Overview
The vulvar, or the outer part of the female genitals, includes the opening of the vagina, the clitoris and the two folds of skin or lips, known as the inner and outer labia. Vulvar cancer typically develops on the inner labia. It is a very rare form of cancer and highly curable if detected at an early stage.
Estimates show nearly 5,000 women are diagnosed with vulvar cancer annually in the U.S.
Some women develop vulvar intraepithelial neoplasia (VIN), a condition of abnormal cells on the surface of the vulvar that can develop into cancer if left untreated.
Symptoms
A spot on the skin of the vulvar may be thicker, lighter or appear red, pink, or darker than surrounding area.
A bump, with wart-like or raw surface.
Open sore that lasts for a month or more.
Itching, burning, pain, bleeding or discharge not related to menstrual period.
A cauliflower-like growth similar to genital warts.
In some cases, there may be no symptoms.
Women with VIN may experience severe itching or have an area of discolored or rough tissue.
Causes
In younger women, most cases of vulvar cancer are caused by an infection with the human papillomavirus (HPV). Vulvar cancer in older women is not usually associated with HPV.
A disorder called lichen sclerosus et atrophicus (LSA) causes the vulvar to become thin and itchy and seems to increase the risk of developing vulvar cancer – about 4 percent of women who have LSA will later develop vulvar cancer.
Risk Factors
Infection with human papillomavirus (HPV) This virus is transmitted from one person to another through skin-to-skin contact with an infected area of the body. It can be spread from genital-to-genital contact, mouth-to-genital or even hand-to-genital contact. It can also spread from one part of the body to another, such as from the cervix to the vagina and vulva. HPV infection is common and often resolves on its own. Chronic HPV infection can eventually cause certain types of cancers, including vulvar cancer.
Human immunodeficiency virus (HIV)
Smoking
Tests and Diagnoses
The only way to confirm whether an abnormality is vulvar cancer is to do a biopsy, which is removing and testing a small piece of tissue from the suspicious area. A physician will typically treat the vulvar area with a vinegar-like solution that turns VIN and cancer areas white and then use a colposcope, a binocular magnifying lens, to find the abnormal cells. A local anesthetic is injected and a biopsy is performed. Depending on the results of the biopsy, further surgery may be necessary.
Treatment And Drugs
Surgery is usually the best treatment option for women with vulvar cancer. Surgical procedures range from removing the cancer and at least two centimeters of normal tissue surrounding the tumor to removing nearby organs and lymph nodes if the cancer has spread.
Radiation and chemotherapy may also be prescribed, depending on the type and stage of the disease. At times, chemotherapy or radiation may be prescribed for women with large vulvar tumors in order to shrink them before surgery.
Biologic therapy is a treatment that uses either the patient's immune system or substances made in a laboratory to boost the body's natural defenses in fighting the disease. Imiquimod is a biologic therapy cream that may be applied to the affected area to treat precancer.
Prevention
Avoid risk factors and treat pre-cancerous conditions.
Get vaccinated to prevent different types of HPV infections.
Have symptoms such as vulvar itching, rashes, moles or lumps examined to be sure they are not indicators of pre-cancerous conditions.
Treat vulvar intraepithelial neoplasia (VIN).
Remove atypical moles in the vulvar area to help prevent vulvar melanomas.
Women should self-examine their vulvar regularly using a mirror and report any changes to their physician. Look for areas that are white, darkly pigmented, red or irritated and check for any new growths, nodules, bumps and ulcers.
