Vulvar Cancer

Cancer of the vulva (the area of the external female genitals) most often occurs after menopause. The average age at which vulvar cancer is diagnosed is 70 years.

The risk of developing vulvar cancer is higher in women who have persistent itching of the vulva, have or had genital warts due to human papillomavirus (HPV), or had cancer of the vagina or cervix.

The large majority of vulvar cancers are skin cancers that develop near or at the opening of the vagina. Squamous cell carcinomas are the most common. Melanomas and basal cell carcinomas are much less common. Rare types include Paget's disease and cancer of Bartholin's glands (the small glands adjacent to the opening of the vagina that secrete fluid for lubrication during intercourse).

Vulvar cancer begins on the surface of the vulva. Most of these cancers grow slowly, remaining on the surface for years. However, some grow quickly. Untreated, vulvar cancer can eventually extend more deeply, sometimes invading the vagina, urethra, or anus. Vulvar cancer may also spread to nearby lymph nodes.

Symptoms and Diagnosis

Patches of vulvar skin may turn white, brown, or red before cancer develops. Such patches may indicate that cancer is likely to develop. Once a cancer is present, the involved skin may have sores that never seem to heal. In other instances, the cancer can be felt as a lumpy area. Sometimes the involved skin is scaly or discolored. The surrounding skin may seem to tighten and pucker. Itching is common. Eventually, the area may bleed or produce a watery discharge.

A sample of the abnormal skin must be removed to determine if cancer is present, and if so, to identify the type of cancer. Sometimes doctors apply stains to the abnormal skin to help locate the best place to obtain a sample of tissue. Doctors may also use an instrument with magnifying lenses (a colposcope) to examine the abnormal skin and to pinpoint the best place to obtain a sample.

Treatment and Outlook

The woman's preferences play an important role in determining treatment options. However, treatment options also depend on the type and stage of cancer and the woman's overall health. Because some vulvar cancers spread quickly, especially squamous cell carcinomas and melanomas, surgery is almost always needed to remove the cancer. For very small cancers that do not extend deeply, surgery may involve removal of only the skin. Alternatively, in a limited number of women with small cancers, treatment may consist of using a beam of light to remove the abnormal tissue (laser surgery), application of an ointment containing a chemotherapy drug, such as fluorouracil, or radiation therapy.

Larger cancers and any that have invaded deeper tissues require more extensive surgery that involves removing all or at least part of the vulva. Radiation therapy, chemotherapy, or both may be used to shrink large cancers before surgery. Sometimes the clitoris must be removed. Nearby lymph nodes may also be removed. Sexual intercourse is usually possible after removal of all or part of the vulva.

Because basal cell carcinomas rarely spread (metastasize) to distant sites, surgery usually involves removing only the cancer. The whole vulva is removed only if the cancer is extensive.

If vulvar cancer is detected early, most women remain free of any sign of cancer for at least 5 years after treatment (although cancer may recur in a small number even after 5 years). If the cancer has invaded nearby lymph nodes, less than one third of women survive for 5 years.