Vulvar Cancer

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By peace | July 16, 2006

The vulva is the outer part of the female reproductive system. The vulva includes the skin folds under the pubic hair that protect the urethra and vagina. The vulva has two folds of skin. The outer fold is called the labia majora and the inner fold is called the labia minora. The inner fold of the vulva forms a hood of skin called the prepuce. Below the prepuce is the clitoris. The clitoris is a sensitive piece of tissue that swells with blood when stimulated. At the bottom of the inner fold of the vulva is the fourchette. This is where the labia minora meet. Below the fourchette is the anus.

Vulvar cancer most often occurs on the inner part of the labia majora or labia minora. Sometimes it can occur on the clitoris or on small glands on the sides of the opening to the vagina. It is a rare type of cancer, representing only about 4% of all female reproductive organ cancers.

Statistics Of Vulvar Cancer

These are 2006 statistics from the American Cancer Society about vulvar cancer.

Vulvar cancer is rare. In 2006 about 3,740 women in the United States will be diagnosed with this cancer.

Vulvar cancer accounts for 4% of reproductive cancers and only 0.6% of all cancers in women.

If vulvar cancer in a woman can be operated on and has not spread to the lymph nodes, the 5-year survival rate is 90%. When the cancer has spread to the lymph nodes, the 5-year survival rate is 50% to 60%.

About 880 women will die this year from vulvar cancer.

Symptoms Of Vulvar Cancer

You can have vulvar cancer without having any symptoms, but many women do. These are some common symptoms of vulvar cancer.

Vulvar itching that does not improve

A change in skin color around the vulva. Your skin may become more red, lighter, or darker in color than the surrounding skin.

A change in the feel of your skin around the vulva. Your skin may feel thicker, scalier, rougher, or bumpier than surrounding skin.

Wartlike bump or bumps, cauliflowerlike growths, or ulcers or sores on the vulva

Pain when urinating

Burning or bleeding and discharge not related to your menstrual cycle

Enlarged glands in your groin

One type of vulvar cancer, called melanoma of the vulva, has different symptoms. These are some of the possible signs of vulvar melanoma.

A new mole on the vulva or a change in a mole that has been present for years

An abnormal mole. It may be asymmetrical, meaning one half doesn’t match the other. The mole may have an irregular or lacy border, meaning the edges are ragged, or it may also be irregular in color. A mole that is wider than 1/4 inch may be of concern as well.

These symptoms may be signs of other problems, including noncancerous changes.

Risk Factors
Certain factors can make women more likely to get vulvar cancer. These are called risk factors. Just because a woman has one or more risk factors does not mean she will get vulvar cancer. In fact, a woman can have all of the risk factors and still not get the disease. Or, a woman can have no known risk factors and get vulvar cancer. Doctors are not exactly sure what causes vulvar cancer but these are some possible risk factors.

Age. Women older than 50 are more at risk for squamous cell carcinoma, which is the most common type of vulvar cancer.

HPV infection. Human papillomaviruses (HPV) are a group of viruses that can cause genital warts. Women infected with HPV may be more at risk for vulvar cancer.

Smoking. Smoking increases your risk for vulvar cancer. If you have smoke and have genital warts, you are at an even greater risk for vulvar cancer.

Vulvar intraepithelial neoplasia (VIN). This condition causes a change in the cells on the surface of the vulva’s lining. Women with VIN may be more likely to develop vulvar cancer.

Lichen scierosus. Women with this condition have vulvar skin that is itchy and thin. These women are at a slightly higher risk of getting vulvar cancer.

Family history of melanoma. Women with a family history of melanoma or atypical moles have a higher risk of getting a melanoma of the vulva.

Chronic inflammation of the vulva. Chronic infections of vulvar skin, caused by poor hygiene or infections, may also be a risk factor for vulvar cancer.

HIV infection. Women with human immunodeficiency virus (HIV) are more at risk for vulvar cancer.

Low socioeconomic status. Many women with low incomes may not have access to medical care. Researchers believe this may prevent these women from seeing a gynecologist. This may partially explain the link between low income and increased risk for vulvar cancer.

Diagnosis Of Vulvar Cancer

Cancer of the vulva can be detected early through regular pelvic checkups. The earlier a cancer is found, the better the chance for conservative therapy and a cure. Typically a gynecologist will diagnose and treat problems of the vulva. The physician will examine the vulvar tissue with a magnifying device (colposcope) and take a biopsy of any suspicious-looking tissue. If cancer is found, referral to a gynecologic oncologist is important. At Mayo Clinic, experienced gynecologic oncologists consider each patient’s personal and medical needs before recommending a treatment plan.

Other noncanerous gynecologic conditions can exhibit similar symptoms to vulvar cancer. Evaluation by a phyisician is critical when the following symptoms appear:

Constant itching of the vulva
Changes in color of the vulva or in the way the vulva looks
White, rough-feeling areas of the vulva
Bleeding or discharge not related to periods
Severe burning, itching or pain in the vulva
Any thickening ulcer or lump not previously present

Once cancer of the vulva has been diagnosed, more tests will be done to determine whether it has spread to other parts of the body. This process is called staging, and it helps doctors determine the best treatment modalities. The stages of vulvar cancer include:

Stage 0 – Precancerous cells, vulvar intraepithelial neoplasia (VIN), are present; VIN often forms slowly.
Stage I – The cancer is 2 cm (about 1 inch) or less and found only in the vulva or perineum (the tissue between the vagina and the anus). The stage is further classified as Stage IA or IB depending on how deeply the cancer has invaded underlying connective tissue.
Stage II – The cancer is greater than 2 cm but is still found only in the vulva or perineum. No cancer has been found in the lymph nodes.
Stage III — The cancer has spread to the adjacent urethra (the opening from the bladder) or to nearby lymph nodes on one side of the vulva or groin.
Stage IV – Cancer has spread to other organs. The stage is classified as stage IVA or IVB depending on which part(s) of the body the cancer has invaded.
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the vulva or another place.