Vulvar cancer is a slow-growing and rare cancer. It forms in the tissues that make up the vulva — the outer part of the female genitals that includes the clitoris, the inner and outer labia, and the opening of the vagina.
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What Is Vulvar Cancer?
Vulvar cancer is a type of cancer that forms slowly in the tissues that make up the vulva — the outer part of the female genitals.
The vulva includes the:
- Clitoris.
- Inner and outer labia.
- Opening of the vagina.
Most often, vulvar cancer forms on the inner edges of the vaginal lips or the sides of the vaginal opening.
A human papillomavirus (HPV) infection can increase your risk of developing vulvar cancer, but not everybody with HPV will develop vulvar cancer.
Early detection is important with vulvar cancer. While pap smears may not detect an HPV infection of the vulva, routine physical exams by a gynecologist can help detect any new, suspicious lesions.
How common is vulvar cancer?
Vulvar cancer is very rare. Vulvar cancer and vaginal cancer combined account for about 7% of all gynecologic cancers in the U.S. each year.
According to the Centers for Disease Control and Prevention (CDC), in 2020:
- 5,276 women (2.5 per 100,000 women) were diagnosed with vulvar cancer.
- 1,466 women (0.6 per 100,000 women) died from vulvar cancer.
What are the types of vulvar cancer?
The most common types of vulvar cancer are:
- Squamous cell carcinoma — Occurs in the squamous cells that make up the vulva, and is the most common type of vulvar cancer.
- Adenocarcinoma — Develops in the glands near the vulva.
- Melanoma — A kind of skin cancer that starts in the melanocytes, the cells that make pigment in the skin.
What causes vulvar cancer?
Doctors don't always know what causes vulvar cancer, but HPV causes about 50% of cases.
Vulvar cancer risk factors
Certain factors may increase your risk of developing vulvar cancer.
These include:
- Age — 80% of vulvar cases happen in people age 50 or older. Half are in women over 70.
- Previous gynecologic cancer — You're at a higher risk of vulvar cancer if you've had cervical cancer.
- Sexual history — First having sexual intercourse at a young age can increase your risk of vulvar cancer, as can having multiple partners.
- History of vulvar intraepithelial neoplasia (VIN) — But not everyone with these precancerous changes will develop vulvar cancer.
- HPV — Some HPV types have been linked to vulvar cancer.
- HIV — This virus damages your immune system, making it easier for you to get HPV and harder for your body to clear the infection as well as fight cancer.
- Skin conditions involving the vulva — A disorder called lichen sclerosus et atrophicus (LSA) makes the vulvar skin very thin and itchy and may slightly increase your risk of vulvar cancer.
- Smoking — Your risk of developing vulvar cancer increases if you smoke, even more so if you have a history of HPV.
Complications of vulvar cancer
Treatment for vulvar cancer can lead to complications, including lymphedema if surgeons also remove the lymph nodes in your groin.
Female sexual dysfunction is also possible following surgery for vulvar cancer. This may include an inability to achieve orgasm and painful intercourse.
How can I reduce my risk of vulvar cancer?
The best way to reduce your risk of vulvar cancer is to get the HPV vaccine if you're eligible. Consider the vaccine for your teens, too, to protect them in the future.
The HPV vaccine protects against the types of HPV that can cause cervical, vaginal, and vulvar cancers, as well as some head and neck cancers.
Continue to get screened for cervical cancer regularly, even if you’ve received an HPV vaccine.
What Are the Signs and Symptoms of Vulvar Cancer?
Symptoms of vulvar cancer may include:
- Abnormal and consistent itching in the vulva.
- Abnormal vaginal bleeding.
- A lump in the vulva.
- Tenderness in the vulva.
Vulvar cancer may develop as a new mass on the vulva. The mass may not cause any symptoms.
- Or it may:
- Be itchy.
- Be painful.
Cause occasional vaginal spotting.
How Do You Diagnose Vulvar Cancer?
To diagnose vulvar cancer, your doctor will take your medical history and ask about your symptoms.
They'll also likely do a pelvic exam — also called an internal exam — to look at and feel the vulva, vagina, and cervix. During the exam, they may do Pap and HPV tests.
Tests to diagnose vulvar cancer
If your doctor sees anything abnormal, they'll do a biopsy to remove the suspicious tissue and then examine it under a microscope.
They may also order imaging tests, such as:
How Do You Treat Vulvar Cancer?
Surgery is the main treatment for vulvar cancer. Your surgeon will consider your ability to have a healthy sex life post-cancer when deciding how much tissue to remove.
Surgery for vulvar cancer
Common surgeries for vulvar cancer:
- Laser surgery — If you have VIN, your surgeon can use a laser beam to burn off the vulvar skin layer with the precancerous cells.
- Lymph node surgery — Your surgeon may need to remove the pelvic lymph nodes, where vulvar cancer often spreads. They may also do a sentinel lymph node dissection to learn if the cancer has spread.
- Vulvectomy/excision — Your surgeon will remove all or part of your vulva. Reconstructive surgery can be done after an extensive vulvectomy.
You may have radiation therapy following surgery to continue to shrink the tumor.
Chemo and radiation for vulvar cancer
If surgery isn't possible due to the size or location of your tumor, your doctor may recommend a combination of chemotherapy and radiation therapy.
Why Choose UPMC for Vulvar Cancer Care?
Through the UPMC Gynecologic Cancer Program, you have access to additional treatment options and services, including:
