Vulvar Cancer

What are common vulvar cancer symptoms?

Signs of this cancer will vary but may include:

• Itching that does not go away or get better
• A burning sensation
• Painful urination
• Bleeding and discharge not associated with your normal menstrual period

You may also notice certain abnormal growths in your vagina, such as:

• A growth that appears as a red, pink, or white bump (or bumps) with a raw surface; it may also feel rough
• An open sore that does not go away after a month
• Cauliflower-like growths similar to genital warts
• A dark, pigmented growth
• A distinct lump on either side of the opening to the vagina
• Soreness and a red, scaly area

If you notice any pain or abnormality, you should immediately make an appointment with your doctor. However, don't wait until you notice vulvar cancer signs—make sure you receive regular Pap tests and pelvic examinations.

What are the risk factors for this cancer?

Keep in mind that many women with the following risk factors never develop cancer, and some women without any risk factors still develop cancer.

• Age: Risk increases as a woman ages
• HPV infection is thought to cause up to half of vulvar cancers
• Smoking
• Human Immunodeficiency Virus (HIV), the virus that causes acquired immunodeficiency virus (AIDS)
• Vulvar intraepithelial neoplasia (VIN), a precancerous condition
• Lichen sclerosus, which causes the vulvar skin to become very thin and itchy
• A personal history of other gynecologic cancers
• Melanoma or atypical moles: Having these moles on other parts of the body leads to an increased risk of developing one on the vulva

Vulvar cancer most often develops from two causes:

• Human papillomavirus (HPV): HPV-caused cancer tends to strike women who are younger and, oftentimes, smokers.
• Genetics: DNA tests from vulvar cancers in older women show certain gene mutations. This gene normally prevents cells from becoming cancerous, but when it mutates, it allows for cells to become cancerous. This type of vulvar cancer affects women aged 55 and older.

Can you prevent vulvar cancer?

You can't eliminate the possibility of this cancer completely, but there are several things you can do to significantly lower your risk. These include:

• Avoid HPV infection by limiting your sexual partners and getting vaccinated against certain HPV infections.
• Quit smoking, which will also lower your risk for several other cancer types.
• Get regular pelvic exams, which allow your healthcare provider to recognize any abnormalities and detect signs of precancer or cancer early.

How do doctors diagnose vulvar cancer?

If you experience symptoms, your doctor will take your complete medical history and perform a comprehensive physical examination. Your doctor will examine your uterus, ovaries, cervix, and vagina for any abnormalities. They will also take a Pap smear.

In patients with no symptoms, cancer may be found during a routine pelvic examination and Pap smear. If a Pap smear is abnormal, but the healthcare provider cannot see problems with the vagina during a pelvic exam, a colposcopy may be done. A colposcopy is a painless procedure in which your doctor uses a lighted microscope to view your cervix.

The best way to be sure the symptoms you are experiencing are caused by vulvar cancer or a non-cancerous condition is to do a biopsy. Your doctor will remove a small piece of the affected tissue and examine it under a microscope.

If your doctor confirms that the mass is cancerous, you will need more tests to find out how far the cancer has spread. A gynecologic oncologist may perform:

• Cystoscopy: Using a lighted tube to check the inside surface of the bladder
• Proctoscopy: Visual inspection of the rectum using a lighted tube
• Pelvic examination using anesthesia: A more thorough exam that can better see how the cancer has spread
• Chest X-ray
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)

What are the main types of vulvar cancer?

Most vulvar cancers begin in squamous cells, a type of skin cell. Therefore, squamous cell carcinomas are the most common type of cancer. Other subtypes of this disease are also named based on the cell type where they begin. These include:

• Adenocarcinomas
• Basal cell carcinomas
• Melanomas
• Sarcomas

What are the stages of vulvar cancer?

Staging classifies how much cancer is in the body and how far it has spread. This information is critical to determining the best treatment approach. Vulvar cancer stages include:

• Stage O: This precancerous stage develops when abnormal cells develop on the surface of the vulvar skin
• Stage I: Cancer is contained to the vulva
• Stage II: Cancer may have spread to nearby tissue but not lymph nodes
• Stage III: Cancer has spread beyond the vulva to nearby lymph nodes
• Stage IV (metastatic vulvar cancer): Cancer has spread outside of the vulva to near or distant organs

What are my vulvar cancer treatment options?

At MedStar Health, your treatment plan will consider the latest advances in surgery and medicine, including clinical trials that may be hard to find elsewhere. Treatment will vary based on the stage of your cancer, as well as your overall health and preferences. Your doctors will thoroughly review all of your options, explaining the advantages and risks associated with your individualized recommendations.

Surgery

Surgery is one of the primary ways we treat vulvar cancer. Our goal is to remove the cancer while preserving as much of the natural appearance and function of the vulva as possible. Our gynecologic oncologists are experts in all of the latest surgical techniques and procedures, including:

• Laser surgery, which may be used to treat precancerous growths
• Excisions, which aims to eliminate all of the cancer
• Vulvectomy, which involves removing part or all of the vulva
• Lymph node dissection, including sentinel lymph node biopsy, to identify and remove affected lymph nodes

For women who have undergone extensive surgeries, your doctor may work closely with plastic and reconstructive surgeons to rebuild the area where cancer was removed using skin grafts. Flap reconstruction may restore both anatomy and function of the pelvic region to minimize complications and improve your quality of life.

Chemotherapy

Chemotherapy uses cancer-fighting medications to fight against the disease. While this is a common cancer treatment used for many types of the disease, we're still investigating how it may be used to treat vulvar cancers. In some instances, women with precancerous lesions (vulvar intraepithelial neoplasia, or VIN) may benefit from a topical chemotherapy that can be directly applied to the skin. Your team will include a medical oncologist who will determine whether or not this type of therapy may be effective in helping to treat your cancer.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Biologic therapy, or immunotherapy, uses your immune system to target and interfere with cancer cell growth. Certain topical immunotherapy medications may be recommended for precancerous growths in the vulva.

Learn More About Immunotherapy

Learn More About Targeted Therapy

Radiation therapy

If cancer has spread beyond the vulva, your treatment team may recommend radiation therapy. Radiation therapy uses high-energy beams to kill cancer cells. At times, this treatment may be used to shrink tumors before surgery. In other cases, radiation may be combined with chemotherapy in an approach called "chemoradiation." Our radiation oncologists are skilled in the latest technologies to deliver precise radiation while limiting the impact on normal tissue. Your care team will thoroughly explain your radiation options if this treatment is appropriate for your cancer.

Learn More About Radiation Therapy

When you seek care for vulvar cancer at MedStar Health, you'll benefit from the comprehensive team approach offered through a team of experts in gynecologic oncology. Patients choose us because:

Treatment considers input from specialists in several medical fields, which leads to your best outcomes. Cancer cases are reviewed at regular tumor boards where experts in various specialties discuss the treatment options that will work best for you. Our multidisciplinary cancer team includes doctors with who have completed rigorous training and attained board certification in:

• Gynecologic oncology
• Radiation oncology
• Medical oncology
• Pathology
• Radiology
• Plastic and reconstructive surgery
• Pelvic medicine
• Reconstructive surgery
• Rehabilitation
• and more

Because each team member is up-to-date in their respective field, we can consider all of the latest vulvar cancer treatment options available to you, including those that may not be widely available elsewhere.

Our gynecologic oncologists have exceptional surgical skill in minimally invasive and robotic procedures. Whenever possible, our surgeons take a minimally invasive approach to surgery, using laparoscopic or robotic-assisted techniques to operate. These advanced approaches often lead to less pain, fewer risks, and faster recoveries, helping many women get back to their normal lives with fewer complications. In addition, we work as a team with plastic and reconstructive surgeons, when necessary, using sophisticated methods to rebuild and restore what cancer has taken away.

It's convenient to see us at a location near you. Because our vulvar cancer experts see patients at several locations throughout Maryland and Washington, D.C., you can spend less time traveling to appointments and more time living your life. With one electronic health record and seamless care coordination throughout the MedStar Health system, you'll benefit from access to all of the most advanced treatment options close to where you live and work.