Your vulva is the outer part of your female organs, including your clitoris, labia majora (outer lips), labia minora (inner lips), and vulvar opening (vestibule). When abnormal cells start growing out of control in the cells in your vulva, it’s called vulvar cancer. It usually affects the edges of your vulvar lips.
The American Cancer Society estimates that only 6,200 people in the US are diagnosed with it each year.
Types of Vulvar Cancer
Squamous cell carcinoma is the most common type of vulvar cancer. It often looks like a wart.
Adenocarcinoma is a rarer type of vulvar cancer. It starts in the Bartholin glands or sweat glands on the sides of your vaginal opening.
Other rare types of vulvar cancer include melanoma and sarcoma.
It is not your fault if you develop vulvar cancer. Risks for vulvar cancers are mostly out of your hands. They include:
- History of abnormal, precancerous cells of the vulva, called vulvar intraepithelial neoplasia (VIN)
- History of human papillomavirus (HPV) infection
- Genital warts
- Age—the average age of women with invasive vulvar cancer is 70
- HIV infection
- Abnormal cells on the surface of the vulvar skin, called vulvar intraepithelial neoplasia (VIN)
- History of melanoma
Symptoms from vulvar cancer can vary, but they may include:
- Lumps with a rough or scaly surface on the genital area
- Change in color size or appearance of a mole on the outer genital area
- Burning, pain, or itching in the outer genital area
- Bleeding or discharge not related to your menstrual period
- Persistent or chronic sores on your vulva that do not heal
Having symptoms of vulvar cancer does not mean you have the disease, but it’s important to talk to your doctor and have a thorough exam. They’ll examine the inside of your vagina using a speculum and do a pelvic exam. They might also do the following tests:
This detailed exam of your cervix, vulva, and vagina uses a magnifying lens called a colposcope. Your doctor may take tissue samples (biopsies) during the test. This procedure can cause more discomfort than a Pap test, but most women tolerate it without anesthesia or pain medication.
Your doctor will take samples of abnormal-looking tissue on the vulva. The tissue samples then go to a pathologist, who looks for abnormalities in the cells under a microscope.
If your doctor suspects vulvar cancer, it’s important that you get further testing and treatment from a gynecologic oncologist. This doctor is a specialist in cancer of the gynecologic system, and they see more cases of rare cancers like vulvar cancer than other doctors.
Your gynecologic oncologist will order other tests to see if cancer has spread beyond the original tumor site. This is called staging. They may include:
- Cystoscopy, which uses a small instrument with a video camera inside your bladder to check for signs of cancer.
- Proctoscopy, which uses a small instrument with a video camera inside your rectum to check for signs of cancer.
- A CT (computed tomography) scan, which converts data from different angles of X-ray images of your body into pictures on a monitor.
- An MRI (magnetic resonance imaging) test, which uses powerful magnetic fields to create a 3D picture of your lower abdomen and pelvis to detect tumors.
- A PET (positron emission tomography) scan, which uses a small amount of radionuclide glucose (sugar) injected into a vein. The PET scanner rotates around your body and makes a picture of where glucose is being used in your body. Malignant tumor cells show up brighter than normal cells do.
Stages describe how far cancer has grown or spread outside of your vulva.
- Stage I. Cancer is found only in your vulvar area. Stage IA is when cancer has spread less than or equal to 2 cm with less than 1 mm depth. Stage IB is when cancer has spread more than 2 cm, or with greater than 1 mm depth.
- Stage II. Cancer of any size has spread to your anus, the outer half of your urethra, or the outer third of your vagina but not to your lymph nodes.
- Stage III. Cancer has spread to your groin lymph nodes. IIIA involves one lymph node that’s equal to or bigger than 5 mm or up to two lymph nodes smaller than 5 mm. IIIB involves two or more lymph nodes equal to or bigger than 5 mm or three or more lymph nodes. IIIC involves any lymph node with cancer on the outside of the nodes.
- Stage IV. Cancer has spread to areas beyond your vulva or nearby lymph nodes. Stage IVA involves organs near your vagina, such as your bladder or rectum. It can also involve fixed or ulderated groin lymph nodes. Stage IVB involves organs distant to your vagina, such as your pelvic lymph nodes, lungs, or bone.