Learn about this rare cancer that forms on the skin that surrounds the urethra and vagina. Treatments include surgery, radiation and chemotherapy.
Vulvar cancer is a type of cancer that occurs on the outer surface area of the female genitalia. The vulva is the area of skin that surrounds the urethra and vagina, including the clitoris and labia.
Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching. Though it can occur at any age, vulvar cancer is most commonly diagnosed in older adults.
Vulvar cancer treatment usually involves surgery to remove the cancer and a small amount of surrounding healthy tissue. Sometimes vulvar cancer surgery requires removing the entire vulva. The earlier vulvar cancer is diagnosed, the less likely an extensive surgery is needed for treatment.
Vulvar cancer is cancer that occurs on the vulva — the fleshy area that surrounds your vagina and the tube (urethra) where urine leaves your body.
Signs and symptoms of vulvar cancer may include:
Make an appointment with your primary care doctor or gynecologist if you experience any persistent symptoms that worry you.
It's not clear what causes vulvar cancer.
In general, doctors know that cancer begins when a cell develops changes (mutations) in its DNA. The DNA contains the instructions that tell a cell what to do. The mutations tell the cell to grow and divide rapidly. The cell and its offspring go on living when other normal cells would die. The accumulating cells form a tumor that may be cancerous, invading nearby tissue and spreading to other parts of the body.
The type of cell in which vulvar cancer begins helps your doctor plan the most effective treatment. The most common types of vulvar cancer include:
Although the exact cause of vulvar cancer isn't known, certain factors appear to increase your risk of the disease, including:
To reduce your risk of vulvar cancer, reduce your risk of the sexually transmitted infection HPV:
Ask your doctor how often you should undergo pelvic exams. These exams allow your doctor to visually examine your vulva and manually examine your internal reproductive organs to check for abnormalities.
Talk to your doctor about your risk factors for vulvar cancer and other pelvic cancers in order to determine the most appropriate screening exam schedule for you.
Tests and procedures used to diagnose vulvar cancer include:
Once your diagnosis is confirmed, your doctor works to determine the size and extent (stage) of your cancer. Staging tests can include:
The stages of vulvar cancer are indicated by Roman numerals that range from I to IV, with the lowest stage indicating cancer that is limited to the vulva. By stage IV, the cancer is considered advanced and has spread to nearby structures, such as the bladder or rectum, or to distant areas of the body.
Treatment options for vulvar cancer depend on the type, stage and location of your cancer, as well as your overall health and your preferences.
Operations used to treat vulvar cancer include:
Surgery carries a risk of complications, such as infection and problems with healing around the incision. Removing lymph nodes can cause fluid retention and leg swelling, a condition called lymphedema.
Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. Radiation therapy for vulvar cancer is usually administered by a machine that moves around your body and directs radiation to precise points on your skin (external beam radiation).
Radiation therapy is sometimes used to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Radiation therapy is sometimes combined with chemotherapy, which can make cancer cells more vulnerable to the radiation.
If cancer cells are discovered in your lymph nodes, your doctor may recommend radiation to the area around your lymph nodes to kill any cancer cells that might remain after surgery. Radiation is sometimes combined with chemotherapy in these situations.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically administered through a vein in your arm or by mouth.
For those with advanced vulvar cancer that has spread to other areas of the body, chemotherapy may be an option.
Chemotherapy is sometimes combined with radiation therapy to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Chemotherapy may also be combined with radiation to treat cancer that has spread to the lymph nodes.
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
Targeted therapy might be an option for treating advanced vulvar cancer.
Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Immunotherapy might be an option for treating advanced vulvar cancer.
After completing vulvar cancer treatment, your doctor may recommend periodic follow-up exams to look for a cancer recurrence. Even after successful treatment, vulvar cancer can return. Your doctor will determine the schedule of follow-up exams that's right for you, but doctors generally recommend exams two to four times each year for the first two years after vulvar cancer treatment.
Treatment for vulvar cancer may involve removing part of the vulva (partial vulvectomy) or the entire vulva (radical vulvectomy).
Living with vulvar cancer can be challenging. Although there are no easy answers for coping with vulvar cancer, the following suggestions may help:
Your first appointment will usually be with either your primary care doctor or a gynecologist. If your doctor or gynecologist suspects or diagnoses cancer, you'll likely be referred to a gynecologic oncologist who specializes in surgery for gynecologic cancers.
Because appointments can be brief, and it can be difficult to remember everything you want to discuss, it's a good idea to be prepared. Here are some suggestions for preparing, and what you can expect from your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For vulvar cancer, some basic questions to ask include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you.
Your doctor will likely have a number of questions for you. Some questions your doctor might ask include: