Vulvar Cancer: What It Is, Types, Symptoms, Diagnosis, and Treatment

Vulvar cancer refers to malignant tumor formations that can arise on the external surface of the female genital organs. The vulva includes the clitoris and the vaginal lips, known as labia, as well as the skin surrounding the urethra (urinary canal) and vagina. Vulvar cancer often presents as a mass or ulcer that causes itching in the vulva. It can occur at any age but is most frequently diagnosed in older adults. The treatment for vulvar cancer typically involves surgery to remove the cancerous tissue along with a small amount of surrounding healthy tissue. Sometimes, this surgery may require the complete removal of the vulva. The earlier the diagnosis, the less likely it is that extensive surgery will be needed. Therefore, early diagnosis and treatment are crucial.

What Is Vulvar Cancer?

Vulvar cancer is a rare type of cancer that can occur in the tissues of a woman’s vulva. It most commonly develops in the inner or outer vaginal lips but can be found in any part of the vulva. This type of cancer typically shows a slow progression, emerging after a process that spans several years. Pre-cancerous lesions, characterized by abnormal cell growth in the outermost layer of the skin, often develop prior to cancer. These precursor lesions are referred to as vulvar intraepithelial neoplasia (VIN).

What Causes Vulvar Cancer?

In general, cancers arise when mutations develop in a cell's DNA. The cell's DNA contains instructions on what the cells should do. As a result of mutations that cause cancer, instructions are given to cells to grow and divide rapidly. While other normal cells die, cancerous cells and their offspring continue to live. Consequently, the accumulating cells, which do not die, form a tumor that invades surrounding tissues and can spread to other parts of the body. Although the exact cause of vulvar cancer has not yet been clearly established, certain factors have been identified that increase the risk of developing it. Relevant risk factors may include:

• Age: The risk of vulvar cancer increases with age. However, it can occur in women of all ages. The average age of diagnosis is 65.
• HPV: Human papillomavirus (HPV) is a sexually transmitted microorganism. HPV infection is associated with an increased risk of various cancers, such as cervical and vulvar cancer. While most sexually active women and men are exposed to HPV, the infection often resolves on its own. In some cases, however, it causes cellular changes that increase the risk of cancer.
• Smoking: Smoking has been found to be associated with an increased risk of vulvar cancer.
• Weakened immune system: Individuals taking immunosuppressive medications due to organ transplants or those with conditions that weaken the immune system, such as HIV, have an increased risk.
• History of precancerous lesions in the vulva: Vulvar intraepithelial neoplasia (VIN) is a precancerous condition that increases the risk of cancer in the vulva. However, the vast majority of VIN cases do not progress to cancer, while a small proportion carries the risk of developing invasive vulvar cancer. Therefore, your doctor may recommend treatment or regular monitoring for areas with abnormal cells.
• Presence of a triggering skin condition in the vulva: Lichen sclerosus, a condition characterized by thinning and itching of the vulvar skin, increases the risk of vulvar cancer.

What Are the Symptoms of Vulvar Cancer?

Symptoms of vulvar cancer may vary from woman to woman, but there are some common symptoms that are frequently observed. Some of the commonly encountered symptoms include:

• Persistent itching, burning, and bleeding in the vulva
• Changes in the color of the vulvar skin, such as a red or pale white appearance compared to its usual state
• Changes in the vulvar skin, such as redness or a wart-like appearance
• Non-healing sores, lumps, or ulcers in the vulva
• Pain in the groin, especially during urination or sexual intercourse
• Sensitivity in the vulva

Types of Vulvar Cancer

Determining the type of cell from which vulvar cancer originates helps plan the most effective treatment. Vulvar cancers are classified based on the type of cell from which they arise. The most common types of vulvar cancer include:

• Vulvar Squamous Cell Carcinoma: This subtype begins in the cells that cover the surface of the vulva. The majority of vulvar cancers are squamous cell carcinomas.
• Vulvar Melanoma: This type of cancer starts in melanocytes, which are pigment-producing cells found in the vulvar skin.

Diagnosis Methods for Vulvar Cancer

To diagnose vulvar cancer, your doctor will first ask questions about your current and past illnesses, medical and family history, medications you are taking, and any existing health conditions. Then, a detailed physical examination will assess your overall health. Other examination methods that may be performed if vulvar cancer is suspected include:

• Vulvar and Pelvic Examination: At this stage, your doctor thoroughly examines the vulva. They look for any unusual lesions, such as masses, changes in color, or sores. If necessary, a biopsy may be taken for laboratory analysis. Your doctor will then perform a pelvic examination by placing one or two fingers in the vagina while placing the other hand on the lower abdomen to evaluate parameters like the shape and size of the uterus and ovaries, as well as investigate any unusual findings, such as masses or lumps. Additionally, a vaginal and cervical examination using a speculum is often conducted, and samples may be taken from the cervix for a Pap smear. The collected cell sample can be checked for HPV during the Pap smear process. In addition to all these examinations, a rectal examination is often performed as well.
• Colposcopic Examination: A colposcope is a medical device designed to examine the vulva, vagina, and cervix in more detail, using a light and magnification. The colposcope can be used during the vulvar and pelvic examination to examine the tissues in more detail. During the examination, a dilute acetic acid solution or a brown-colored dye may be applied to the tissues being examined to highlight abnormal cells that are not visible to the naked eye. Biopsies or tissue samples can be taken from areas that appear abnormal.

Treatment of Vulvar Cancer

The methods used for treating vulvar cancer are determined based on the type of cancer, its stage, location, and the patient's overall health and preferences. The treatment methods are detailed below:

• Surgery:
  The most commonly used treatment option for vulvar cancer is surgical. The aim of surgery is to remove all cancerous tissue without losing sexual function. Types of surgeries used in treatment include:
  • Laser Surgery: A laser beam is used to remove cancerous surface lesions.
  • Local Excision: This surgery involves the removal of the cancer and a small amount of surrounding healthy tissue. Sometimes, neighboring lymph nodes may also be removed.
  • Vulvectomy: This surgical procedure involves the removal of part or all of the vulva and nearby lymph nodes. Skin grafts may be used to replace the removed skin.
  • Pelvic Exenteration: This surgery is a comprehensive surgical procedure that may be necessary in advanced stages of cancer. It involves the removal of the lower part of the colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. Artificial openings are created in the body to collect urine and stool in a bag.

  After surgery, chemotherapy or radiation therapy may be needed to eliminate any remaining cancerous cells. Sometimes, radiation therapy or chemotherapy can be administered before surgery or without surgery.

• Radiation Therapy:
  Radiation therapy often aims to kill cancer cells using high-energy X-rays.
• Chemotherapy:
  Chemotherapy involves the use of cancer-killing drugs, which can be administered orally, intravenously, or via injection into the muscle.

If you notice any symptoms that suggest vulvar cancer, you should seek medical attention promptly for early diagnosis and treatment.