Vulvar Cancer

What is the vulva?

The vulva is the external portion of the female genital organs. It includes:

• labia majora - two large, fleshy lips, or folds of skin
  
  
• labia minora - small lips that lie inside the labia majora and surround the openings to the urethra and vagina
  
  
• vestibule - space where the vagina opens
  
  
• prepuce - a fold of skin formed by the labia minora
  
  
• clitoris - a small protrusion sensitive to stimulation
  
  
• fourchette - area beneath the vaginal opening where the labia minora meet
  
  
• perineum - area between the vagina and the anus
  
  
• anus - opening at the end of the anal canal
  
  
• urethra - connecting tube to the bladder

What is vulvar cancer?

Vulvar cancer is a malignancy that can occur on any part of the external organs, but most often affects the labia majora or labia minora. Cancer of the vulva is a rare disease, which accounts for half of one percent of all cancers in women, and may form slowly over many years. Nearly 90 percent of vulvar cancers are squamous cell carcinomas. Melanoma is the second most common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include:

• adenocarcinoma
• Paget's disease
• sarcomas
• verrucous carcinoma
• basal cell carcinoma

What are risk factors for vulvar cancer?

The following have been suggested as risk factors for vulvar cancer:

• age - of the women who develop vulvar cancer, three-fourths are over age 50, and two-thirds are over age 70

• chronic vulvar inflammation

• infection with the human papillomavirus (HPV)

• human immunodeficiency virus (HIV) infection

• lichen sclerosus - can cause the vulval skin to become very itchy and may slightly increase the possibility of vulvar cancer

• melanoma or atypical moles on non-vulvar skin - a family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer

• low socioeconomic status

• vulvar intraepithelial neoplasia (VIN) - there is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer

• other genital cancers

• smoking

What are the symptoms of vulvar cancer?

• constant itching
• changes in the color and the way the vulva looks
• bleeding or discharge not related to menstruation
• severe burning/itching or pain
• skin of the vulva looks white and feels rough

The symptoms of vulvar cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

How can vulvar cancer be prevented?

The cause of vulvar cancer is not known at this time, however, certain risk factors are suspected as contributors to the development of the disease. Suggestions for prevention include:

• Avoid known risk factors when possible.
• Delay onset of sexual activity.
• Use condoms.
• Do not smoke.
• Have regular physical checkups.
• Have routine Pap tests and pelvic examinations.
• Routinely check entire body for irregular growth of moles.

How is vulvar cancer diagnosed?

Vulvar cancer is diagnosed by biopsy, removing a section of tissue for examination in a laboratory by a pathologist.

Treatment for vulvar cancer:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment for patients with cancer of the vulva may include:

• surgery, including:
  
  
  • laser surgery - use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells
    
    
  • excision - the cancer cells and a margin of normal appearing skin around the cancer is removed
    
    
  • vulvectomy - surgical removal of part of all of the tissues of the vulvar
    
    
• radiation therapy
• chemotherapy

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