Vulvar Cancer: A Comprehensive Guide
Overview
Vulvar cancer is a rare type of cancer that occurs on the outer surface area of the female genitalia. The vulva is the skin surrounding the urethra and vagina, including the clitoris and labia. Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching.
Though it can occur at any age, vulvar cancer is most commonly diagnosed in older adults. The American Cancer Society estimates that about 6,120 new cases of vulvar cancer will be diagnosed in the United States in 2023. The average age of diagnosis is 65, but the number of cases in women under 50 is increasing, possibly due to the rise in human papillomavirus (HPV) infections.
Vulvar cancer is highly treatable when found early. Treatment typically involves surgery to remove the cancer and a small amount of surrounding healthy tissue. Sometimes, additional treatments like radiation or chemotherapy are needed.
Symptoms
Vulvar cancer may not cause early symptoms. When symptoms do occur, they can include:
- Itching that doesn't go away: This is the most common symptom, affecting up to 90% of women with vulvar cancer.
- Pain or tenderness in the vulvar area.
- Bleeding that is not related to menstruation.
- Skin changes, such as color changes or thickening (the vulva may look red, pink, or white and feel rough or thickened).
- An open sore or ulcer that lasts for more than a month.
- A lump or bump, which could be red, pink, or white and may have a wart-like surface or feel hard.
- Burning sensation during urination.
- Painful intercourse (dyspareunia).
- Enlarged groin lymph nodes, which may feel like lumps in the groin area.
These symptoms can also be caused by non-cancerous conditions, such as infections or skin disorders. However, it's important to see a healthcare provider if you experience any persistent symptoms.
Causes and Risk Factors
The exact cause of vulvar cancer is unknown, but certain factors can increase your risk:
Risk Factors
- Age: The risk increases with age, with most cases occurring in women over 65.
- HPV infection: Infection with certain strains of HPV, particularly HPV-16 and HPV-18, increases the risk. HPV is responsible for about 30% of vulvar cancers, according to the Centers for Disease Control and Prevention (CDC).
- Smoking: Smoking increases the risk of vulvar cancer, especially in women with HPV infections.
- Weakened immune system: Women with weakened immune systems, such as those with HIV or taking immunosuppressant drugs, have a higher risk.
- History of precancerous conditions: Vulvar intraepithelial neoplasia (VIN) is a precancerous condition that increases the risk of vulvar cancer.
- Skin conditions: Chronic skin conditions affecting the vulva, such as lichen sclerosus, can increase the risk.
- Personal history of other cancers: Women who have had cervical cancer or vaginal cancer have an increased risk of vulvar cancer.
- Melanoma or atypical moles: These can increase the risk of vulvar melanoma, a rare type of vulvar cancer.
Having one or more risk factors doesn't mean you will develop vulvar cancer. Many women with risk factors never develop the disease, while some women with no known risk factors do.
Diagnosis
Diagnosing vulvar cancer typically involves several steps:
- Medical history and physical exam: Your healthcare provider will ask about your symptoms and medical history, followed by a physical exam of the vulva and pelvis.
- Colposcopy: A special instrument called a colposcope is used to magnify the vulva and look for abnormal areas.
- Biopsy: If an abnormal area is found, a small sample of tissue is removed and examined under a microscope to check for cancer cells. This is the only definitive way to diagnose vulvar cancer.
- Imaging tests: If cancer is found, imaging tests like CT scans, MRIs, or PET scans may be used to determine the extent (stage) of the cancer.
- Lymph node assessment: Since vulvar cancer can spread to the lymph nodes, your doctor may perform a sentinel lymph node biopsy or lymphadenectomy to check for cancer spread.
Staging is crucial for determining the best treatment plan. Vulvar cancer is staged from I to IV, with stage I being the earliest and most treatable, and stage IV indicating advanced cancer that has spread to other parts of the body.
Treatment Options
Treatment for vulvar cancer depends on the type and stage of the cancer, as well as your overall health and preferences. Options may include:
Surgery
- Excision: Removing the cancer and a small amount of surrounding healthy tissue.
- Vulvectomy: Removing part or all of the vulva. This can be a partial (simple) vulvectomy or a radical vulvectomy, depending on the extent of the cancer.
- Lymph node removal: If the cancer has spread to the lymph nodes, some or all of the lymph nodes in the groin may be removed.
- Reconstructive surgery: In some cases, skin grafts or flaps may be used to reconstruct the vulva after surgery.
