Vulvar Cancer

Symptoms of Vulvar Cancer

Vulvar cancer can usually be treated successfully if it is diagnosed before the cancer has spread to distant parts of the body. 

Symptoms of vulvar cancer include:

• Itching that does not get better or go away.
• Abnormal area on the vulva that could be darker or lighter than the skin around it.
• Bump or lump with wart-like or raw surface.
• Thickening of the skin of the vulva.
• Pain or a burning sensation.
• Bloody discharge.
• Open sore that doesn’t go away.
• Abnormal moles on or near the vulva.

Screening for Vulvar Cancer

Screening is used to look for cancer before a person shows any symptoms of the disease. There are no standard screenings for vulvar cancer, though it may be detected during a pelvic exam. The Pap smear does not check for vulvar cancer; it is a screening test for cervical cancer. A doctor may also do an HPV test if vulvar cancer is suspected.

Diagnosing Vulvar Cancer

Based on a patient’s symptoms and after an initial physical examination, a doctor may order certain tests to determine whether the patient has vulvar cancer. Though testing procedures can vary based on the type of vulvar cancer the doctor is looking for, common tests for vulvar cancer include:

Biopsy: During a biopsy, a doctor extracts a sample of tissue from the vulva. This is sent to a laboratory for analysis by a pathologist to determine whether the cells in the sample are cancerous.

Magnetic resonance imaging (MRI): An MRI uses radio waves and magnetic fields to produce detailed images of the body.

Computed tomography (CT or CAT) scan: A CT scan uses X-rays to take detailed images of the body and can help determine if cancer has spread to other organs or come back after treatment.

Positron emission tomography (PET) scan: A slightly radioactive form of sugar is injected into the blood, where it is taken in by cells in the body. Since cancer cells grow faster than normal cells, they take in larger amounts of the sugar. Doctors use PET scans to look for possible areas of cancer spread, and to determine if suspicious areas seen in other imaging tests are cancer or not.

Stages of Vulvar Cancer

After diagnosing the presence of vulvar cancer, the doctor will identify the stage of the disease. The stage is determined by several factors, including where exactly the disease formed, how extensive it is, and whether and how much it has spread. 

Many of the same tests used to diagnose vulvar cancer can also be used to help determine the stage, including biopsies, X-rays, CT/CAT scans, and PET scans.

Doctors typically use the TNM system to determine the stage of vulvar cancer. The TNM system assesses the size and extent of the tumor (T) and whether it has ulcerated; whether the cancer has spread to nearby lymph nodes (N); and the presence and extent of metastasis (M) to distant lymph nodes, bones, and organs.

After the TNM assessment, the doctor will assign an overall stage number from I to IV, which can be further broken down based on the size of the original tumor and the extent to which the cancer has spread. In general, the lower the stage the better the prognosis and treatment options.

• Stage I: Cancer is found in the vulva or the space between the opening of the rectum and the vagina (perineum) or both. It has not spread to nearby lymph nodes or other parts of the body.
  • Stage IA: The tumor is no more than 2 centimeters across, and it has grown no more than 1 millimeter into the tissue of the vulva. 
  • Stage IB: The tumor is more than 2 centimeters across or has spread more than 1 millimeter beneath the surface of the vulva. 
• Stage II: The tumor is any size. It has spread outside the vulva to nearby sites such as the urethra, lower vagina, or anus. It has not spread to lymph nodes or distant sites in the body. 
• Stage III: The cancer is in the vulva or the perineum or both. It may or may not have spread to the urethra, lower vagina, or anus. It has not spread to organs in distant sites in the body.
  • Stage IIIA: The cancer has spread either to one lymph node that is at least 5 millimeters across, or it has spread to one or two lymph nodes that are less than 5 millimeters across. 
  • Stage IIIB: The cancer has spread to three or more lymph nodes that are no more than 5 millimeters across, or it has spread to two or more lymph nodes that are more than 5 millimeters across. 
  • Stage IIIC: The cancer has spread to nearby lymph nodes, and at least one of the nodes has cancer growing through its outer layers. 
• Stage IVA: The cancer has not spread to organs in other parts of the body, and one of these is true: 
  • The cancer is in the vulva or the perineum or both. It may or may not have spread to the urethra, lower vagina, or anus. It has spread to nearby lymph nodes that are stuck to deeper tissues or have ulcerated. 
  • The cancer has spread beyond nearby tissues to the upper part of the urethra, upper vagina, bladder, rectum, or pelvic bone. It may or may not have spread to nearby lymph nodes. 
• Stage IVB: This is the most advanced stage of vulvar cancer. The cancer has spread to organs such as the lungs, or bone, or to lymph nodes farther away in the body. It may or may not have spread to nearby lymph nodes and organs. 

Treatments for Vulvar Cancer

The treatment for vulvar cancer is customized to each patient and depends on the stage at which the patient is diagnosed, and the patient’s general health.

Vulvar cancer care teams may include multiple health care specialists, including primary care providers, gynecologists, gynecologic oncologists, medical oncologists, hematologists, and radiation oncologists, as well as nurse practitioners, physician assistants, nurses, psychologists, social workers, and rehabilitation specialists. CU Cancer Center doctors offer specialized care for patients with vulvar cancer.

Treatments for vulvar cancer include surgery, radiation therapy, and chemotherapy. Patients may receive one or more of these treatments in combination. The vulvar pre-cancer known as vulvar intraepithelial neoplasia (VIN) may be treated topically. Some patients may also be eligible to participate in clinical trials — doctor-led research studies of new or experimental procedures or treatments. 

Surgery for Vulvar Cancer

Surgery is the primary treatment for vulvar cancer. The two main types of surgery for this cancer are excision, which removes the cancer along with a margin of healthy skin around it, or vulvectomy — surgery to remove all or part of the vulva. 

Radiation Therapy for Vulvar Cancer

Radiation therapy uses high-powered energy to kill cancer cells. A doctor who specializes in radiation therapy to treat cancer is a radiation oncologist. The primary type of radiation therapy used to treat vulvar cancer is external beam radiation, which uses a machine located outside the body to focus a beam of X-rays on the area with the cancer. In vulvar cancer, radiation is most often used in combination with chemotherapy.

Chemotherapy for Vulvar Cancer

Chemotherapy uses drugs to kill rapidly growing cancer cells. Drugs are either injected into a vein or taken orally. The chemotherapy drug most often used to treat vulvar cancer is cisplatin. In vulvar cancer, chemotherapy is often combined with radiation therapy.