• Vulvar cancer is a rare malignancy affecting the external female genitalia, predominantly in older women.
• Key symptoms of vulvar cancer include persistent itching, pain, bleeding, and changes in skin appearance on the vulva.
• Risk factors often involve human papillomavirus (HPV) infection and certain skin conditions like lichen sclerosus.
• Vulvar cancer diagnosis typically involves a biopsy, followed by imaging to determine the stages of vulvar cancer.
• Vulvar cancer treatment options range from surgery, radiation, and chemotherapy, often used in combination, tailored to the stage and type of cancer.
• Living with vulvar cancer requires comprehensive support, including medical follow-up, emotional care, and lifestyle adjustments.

What is Vulvar Cancer?

Vulvar cancer is a malignant growth that originates in the vulva, the external female reproductive organs. This includes the labia majora, labia minora, clitoris, and the opening of the vagina. While it is a relatively uncommon cancer, accounting for about 0.6% of all cancers in women, its incidence tends to increase with age. The most common type is squamous cell carcinoma, which develops from the thin, flat cells lining the surface of the vulva. Other less common types include melanoma, adenocarcinoma, and sarcoma.

The precise causes of vulvar cancer are not fully understood, but several risk factors have been identified. Chronic infection with certain high-risk types of human papillomavirus (HPV) is a significant contributor, particularly in younger women. HPV is a common sexually transmitted infection that can lead to abnormal cell changes. Other risk factors include a history of vulvar intraepithelial neoplasia (VIN), a precancerous condition, and certain chronic inflammatory skin conditions of the vulva, such as lichen sclerosus. Smoking, a weakened immune system, and older age also increase the likelihood of developing this cancer.

According to the American Cancer Society, approximately 6,000 new cases of vulvar cancer are diagnosed in the United States each year, with the average age of diagnosis being around 68. Early detection significantly improves prognosis, highlighting the importance of awareness of symptoms and regular gynecological check-ups.

Signs, Symptoms, and Stages

Recognizing the symptoms of vulvar cancer is vital for early detection and prompt medical attention. These symptoms can often be subtle in their initial stages and may mimic other, less serious conditions, making accurate diagnosis challenging. Persistent changes or discomfort in the vulvar area should always be investigated by a healthcare professional.

The most common signs and symptoms include:

• Persistent Itching: Often the most common and earliest symptom, which does not resolve with typical treatments.
• Pain or Tenderness: Discomfort, burning, or soreness in the vulvar region.
• Bleeding or Discharge: Unusual bleeding not related to menstruation, or a watery, bloody discharge.
• Skin Changes: A lump, wart-like growth, ulcer, or sore that doesn’t heal. Changes in skin color, such as redness or paleness, or thickening of the skin.
• Burning with Urination: Dysuria can occur if the cancer is near the urethra.
• Painful Intercourse: Dyspareunia due to vulvar discomfort or lesions.

These symptoms can vary in intensity and appearance. It is crucial to remember that while these signs can indicate vulvar cancer, they can also be caused by other benign conditions. Therefore, a medical evaluation is essential for an accurate diagnosis.

Early Symptoms and Detection

In its earliest stages, vulvar cancer may present with very subtle changes, such as a small lump or an area of skin discoloration that might be mistaken for a benign skin condition or irritation. Persistent itching, which can often be dismissed as a yeast infection or dermatitis, is a particularly common early symptom. Regular self-examinations and prompt consultation with a doctor for any new or persistent vulvar changes are key to early detection. Early-stage vulvar cancer, when localized, has a much higher chance of successful treatment.

Stages of Vulvar Cancer

The stages of vulvar cancer describe the extent of the cancer’s spread, which is crucial for determining the most effective treatment plan. Staging is typically based on the TNM (Tumor, Node, Metastasis) system developed by the American Joint Committee on Cancer (AJCC). This system evaluates the size and extent of the primary tumor (T), whether the cancer has spread to nearby lymph nodes (N), and whether it has metastasized to distant parts of the body (M).

Understanding the stage helps oncologists tailor treatment strategies, from localized surgery for early stages to more extensive treatments involving radiation and chemotherapy for advanced disease. The prognosis generally worsens with higher stages, underscoring the importance of early diagnosis.

Vulvar Cancer Diagnosis and Treatment

The process of vulvar cancer diagnosis begins with a thorough physical examination, including a visual inspection of the vulva and palpation of the groin lymph nodes. If suspicious areas are found, a biopsy is the definitive diagnostic tool. During a biopsy, a small tissue sample is removed from the abnormal area and examined under a microscope by a pathologist to confirm the presence of cancer cells and determine the type of cancer.

Following a confirmed diagnosis, further tests are conducted to determine the stages of vulvar cancer. These may include imaging studies such as MRI, CT scans, or PET scans to assess the extent of the tumor, involvement of nearby lymph nodes, and potential spread to distant organs. A sentinel lymph node biopsy may also be performed to identify if cancer cells have spread to the first lymph nodes that drain from the tumor site, guiding further surgical decisions.

Vulvar cancer treatment options are highly individualized, depending on the stage of the cancer, its type, the patient’s overall health, and personal preferences. The primary treatment modalities include surgery, radiation therapy, and chemotherapy, often used in combination.

• Surgery: This is the most common treatment for vulvar cancer. It can range from wide local excision (removing the cancer and a margin of healthy tissue) for early-stage disease to radical vulvectomy (removal of the entire vulva) for more extensive cancers. Lymph node dissection may also be performed to remove affected lymph nodes.
• Radiation Therapy: High-energy rays are used to kill cancer cells or shrink tumors. It can be used after surgery to destroy any remaining cancer cells, before surgery to shrink a large tumor, or as a primary treatment for advanced or inoperable cases.
• Chemotherapy: Drugs are used to kill cancer cells throughout the body. It may be given alone or in combination with radiation therapy (chemoradiation), especially for advanced or recurrent vulvar cancer.
• Targeted Therapy and Immunotherapy: These newer treatments specifically target cancer cells based on their unique characteristics or boost the body’s immune system to fight cancer. They are typically used for advanced or recurrent cases where other treatments have been less effective.

A multidisciplinary team, including gynecologic oncologists, radiation oncologists, and medical oncologists, collaborates to develop the most appropriate treatment plan for each patient.

Living with Vulvar Cancer

Living with vulvar cancer, both during and after treatment, involves navigating a range of physical, emotional, and practical challenges. The journey extends beyond medical treatment, encompassing comprehensive care that addresses quality of life and long-term well-being. Patients often experience changes in body image, sexual function, and emotional health, which require ongoing support.

Post-treatment, regular follow-up appointments are crucial to monitor for recurrence and manage any long-term side effects. These appointments typically involve physical examinations, imaging, and symptom review. Support groups, counseling, and psychological services can provide invaluable assistance in coping with the emotional impact of cancer, including anxiety, depression, and fear of recurrence. Open communication with healthcare providers about all aspects of recovery, including sexual health and intimacy, is encouraged to find solutions and resources.

Adopting a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking, can contribute to overall well-being and potentially reduce the risk of recurrence. Many women find strength in connecting with others who have faced similar diagnoses. While complementary therapies like acupuncture or meditation may offer supportive benefits for managing symptoms and stress, it is important to note that these should always be used as adjuncts to, and not replacements for, conventional medical treatments, and should be discussed with a healthcare provider.