Radiation Therapy
High-energy beams, such as X-rays or protons, are used to kill cancer cells. Radiation may be used before surgery to shrink a tumor, after surgery to kill any remaining cancer cells, or as the primary treatment if surgery isn't an option.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be used in combination with radiation therapy (chemoradiation) for advanced vulvar cancer or if the cancer has spread to other parts of the body.
Targeted Therapy
Targeted therapy drugs focus on specific abnormalities present within cancer cells. For example, some vulvar cancers may be treated with drugs that target the EGFR pathway.
Immunotherapy
Immunotherapy helps your immune system recognize and attack cancer cells. This treatment is still being studied for vulvar cancer but shows promise for certain types.
Clinical Trials
Clinical trials offer access to new treatments and approaches that are not yet widely available. Talk to your doctor about whether a clinical trial might be right for you.
Living with Vulvar Cancer
Living with vulvar cancer can be challenging, but there are ways to manage symptoms and improve your quality of life:
- Manage pain and discomfort: Over-the-counter pain relievers, prescribed medications, or topical creams can help with pain and itching. Always consult your healthcare provider before taking new medications.
- Practice good hygiene: Keep the vulvar area clean and dry to prevent infections. Use mild, unscented soap and avoid douching.
- Wear comfortable clothing: Choose loose-fitting, cotton underwear and avoid tight clothing that can irritate the vulva.
- Stay active: Gentle exercise, such as walking or yoga, can help reduce fatigue and improve your mood.
- Seek support: Join a support group for women with vulvar cancer, either in-person or online. Talking to others who understand what you're going through can be incredibly helpful.
- Communicate with your partner: Vulvar cancer can affect your sexual health and intimacy. Open communication with your partner and guidance from a healthcare provider or counselor can help.
- Follow-up care: Regular follow-up appointments are crucial to monitor for recurrence and manage any long-term side effects of treatment.
Prevention
While there's no sure way to prevent vulvar cancer, you can take steps to reduce your risk:
- Get the HPV vaccine: The HPV vaccine protects against the types of HPV that are most likely to cause vulvar cancer. The CDC recommends the vaccine for girls and boys starting at age 11 or 12, but it can be given as early as age 9 and up to age 45.
- Practice safe sex: Using condoms and limiting your number of sexual partners can reduce your risk of HPV and other sexually transmitted infections (STIs).
- Don't smoke: If you smoke, quit. If you don't smoke, don't start. Smoking increases the risk of vulvar cancer, especially in women with HPV.
- Get regular pelvic exams: Regular exams can help detect precancerous conditions or early-stage vulvar cancer.
- Be aware of your body: Pay attention to any changes in your vulvar area and report them to your healthcare provider.
- Manage chronic skin conditions: If you have a chronic skin condition like lichen sclerosus, work with your healthcare provider to manage it effectively.
Complications
If left untreated, vulvar cancer can lead to serious complications, including:
- Spread of cancer: Vulvar cancer can spread (metastasize) to nearby organs, such as the vagina, urethra, or anus, and to distant organs like the lungs or liver.
- Lymph node involvement: Cancer that spreads to the lymph nodes can lead to swelling, pain, and an increased risk of the cancer spreading further.
- Recurrence: Even after successful treatment, vulvar cancer can recur. Regular follow-up care is essential to catch any recurrence early.
- Sexual dysfunction: Treatment for vulvar cancer, especially surgery, can affect sexual function and intimacy.
- Emotional and psychological impact: A diagnosis of vulvar cancer can lead to anxiety, depression, and other emotional challenges.
- Infections: Advanced vulvar cancer can lead to infections due to the breakdown of skin and tissues.
Early detection and treatment can significantly reduce the risk of these complications.
When to Seek Emergency Care
Seek immediate medical attention if you experience any of the following:
- Severe pain in the vulvar area that is not relieved by over-the-counter pain medications.
- Heavy or uncontrolled bleeding from the vulva.
- Signs of infection, such as fever, chills, or foul-smelling discharge from the vulva.
- Severe swelling or sudden increase in the size of a lump or sore on the vulva.
- Difficulty urinating or having a bowel movement due to a vulvar mass.
- Signs of advanced cancer, such as unexplained weight loss, severe fatigue, or pain in the bones or other parts of the body.
These symptoms can indicate a serious condition that requires prompt medical evaluation. Do not wait for a scheduled appointment—go to the nearest emergency room or call your healthcare provider immediately.
Additional Resources
For more information about vulvar cancer, visit these reputable sources: