Vulvar cancer is a type of gynecological cancer that originates in the vulva, a woman’s external genitals. The American Cancer Society estimates that nearly 7480 new cases of vulvar cancer will be diagnosed in 2025.
This rare type of cancer typically develops over several years, beginning as precancerous cells. Since vulvar cancer is slow-growing, it can sometimes be detected and treated before it even turns into invasive cancer.
There are two most common types of cancer affecting the vulva:
- Vulvar squamous cell carcinoma grows in the cells on the surface of the skin. This type of cancer accounts for up to 90 percent of all cases of vulvar cancer.
- Vulvar melanoma is the second most common vulva cancer, accounting for 2 to 10 percent of vulva cancer cases.
Uncommon forms of vulvar cancer include basal cell carcinoma, Bartholin gland adenocarcinoma, Paget’s disease of the vulva, sarcoma, and verrucous carcinoma. You’ll notice that many types of cancer affecting the vulva have familiar names, usually associated with skin cancer. That’s because vulvar cancer develops on the external genitals, affecting the skin and tissue in that area.
Vulvar cancer has two things in common with other types of gynecological cancer—being a woman is a risk factor and risk increases with age.
Other risk factors for vulvar cancer include:
● Certain immunodeficiencies, including HIV
● Exposure to certain strains of human papillomavirus (HPV)
● Lichen sclerosus, a chronic skin condition causing inflammation and vulvar skin changes
● Sexual behaviors, such as having sexual intercourse at a young age or having many sexual partners. This is due to increased exposure to high HPV virus
● Smoking
● Vulvar intraepithelial neoplasia, a precancerous condition
HPV infection is the most common cause of vulvar cancer. Most sexually active people in the United States are infected with HPV at some point, but the virus usually clears the body on its own. When it doesn’t, it can develop into precancerous cell changes and cancer, including gynecological cancers of the vulva, vagina, and cervix.
When symptoms develop, they most often affect the labia majora or labia minora, the outer and inner lips of the vulva.
Symptoms may include:
- Abnormal vaginal bleeding (not during a menstrual period)
- Changes in vulvar skin color
- Itching or tenderness in the vulva
- Lump in the vulva
- Vulvar pain
- Warts or lesions in the vulvar area
While many of these symptoms can be caused by less-serious medical issues, it’s important to have them checked out by your OB/GYN or another medical provider.
If you’re experiencing symptoms that may be related to vulvar cancer, a medical provider will use a number of tools to determine a diagnosis:
- Pelvic exam
- Biopsy of a tissue sample from the vulva
- Imaging, such as CT scans, MRI scans, or PET scans
Other procedures may be recommended to determine whether cancer has spread to surrounding areas. A colposcopy may be used to examine the cervix and vagina, a proctoscopy may be used to examine the rectum and anus, and a cystoscopy may be used to examine the bladder and urethra.
Vulvar Cancer Treatment at NGMC
If you’ve been diagnosed with vulvar cancer, a team of providers, including a gynecologic oncologist, will create a personalized treatment plan for you. This plan will consider many factors, such as your overall health, the type of vulvar cancer, and whether cancer has spread.
Surgery for vulvar cancer
Surgery is the most common treatment for vulvar cancer and for the treatment of precancerous growths called vulvar intraepithelial neoplasia (VIN).
Multiple types of surgery may be used to treat VIN:
- Excision removes individual lesions.
- Laser surgery uses a laser beam to make bloodless cuts in the tissue or destroy surface lesions.
- Skinning vulvectomy removes the top layer of vulvar skin while preserving underlying subcutaneous tissue and deeper structure.
- Ultrasound surgical aspiration breaks a tumor into small pieces using vibrations, then washes away the pieces using ultrasound.
- Wide local excision removes the affected area of skin and normal tissue around it.
Surgical procedures used to treat vulvar cancer include:
- Wide local excision removes the affected area of skin and normal tissue around it. This procedure will be used selectively for early stage vulva cancer who qualifies this procedure.
- Radical Vulvectomy removes affected area of skin, wide range of surrounding tissue, and deeper tissue to get clean margin. Lymph node removal often done simultaneously with radical vulvectomy. Sentinel lymph node evaluation will be done (either unilateral or bilateral groin area) for tumors size of 4 cm of less. Full lymphadenectomy may need to be done with bigger size tumors.
If cancer is locally advanced without evidence of distant spread, but beyond that tumor cannot be removed by radical vulvectomy, a procedure known as pelvic exenteration could be an option. This procedure removes the vulva cancer lesion along with other pelvic organs, such as cervix, uterus, vagina, ovaries, lower colon, rectum, and bladder. During the procedure, openings are created to allow urine and/or stool to exit the body.
Radiation therapy for vulvar cancer
Vulvar cancer may also be treated using radiation therapy, most commonly external beam radiation. During external radiation therapy, high-energy X-rays are targeted through the skin to the cancer site. Radiation therapy may be used before surgery to shrink a tumor or after surgery to kill off any remaining cancer cells.
Chemotherapy is often given with radiation therapy —known as chemoradiation.
Chemotherapy for vulvar cancer
If cancer has spread distantly, chemotherapy will be the main treatment option for vulva cancer. Chemotherapy can be also given along with target therapy or immunotherapy. Chemotherapy uses drugs to attack cancer cells in the body. Chemotherapy also could be given during radiation therapy to boost up radiation therapy effects. — known as chemoradiation.
Immunotherapy and target therapy for vulvar cancer
Immunotherapy boosts up the body’s own immune system to identify and attack cancer cells. Advanced vulvar cancer may be treated using immunotherapy and target therapy.
Vulvar Cancer Research
We’re committed to providing patients with the latest advancements in care, including clinical trials. When appropriate, we can connect patients with trials offering new, innovative options for treatment. Learn more about the current clinical trials we are participating in.
Cancer Rehabilitation
Vulvar cancer can often be treated using powerful medications and other therapies, but treatment may cause a variety of uncomfortable side effects, including fatigue, skin changes, and bowel or urinary issues. At NGMC, we offer a unique type of rehabilitation designed to help cancer patients overcome the effects of cancer and treatment.
Patient Navigation
Not sure where to even begin after a vulvar cancer diagnosis? A patient navigator can help you find your footing and next steps. Reach out to our patient navigation program today to connect with a navigator.
Choose NGMC for Vulvar Cancer Care
While vulvar cancer is a less-common form of cancer, it still affects thousands of women in the United States each year. If you’ve been diagnosed with this type of cancer, take comfort in knowing that a team of experts at NGMC is here to help.
We offer comprehensive access to diagnostic tools and treatment options for vulvar cancer, along with support and resources to guide you through treatment and survivorship. We also strive to provide our patients with the least-invasive treatment necessary to remove cancer and fully eradicate it from the body, including minimally invasive procedures when possible.
For more information about cancer care at NGMC or to learn about support groups, please call 770-219-8815.