Vulvar Cancer

Columbia provides expert care for people with vulvar cancer, vulvar precancer, and other complex vulvar conditions. Because vulvar cancer is uncommon, patients benefit from care provided by specialists experienced in treating both common and rare gynecologic cancers.

Your treatment is tailored to the type and stage of cancer, your overall health, and your personal goals. Whenever possible, our team focuses on removing the cancer while preserving healthy tissue, function, comfort, sexual health, and quality of life.

What Is Vulvar Cancer?

Vulvar cancer is a cancer that begins in the vulva, the external female genital area. The vulva includes the labia majora, labia minora, clitoris, and the opening of the vagina.

Most vulvar cancers develop slowly over many years. About 90 percent are squamous cell carcinomas, which begin in the thin, flat cells covering the surface of the vulva. Less common types include melanoma, adenocarcinoma, Paget disease of the vulva, sarcoma, verrucous carcinoma, and basal cell carcinoma.

Because vulvar cancer is uncommon, diagnosis and treatment are often best managed by a gynecologic oncology team with expertise in these rare cancers.

What Causes Vulvar Cancer?

Vulvar cancer develops when cells in the vulva grow abnormally and multiply out of control. The exact cause is not always known.

Some vulvar cancers are associated with persistent infection with certain high-risk types of human papillomavirus (HPV). Others develop in people with long-term vulvar skin conditions, such as lichen sclerosus, or from abnormal cell changes that occur over time.

What Are the Risk Factors for Vulvar Cancer?

Risk factors for vulvar cancer may include:

• Older age
• Persistent HPV infection
• Vulvar intraepithelial neoplasia (VIN)
• A history of cervical or vaginal precancer
• Lichen sclerosus or other chronic vulvar skin conditions
• Smoking
• A weakened immune system, including HIV infection
• A personal or family history of melanoma

Having one or more risk factors does not mean you will develop vulvar cancer. Many people diagnosed with vulvar cancer have no obvious risk factors.

What Are the Symptoms of Vulvar Cancer?

Early vulvar cancer may resemble irritation or a common skin condition.

Symptoms may include:

• A lump, bump, or sore on the vulva
• Persistent itching
• Pain, tenderness, or burning
• Bleeding not related to menstruation
• Unusual vaginal discharge
• Changes in the color or texture of the vulvar skin
• Thickened, raised, rough, or scaly skin
• Pain during sex
• Pain with urination

Any vulvar symptom that is new, persistent, or worsening should be evaluated by a healthcare provider.

When Should I See a Doctor?

You should see a healthcare provider if you have persistent itching, pain, bleeding, a lump, a sore that does not heal, or changes in the skin of the vulva.

You should also seek evaluation if you have been diagnosed with vulvar precancer (VIN), lichen sclerosus, or another chronic vulvar condition that requires ongoing monitoring.

How Is Vulvar Cancer Diagnosed?

Vulvar cancer is diagnosed with a physical examination, biopsy, and imaging tests when needed.

Tests may include:

• Pelvic examination
• Vulvar examination
• Colposcopy in selected cases
• Vulvar biopsy
• CT scan, MRI, or PET scan
• Lymph node evaluation when appropriate

A biopsy is needed to determine whether cancer is present and to identify the type of cancer. Imaging studies help determine whether the cancer has spread and guide treatment planning.

How Is Vulvar Cancer Treated?

Treatment depends on the type of vulvar cancer, the size and location of the tumor, whether the cancer has spread, your overall health, and your treatment goals. Your care team will develop a personalized treatment plan based on your specific diagnosis.

Treatment may include:

• Surgery
• Laser treatment for selected precancerous lesions
• Sentinel lymph node biopsy
• Lymph node removal when appropriate
• Radiation therapy
• Chemotherapy
• Immunotherapy
• Targeted therapy
• Clinical trials

Surgery is often the primary treatment for vulvar cancer. Whenever possible, surgeons remove the cancer while preserving healthy tissue and maintaining normal function.

Depending on the size and location of the cancer, surgery may involve removing only the tumor, part of the vulva, or more extensive tissue. Sentinel lymph node biopsy may be performed to determine whether cancer has spread to nearby lymph nodes while minimizing unnecessary surgery.

Patients with more advanced disease may also receive radiation therapy, chemotherapy, immunotherapy, targeted therapy, or a combination of these treatments.