Vulvar Cancer Overview

What is vulvar cancer?

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

The vulva is the outer part of the female reproductive system. It’s also called the external genitalia. The labia majora and minora are two folds of skin that are part of the vulva. The outer folds are called the labia majora. The inner folds are called the labia minora. Most vulvar cancers start in the labia majora in the squamous cells. Squamous cell carcinoma is the most common type of vulvar cancer. Squamous cells are the cells that make up most of the skin and other surfaces of the body. Rare types of vulvar cancer include melanoma, basal cell carcinoma, adenocarcinoma, and sarcoma of the vulva.

Who is at risk for vulvar cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. The risk factors for vulvar cancer include:

• Older age

• HPV (human papillomavirus) infection

• Tobacco use

• Weakened immune system

• A precancer condition called vulvar intraepithelial neoplasia (VIN) or dysplasia

• A disorder called lichen sclerosus

• You had melanoma in the past

• You had other genital cancers in the past

Unlike some other cancers, such as breast or ovarian cancer, there is no hereditary risk for vulvar cancer. This means that it isn't passed down in families. Talk with your healthcare provider about your risk factors for vulvar cancer and what you can do about them.

Can vulvar cancer be prevented?

You may be able to prevent vulvar cancer by treating vulvar intraepithelial neoplasia (VIN). This is a precancerous change in your vulva. VIN is not cancer. But if not treated, it can turn into cancer. Treating VIN early helps reduce the chance that the changed cells will progress to cancer. All cases of VIN should be treated. Treatment can destroy or remove all of the precancer cells.

You may also help lower your risk of vulvar cancer if you:

• Don't have sex with people who have many sex partners. Ask your healthcare provider if the HPV vaccine is right for you.

• Don’t smoke. Ask your healthcare provider for help quitting.

Are there screening tests for vulvar cancer?

There are no regular screening tests for vulvar cancer. Screening tests are done to check for disease in people who don’t have symptoms.

But make sure to have regular Pap tests and pelvic exams as advised by your healthcare provider. They will look at your vulva during these checkups.

You can also do self-exams. Look for changes in your vulva, such as red, irritated, dark, or white spots. Check for bumps, ulcers, or moles that are new or have changed.

What are the symptoms of vulvar cancer?

You can have vulvar cancer with no symptoms. Some women do have symptoms. Common symptoms of squamous cell carcinoma can include:

• Vulvar itching that does not get better

• An area of skin on your vulva that is red, or lighter or darker in color

• A patch of skin on your vulva that feels thick, scaly, rough, or bumpy

• Wart-like bump or bumps, cauliflower-like growths, or ulcers or sores on the vulva that last for more than a month

• Pain or burning when you urinate

• Burning or bleeding and discharge not related to your menstrual cycle

• Enlarged lymph glands in your groin

Many of these symptoms may be caused by other health problems. But it is important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is vulvar cancer diagnosed?

Your healthcare provider may find signs of vulvar cancer during a routine pelvic exam. You’ll likely have a Pap test and an HPV test.

A biopsy is the only way to confirm cancer. Small pieces of tissue are taken and checked for cancer cells. The area may be numbed first with a local anesthetic. Your healthcare provider will use a tool or small knife to remove skin from the area that may be cancer. The samples are sent to a lab. Ask your healthcare team how soon you can expect your results.

After a diagnosis of vulvar cancer, you may have other tests. These help your healthcare providers learn more about the cancer. They can help find the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It is one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your provider to explain the stage of your cancer to you in a way you can understand.

How is vulvar cancer treated?

Your treatment choices depend on the type of vulvar cancer you have, test results, and the stage of the cancer. Other things to think about are if you want to be able to have future pregnancies and your overall health. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. Most women with vulvar cancer will be treated with surgery. Some will also need radiation, chemo, or both.

You may have just one treatment or a combination of treatments.

Talk with your healthcare providers about your treatment choices. Make a list of questions. Think about the benefits and possible side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects? 

Cancer treatment, such as chemotherapy and radiation, can damage normal cells. This causes side effects, such as hair loss, mouth sores, and vomiting. Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects. 

Coping with vulvar cancer 

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life. 

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if any of the following occur:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever

• Side effects of treatment that affect your daily function or don’t get better with function

Ask your healthcare provider what signs to watch for, and when to call. Know how to get help after office hours and on weekends and holidays.

Next steps 

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.