Cancer Of The Vulva
Easy Guide To: Signs, Treatment And Prevention

Early Signs
- Itching and burning
- White patches
- Sores that won't heal
- Lumps

Cancer Of The Vulva

Contents

• What Is Vulva Cancer?
• What Is The Survival Rate?
• What Are The Symptoms?
• Types Of Vulvar Cancers
• What About The Precancerous Stage?
• What Are The Causes?
• How Is It Diagnosed?
• How Is It Treated?
• What Are The Chances Of Recurrences?
• Can It Be Prevented?

OTHER TOPICS

Breast Cancer Guide
Cancer Guide
Cervix Cancer
Womb Cancer
Fallopian Tube Cancer
Ovarian Cancer
Vaginal Cancer

Topics In This Section:

Symptoms
Causes
Diagnosis
Stages
Treatment
Survival Rates
Prevention
Recurrence
Cancer Remission

Related Articles:

Female Reproductive System

What Is Vulva Cancer?

The vulva is the fleshy tissue which surrounds and protects the opening of the vagina. Cancer of this area is very rare and accounts for 1 percent of all cancers (and 4 percent of gynecologic cancers) in American women. This amounts to about 4,000 new cases being diagnosed every year. Although vulva cancer can occur in women in their 30's and 40's, 85 percent of cases are reported in postmenopause women after the age of 50. In most Western countries, nearly half of all incidences are found when they are very small and highly curable. A routine self-examination of the vulva can aid early detection.

What Is The Survival Rate?

In 2011 there were 4,340 cases of vulva cancer and 940 related deaths in North America. The 10 year survival rate for the most common type of vulva cancer (squamous cell carcinoma) is 87 percent for stage 1. This declines to 69 percent for stage 2, 46 percent for stage 3 and 16 percent for stage 4.

What Are The Symptoms?

Signs and symptoms of vulva cancer include:

1. Change in color or texture of the vulva skin.
2. Constant itching of the vulva (although this could by vulvodynia).
3. A burning sensation in the vulva when urinating.
4. A change in a birthmark or mole in the vagina.
5. Fleshy white patches or warts on the vulva (image).
6. A cut or sore on the vulva that will not heal.

If cancer does develop it is usually because the woman has ignored some of these symptoms. Fortunately because vulva cancer grows very slowly it does not spread to other parts of the body until the disease is quite advanced (picture of advanced stage).

Types Of Vulvar Cancers

Squamous Cell Carcinomas
The majority of vulva cancers are squamous cell carcinomas. Squamous cells are the main type of cell in the skin. The majority of the vulva cancer symptoms are likely to occur with this type of cancer, including white bumps, vulva itching, skin changes, bleeding and painful urination. Verrucous carcinoma is a sub-group that can produce growths in a cauliflower shape. If found early and the affected area is small, both types are highly curable by surgery alone.

Adenocarcinoma
This is cancer which begins in the gland cells. It accounts for about 8 percent of all vulvar cancers. Some types of adenocarcinoma develop in the Bartholin's glands which are found in the opening of the vagina and make a mucus-like fluid. If the glands become swollen they may be mistaken for harmless cysts and as a consequence a delay in diagnosis occurs. Adenocarcinomas can also form in the sweat glands of the vulva skin. Paget disease of the vulva is a condition where adenocarcinoma forms in the top layer of the vulva skin. It typically causes skin changes, causing scaly red areas.

Vulva Melanoma
Relatively rare, this type only accounts for 2 to 4 percent of all vulva cancers. A typical sign is the appearance of a dark pigmented growth (image) or a change in the appearance of a mole.

Other Types
Extremely rare types include vulvar sarcomas and basal cell carcinoma.

What About The Precancerous Stage?

There are several non-cancerous conditions which can cause vulva problems. These include squamous cell hyperplasia (used to be called hyperplastic dystrophy), lichen sclerosis and vulvar intraepithelial neoplasia (VIN). VIN, also known as carcinoma in situ, is generally considered the precancerous condition for vulva cancer. Formerly known as Bowen's disease, VIN is similar to VAIN, the precancerous condition related to cancer of the vagina and cervical intraepithelial neoplasia (CIN), the precancerous condition related to cervical cancer. VIN usually causes itching and burning although the woman may mistake it for vaginitis. They may self-diagnose it as a yeast infection and use anti-fungal medications or other yeast infection treatments with little effect. It is easy to detect during an examination by the presence of raised white patches. A biopsy will confirm the diagnosis.

What Are The Causes?

