Vulvar Cancer

The vagina, also known as the birth canal, is a three- to four-inch tube that leads from the opening of the uterus to the outside of the body. The outside region is called the vulva, and includes the tissues that form the external genitalia such as the inner and out lips of the vagina, the clitoris, and the perineum. Cancer can form anywhere in the vaginal or vulvar region, and is often caused by human papillomavirus (HPV) infection.

Vaginal and vulvar malignancies are in a group known as gynecological cancers. Wilmot Cancer Institute offers comprehensive, advanced patient care for vaginal and vulvar cancers as part of our Gynecological Oncology Program. Our investigators also conduct research at the University of Rochester Medical Center’s Targeted Therapeutics Laboratory for Gynecological Cancers.

Our physicians have received additional specialty training in gynecological cancers, which means they are not just specialists in cancer but in gynecological cancers. All gynecological cancer surgeries are performed at UR Medicine’s Highland Hospital in Rochester.

Vaginal and vulvar cancer types

Most cases of vaginal and vulvar cancers are squamous cell carcinomas. In the vagina, squamous cell carcinoma begins in the lining and develops slowly. The pre-cancerous form of this disease is called vaginal intraepithelial neoplasia (VIN). Vulva squamous cell carcinoma begins in the skin cells and includes three different subtypes, two of which appear initially as warts.

Rarer types of vaginal and vulvar cancers are adenocarcinomas, which form in the glands just inside the opening of the vagina or in the birth canal. Melanoma can also develop in the lower portion of the vagina or on the external genitals, even though melanoma is more commonly found on sun-exposed areas of the skin.

Vaginal and vulvar cancer facts

Both of these cancers are rare. About one out of every 1,100 women will get vaginal cancer in her lifetime; and one out of every 333 women will get vulvar cancer. Doctors diagnose less than 6,000 new cases of each type annually in the U.S.

Causes and risk factors

Aging is a key risk factor for both types of cancer. Only 15 percent of vaginal cancer cases and less than 20 percent of vulvar cancer cases occur in women younger than 50. Infection from the HPV virus is another major risk factor for vaginal and vulvar cancer, although most women who have HPV will not get cancer. 

Additional vaginal cancer risk factors include:

• Having a history of abnormal cells in the cervix or uterus or having cancer in either of those organs
• Smoking cigarettes
• Infection with HIV, the virus that causes AIDS'
• Exposure to the drug DES (diethylstilbestrol) before birth while in the mother’s womb. In the 1950s doctors prescribed DES to some pregnant women to prevent miscarriage.

Additional vulvar cancer risk factors include:

• A history of genital warts
• Having many sexual partners
• A history of abnormal Pap tests
• Smoking cigarettes
• Pre-cancerous changes in the vulva tissues (VIN)
• A disorder called lichen sclerosus, which causes the vulvar skin to become very thin and itchy
• Having melanoma or several atypical moles on other parts of the body

Prevention

Avoiding exposure to the HPV virus is an important way to prevent both vaginal and vulvar cancer. The HPV vaccine for young girls (before sexual activity) and young women up to age 26 helps to prevent vaginal and vulvar cancer. HPV infections are the most common sexually transmitted infections in the U.S., and they include 200 different viruses; more than 40 types of HPV are spread through sexual contact.

HPV types 16 and 18 have been linked to vaginal cancers, cervical cancer, anal cancer, and cancers of the throat, tongue and tonsils. The FDA-approved HPV vaccine strongly protects against HPV types 16 and 18—although it does not prevent cancer if the infection is already present. For this reason it’s important to continue to see a gynecologist frequently and get screening Pap tests and examinations even after vaccination.

University of Rochester Medical Center scientists played a key role in the development of the HPV vaccine. A U.S. patent was awarded in 2011 to recognize our pioneering research.

Other ways to prevent vaginal and vulvar cancers include quitting smoking, practicing safe sex by using condoms and limiting sexual partners, and making sure you seek prompt treatment for anything unusual occurring in the vaginal and vulvar region.