Vulvar Cancer

Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40.

Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. A doctor should be seen if there is bleeding or discharge not related to menstruation (periods), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough.

Our patients with vulvar cancer are treated at the Moores Gynecological Cancer Unit. See the Gynecological Cancer Unit for more information.

You can also review the tabs at top of this page for information on vulvar cancer symptoms and risks, diagnosis, and treatment.

Types of vulvar cancers

Over 90% of vulvar cancers are squamous cell carcinomas, which form slowly over many years. They may be preceded by pre-cancerous changes called vulvar intraepithelial neoplasia (VIN), which is also called dysplasia. Because it is possible for VIN or dysplasia to develop into vulvar cancer, treatment of this condition is very important.

Additional types include:

• Melanoma, representing about 2% to 4%
• Adenocarcinomas, which develop from glands. Paget disease of the vulva, in which abnormal cells are found in the vulvar skin, can be a precancerous condition that develops into adenocarcinoma.
• Sarcomas, tumors of connective tissues under the skin. Less than 2% of vulvar cancers, these tend to grow rapidly.
• Verrucous carcinoma, which resembles a large wart
• Basal cell carcinoma, a very rare type of vulvar cancer

Symptoms

Most patients with vulvar cancer do not have symptoms. However, it is possible to notice the following:

• Vulvar itching that does not improve
• A change in skin color around the vulva (more red, lighter or darker than surrounding skin)
• A change in the feel of your skin around the vulva (thicker, scalier, rougher or bumpier)
• Wart-like bump or bumps, ulcers, or sores
• Pain when urinating
• Burning or bleeding and discharge not related to your menstrual cycle
• Enlarged glands in your groin

Risk factors

While the cause of this rare cancer is unknown, doctors have identified possible risk factors. It's important to keep in mind that having one or more risk factors doesn't mean you are going to develop cancer.

If you have questions or concerns, ask your physician or schedule a consultation with one of UCSD's gynecologic oncologists.

Possible risk factors include:

• Age: Many women diagnosed with vulvar cancer are in their 70s or older.
• Human Papilloma Virus (HPV) infection: HPV is thought to be responsible for most of the vulvar cancers in younger women.
• Vulvar Intraepithelial neoplasia (VIN), also called dysplasia
• Human immunodeficiency virus (HIV) infection
• Lichen sclerosus: This is a disorder than can cause the vulvar skin to become itchy, very thin and subject to lesions and scarring. Although most lichen sclerosus is not precancerous, about 4% of women with this condition develop vulvar cancer.
• Melanoma or atypical moles on nonvulvar skin
• Smoking

Your doctor will take a complete medical history to look for risk factors, then perform a physical exam, including a pelvic examination. Additional tests may include:

• A Pap test, to check cells from the cervix and vagina.
• Colposcopy of the vulva, in which a special instrument is used to magnify your cervix, vagina and vulva.  A biopsy (tissue sample) may be taken and examined by a pathologist in the lab.
• Endoscopic tests to determine if the cancer has spread to other organs, such as the rectum or colon.  These may include a proctoscopy or cystoscopy.
• Imaging studies such as a chest X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan, or Positron Emission Tomography (PET) scan

Stages

A process called staging is used to determine how much a cancer has spread and what treatment options will be considered.  According to the National Cancer Institute, the following stages are used for vulvar cancer.

• Stage 0 (Carcinoma in Situ): Cells are found on the surface of the vulvar skin. These abnormal cells may become cancer and spread into nearby normal tissue.
• Stage I: Cancer has formed and is found in the vulva only or in the vulva and perineum (area between the rectum and the vagina). The tumor is 2 centimeters or smaller and has spread to the epidermis of the vulva. 
• Stage IA: The tumor has spread 1 millimeter or less beneath the epidermis.
• Stage IB: The tumor has spread more than 1 millimeter beneath the epidermis.
• Stage II: Cancer is found only in the vulva or the vulva and perineum (space between the rectum and the vagina), and the tumor is larger than 2 centimeters.
• Stage III: Cancer is of any size and either:
• is found only in the vulva or the vulva and perineum and has spread to nearby lymph nodes in one groin,or
• has spread to nearby tissues such as the lower part of the urethra and/or vagina or anus, and may have spread to nearby lymph nodes in one groin
• Stage IVA: Cancer has spread to nearby lymph nodes in both groins, or has spread beyond nearby tissues to the upper part of the urethra, bladder, or rectum, or has attached to the pelvic bone and may have spread to lymph nodes.
• Stage IVB: Cancer has spread to distant parts of the body.

Treatment for vulvar cancer is either local (removal or destruction of cells in a certain area) or systemic (to destroy or control cancer cells throughout the entire body). The three standard treatments for vulvar cancer are surgery, radiation therapy, and chemotherapy.

Surgery

Surgery removes the cancer while keeping as much of the surrounding tissue as possible. Your options may include:

• Laser surgery: Uses a laser beam to burn off abnormal cells on the vulva.
• Excision: Taking out the cancer and some of the healthy tissue around it.
• Vulvectomy: Surgery to remove all or part of the vulva
• Inguinal (groin) node dissection: Removal of lymph nodes in the groin, if the cancer has spread
• Depending on the stage of the cancer, some patients will receive additional treatment such as radiation after surgery. Treatment given after surgery is called adjuvant therapy.

Radiation therapy

Radiation therapy is used in the treatment of a wide variety of gynecologic cancers. It may be used alone in early stage tumors or combined with chemotherapy in locally advanced disease. In addition, it may be used before or after surgery.

• High-Dose Brachytherapy is a form of internal radiation therapy where radioactive sources are placed inside the body, close to the tumor.  Methods used at UCSD include cylinder, interstitial, tandem and ovoid, and tandem and ring.
• Image Guided Radiation Therapy (IGRT) is a form of external-beam radiation that uses sophisticated technologies to locate the tumor and improve treatment accuracy so that healthy tissue is not harmed.
• Intensity Modulated Radiation Therapy (IMRT) is another state-of-the-art external beam radiation therapy that improves delivery precision, thereby minimizing dosage to surrounding normal tissue. UCSD’s Dr. Arno Mundt pioneered the use of IMRT in gynecologic cancers.
  

Chemotherapy

Chemotherapy is the administration of drugs by mouth, injection or IV to kill cancer cells. One of the unique aspects of gynecologic oncology is that specialists in this field are specially trained in chemotherapy for cancers of women’s reproductive organs. With their advanced knowledge, gynecologic oncologists can select the best drug combinations for each patient, manage complications and minimize side effects.