Vulvar Cancer

 

OVERVIEW

The vulva is the external part of the female reproductive system. It has two skin folds: the labia majora and the labia minora. These inner and outer labia protect the opening of the vagina and urethra, the short tube that connects to the bladder.

Vulvar cancer is most common on the inner edges of the labia majora or labia minora. Cancer occurs less frequently on the clitoris or the Bartholin's glands, which are small mucus-producing glands on either side of the opening of the vagina. Squamous cell carcinomas, which is a skin cancer that begins in squamous cells, account for about 90 percent of vulvar cancers. This type of slow-growing cancer is usually preceded by pre-cancerous changes that may last for several years. The pre-cancerous condition is called vulva intraepithelial neoplasia. Melanoma (a type of skin cancer) accounts for about 4 percent of vulvar cancers. Other types of vulvar cancer include adenocarcinomas and sarcomas.

In the United States, vulvar cancer accounts for about 4 percent of gynecologic cancers. In 2007, the American Cancer Society estimates that about 3,500 new cases of vulvar cancer will be diagnosed in the United States.

The Cancer Center's Division of Gynecologic Oncology also provides:

  • minimally invasive laparoscopic surgical procedures
  • a twice-monthly gynecologic oncology clinic
  • sophisticated diagnoistic testing and imaging studies 
  • crinical trials to investigate new medications and treatment methods
  • monthly meetings of the Gynecologic Tumor Board, where cases are discussed and treatment plans are developed by a multidisciplinary team of cancer specialists
  • a full range of support services

 

RISK FACTORS

At least 40 percent of all cases of vulvar cancer are related to infection with the human papillomavirus (HPV). Other risk factors include:

  • increased age (two-thirds of women are over age 70 when first diagnosed)
  • infection with HIV (human immunodeficiency virus)
  • chronic vulvar inflammation resulting from infection and poor hygiene
  • a personal history of cervical cancer or melanoma
  • having the pre-cancerous condition vulvar intraepithelial neoplasia
  • having lichen sclerosis, a skin disease that causes the vulvar skin to be thin and itchy

 

SYMPTOMS

Many women develop a pre-cancerous condition of the vulva called vulvar intraepithelial neoplasia (VIN). Symptoms of this include persistent itching that does not improve and areas of skin in the vulva that are thicker and lighter in color than the surrounding skin. Invasive squamous cell vulvar cancers resemble VIN and progress until a distinct tumor is recognized.

Symptoms of squamous cell vulvar cancer include:

  • a red, pink, or white bump or bumps with a wart-like and/or raw surface
  • white and rough vulva
  • pain
  • burning
  • painful urination
  • bleeding
  • a discharge not associated with a normal menstrual period
  • an ulcer that lasts longer than a month

Symptoms of vulvar melanoma include a darkly pigmented growth or a change in a mole that has been present for years. Symptoms of other types of vulvar cancers that are less common include a distinct mass on either side of the vaginal opening; a red-scaly area on the vulva; and cauliflower-like growths.

 

TREATMENT SERVICES

The three main methods used to treat vulvar cancer are surgery, radiation therapy, and chemotherapy. A combination of methods may be used.

Surgery

There are several different surgical approaches used to treat vulvar cancer. Your physician will decide which is the best for you, depending on the stage, type, and grade of the cancer, any spread of cancer, your overall health, your age, and other factors:

  • laser surgery to vaporize a layer of skin containing pre-invasive vulvar cancer
  • excision (removal of the cancerous lesion and some surrounding normal tissue)
  • skinning vulvectomy (removal of the top layer of the vulva only)
  • simple vulvectomy (removal of the entire vulva)
  • partial radical vulvectomy (removal of part of the vulva including deep tissue)
  • complete radical vulvectomy (removal of the entire vulva and deep tissue, including the clitoris)
  • groin dissection (removal of lymph nodes near the vulva)

For patients with vulvar adenocarcinoma with Paget's disease and no invasive carcinoma, treatment is wide local excision or a simple vulvectomy. If cancer invades a Bartholin's gland or the vulvar sweat glands, a radical vulvectomy is usually performed, combined with removal of inguinal (groin) lymph nodes on one or both sides of the body. For vulvar melanoma, a partial vulvectomy is usually performed.

Radiation Therapy and Chemotherapy

External beam radiation therapy (beams are directed to the cancer site from outside the body) may be used alone or in combination with chemotherapy to shrink a vulvar tumor before surgery.