the size of the tumor.

If areas of cancer that measure less than 2 mm (called micrometastases) are detected in the sentinel lymph nodes, they are treated with radiation therapy. If the areas are larger (macrometastases), the lymph nodes in the groin are removed (lymphadenectomy).

For more advanced vulvar cancers, radiation therapy, often with chemotherapy (with cisplatin or fluorouracil), are usually used before vulvectomy. Such treatment can shrink very large cancers, making them easier to remove. Sometimes the clitoris and other organs in the pelvis must be removed.

For very advanced vulvar cancers, treatment may include surgery to remove all pelvic organs (called pelvic exenteration), radiation therapy, and/or chemotherapy. These organs include the reproductive organs (vagina, uterus, fallopian tubes, and ovaries), bladder, urethra, rectum, and anus. Which organs are removed and whether all are removed depend on many factors, such as the cancer's location, the woman's anatomy, and her goals after surgery. Permanent openings—for urine (urostomy) and for stool (colostomy Understanding Colostomy )—are made in the abdomen so that these waste products can leave the body and be collected in bags.

After the cancer is removed, surgery to reconstruct the vulva and other affected areas (such as the vagina) may be done. Such surgery can improve function and appearance.

Doctors work closely with the woman to develop a treatment plan that is best suited to her and takes into account her age, sexual lifestyle, and any other medical problems. Sexual intercourse is usually possible after vulvectomy.

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.