Little is known for certain about the causes of vulvar cancer, however several risk factors have been identified:

Diabetes
Diabetics are more prone to developing the disease although scientists do not understand why. If you have diabetes and have burning or itching of the vulva you should have it investigated.

HPV Infection
Contraction of the sexually transmitted infection (STI) human papilloma virus (HPV) appears to play an important role. A HPV infection is more likely to be a possible cause of vulvar cancer in younger women than older women. See Cervical cancer causes for an explanation.

DNA Mutations
Genetic testing of older woman with vulva cancer often shows mutations in the p53 tumor suppressor gene. This gene is important for preventing cells becoming cancerous. If this gene mutates, cancer is more likely to develop. Younger women with vulva cancer are more likely to have HPV infections but rarely have p53 mutations.

Previous Gynecologic Cancers
A history of other gynecologic cancers increases a woman's risk for vulva cancer. Nearly 1 in 3 women with the disease have also been diagnosed with in situ or squamous cancer of the cervix within the previous 5 years.

Inflammation
A history of burning, itching or inflammation of the vulva along with thickening of the vulvar tissues can increase risk factors. This condition is known as leukoplakia. Another condition, lichen sclerosus (LS) causes the vulva skin to thin and become itchy. About 4 percent of women with LS go on to develop vulva cancer.

Lifestyle Factors
Smoking and drinking more than 2 cups of coffee a day appear to be risk factors. Morbidly obese women are at greatest risk and some scientists believe this may be because their vagina is likely to contain more moisture and warmth. Lack of cleanliness of the vaginal area may be another factor but this has not been proven.

How Is It Diagnosed?

A vulva cancer diagnosis is made after taking a medical history and carrying out a physical examination and biopsy of suspicious tissue. This can usually be completed in a doctor's office. If the biopsied sample comes back positive, the woman will be referred to a specialist, such as a gynecologist for further testing and staging purposes. A specialist might use a cystoscopy, proctoscopy or intravenous urography. This will help determine type, location and size of the cancer. Imaging tests such as an X-ray, CT scan or MRI scan may be used to check for staging and metastasis (i.e. to see if cancerous cells have spread - see vulva cancer staging). This information is important for determining a treatment plan. It also helps determine the chances of survival for a patient (see vulva cancer survival rates).

How Is It Treated?

The three main types of vulva cancer treatment are surgery, radiation therapy and chemotherapy. The precancerous stage VIN is usually treated by local excision, laser therapy or vulvectomy. The cure rate is practically 100 percent. The topical chemotherapy cream fluorouracil is sometimes used but results are not reliable. Stage 1 cancer is also treated with surgery, but the incision may be wider and require removing lymph nodes. Stages 2 and 3 may involve removing parts of the vulva and lymph nodes in addition to radiation therapy. Patients who are too old to undergo surgery may be given radiation combined with chemo (see chemotherapy guide). Stage 4 vulvar cancer can involve radical vulvectomy combined with pelvic exenteration. This is a radical procedure and only considered as a treatment of last resort.

What Are The Chances Of Recurrences?

Recurrent vulva cancer: Regular follow-up tests after treatment will be scheduled by the doctor. This means any signs of a recurrence will be spotted immediately. One study showed that about 10 percent of patients who were treated for vulvar cancers had recurrences within 5 years, another indicated 24 percent. As about 80 percent of all recurrences occur within 2 years of original treatment this emphasizes the importance of follow up. Cancer can return to the vulva or other areas. If the recurrence is small it may be treated with radiation. If it is aggressive surgical options such as a radical vulvectomy or pelvic exenteration combined with external radiation will be considered.

Can It Be Prevented?

Vulva cancer prevention: As the cause has not been clearly identified preventative care must focus on reducing exposure to possible risk factors. This includes:

1. Limiting your number of sexual partners to avoid HPV exposure.
2. Have regular pap test screenings.
3. Drinking coffee in moderation.
4. Quit smoking if you do smoke.
5. Maintain a healthy body weight.
6. Ensure good hygiene.
7. Perform monthly vulvar self-examination in the privacy of your home.

Also do be sure to report any vulva itching, rashes, lumps or mole changes to your doctor. The sooner VIN is diagnosed the faster it can be cured and the less likely cancer is to develop. If you have any questions on this or any other topics, see womens health questions.

Other Useful Guides

Recommended Health Screenings For Women: Your must-have list of tests.
The Female Body Explained: Functions and what can go wrong.
Reproductive System Disorders: Vulva pain and symptoms compared.

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