The 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 vulva, it’s called vulvar dsyplasia, which can lead to vulvar cancer.
The American Cancer Society estimates that only 6,300 people in the US are diagnosed with it each year.
Types of Vulvar Cancer
Only 6% of cancers found in women’s reproductive organs are vulvar cancer, and 1% of all female cancers.
The most common type of vulvar cancer is squamous cell carcinoma. This type of vulvar cancer starts in the thin cells that line the vulva’s surface and 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 the 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 65
- Weakened immune system, such as those who have previous undergone organ transplant and are taking medications to suppress your immune system, or a known HIV infection.
- Abnormal cells on the surface of the vulvar skin, called vulvar intraepithelial neoplasia (VIN)
- History of melanoma
Reducing Your Risk
Although any woman can develop vulvar cancer, there are steps that can be taken to reduce your risk, including:
- HPV vaccine. Being vaccinated for the human papillomavirus before the age of 26 can reduce your risk for developing vulvar cancer. However, you can be vaccinated up to age 45, if your clinician decides that the HPV vaccine is right for you. Male partners can also be vaccinated against HPV to prevent the spread of the virus.
- Condoms and dental dams. Utilizing protection during sex can prevent contracting HPV from your partner.
- Pelvic exams. While there’s no screening test for vulvar cancer, a regular pelvic exam from your doctor can identify anything that needs to be checked.
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
- Pelvic pain during sex
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 the vagina using a speculum and do a pelvic exam. They might also do the following tests:
This detailed exam of the 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 well with the use of local anesthesia.
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. Uses a small instrument with a video camera inside the bladder to check for signs of cancer.
- Proctoscopy. Uses a small instrument with a video camera inside the rectum to check for signs of cancer.
- A CT (computed tomography) scan. Converts data from different angles of X-ray images of the body into pictures on a monitor.
- An MRI (magnetic resonance imaging) test. Uses powerful magnetic fields to create a 3D picture of the lower abdomen and pelvis to detect tumors.
- A PET (positron emission tomography) scan. Uses a small amount of radionuclide glucose (sugar) injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter than normal cells do.
Stages describe how far cancer has grown or spread outside of the vulva.
- Stage I. Cancer is found only in the 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 the anus, the outer half of the urethra, or the outer third of the vagina but not to the lymph nodes.
- Stage III. Cancer has spread to the 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 the vulva or nearby lymph nodes. Stage IVA involves organs near the vagina, such as the bladder or rectum. It can also involve fixed or ulcerated groin lymph nodes. Stage IVB involves organs distant to the vagina, such as pelvic lymph nodes, lungs, or bone.