Obstetrics and Gynecology

Obstetrics and Gynecology

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Vulvar Cancer

What is Vulvar Cancer?

Vulvar cancer is cancer that starts in the vulva, the outside part of the female reproductive system that includes the labia and clitoris. The vulva opens into the vagina. It also includes the are between the vagina and anus, the perineum.

What Causes Vulvar Cancer?

Vulvar cancer most often affects the labia, the folds of skin found outside the vagina. In some cases, vulvar cancer may start on the clitoris or in glands on the sides of the vaginal opening. The majority of vulvar cancers begin in skin cells called squamous cells. The others are classified as melanoma, adenocarcinoma, sarcoma, and basal cell carcinoma. Vulvar cancer is relatively rare. The cause is unknown, but a sexually-transmitted disease such as human papilloma virus (HPV or genital warts) may play a role. Cancer of the vulva usually occurs after menopause, typically in women age 50 or older. However, 15% of cases occur in women age 40 or younger. Risk factors include previous HPV infection, previous cervical cancer or vaginal cancer, syphilis infection, diabetes, obesity, and high blood pressure. Women with a condition called vulvar intraepithelial neoplasia (VIN) have a greater risk of developing vulvar cancer that spreads. However, most cases of VIN never lead to cancer.

What are Symptoms of Vulvar Cancer?

  • Bleeding
  • Ulcer, thickening or lump (Usually on the labia majora, may be anywhere on the vulva)
  • Local itching, pain, burning
  • Pain with urination
  • Pain with intercourse
  • Unusual odor

Over 80% of women with vulvar cancer have symptoms.

Vulvar Cancer Exams and Tests Available:

The following are used to diagnose vulvar cancer:

  • Pelvic examination to look for any skin changes
  • Excisional biopsy of the lesion to make an accurate diagnosis
  • A chest X-ray is done before surgery
  • Often a CT scan of abdomen and pelvis is performed

Vulvar Cancer Treatment Options:

Surgery to remove the cancer cells is the most common treatment. For an invasive cancer, the surgery is called a modified radical vulvectomy. For pre-invasive disease (VIN), the surgery is called a partial vulvectomy or wide local excision. If the tumor is larger than 2 cm in width or has grown deeper than 1 mm into the underlying skin, the lymph nodes in the groin on the side of the tumor (or both sides) may also be removed. Occasionally, for large tumors that are close to the urethra or anus, chemotherapy will be given before surgery to shrink the tumor and make surgery more tolerable for the patient. This allows a more conservative approach and preservation of the bladder and rectum. Radiation, with or without chemotherapy, may be used to treat advanced tumors or vulvar cancer that comes back. Prognosis

Most women with vulvar cancer, are diagnosed and treated at an early stage, and do very well. However, a woman's outcome depends on the size of the tumor, the specific type of vulvar cancer, and whether the cancer has spread. Often, the cancer will come back (recur) at or near the site of the original tumor.

Possible complications may include:

  • Spread of the cancer to other areas of the body
  • Side effects of radiation, surgery, or chemotherapy
  • Swelling in the legs (lymphedema) after removing nodes or having radiation
When to contact a medical professional:

Call your health care provider if any vulvar lesion, skin color change, or local irritation persists longer than 2 weeks. A woman with vulvar cancer should see a gynecologic oncologist (a women’s cancer specialist) for management of her disease.

Vulvar Cancer Prevention:

Safe sex behaviors may decrease your risk of vulvar cancer. This includes using condoms to protect against sexually transmitted diseases. Although HPV is linked to VIN and some vulvar cancers, the role of the HPV vaccine to protect against vulvar disease is unknown. The vaccine is approved to prevent cervical cancer and pre-cancers, but it may help prevent other cancers linked to HPV, such as vulvar cancer. The vaccine is best given to young girls before they become sexually active. Routine pelvic exams can help diagnose vulvar and other cancers at an earlier stage, which improves treatment.

Vulvar Cancer Support Groups:

Last Updated: 4/20/16