This information explains vulvar cancer, including symptoms, diagnosis, and treatment.
The diagnosis of vulvar cancer brings many questions. We hope this information will review and add to what you learn from your healthcare provider. Do not feel you have to read all of this information at once. It is meant for you to use over time. It may help to read some sections before you speak with your healthcare provider so you will have a better idea of what to ask. Other sections may help you remember what your healthcare provider has told you.
Vulvar cancer is rare. Your vulva includes the inner and outer lips of your vagina, your clitoris, the opening of your vagina and its glands, which are in the area called the perineum (see Figure 1). Vulvar cancer can be in any of these areas, but it’s usually in the outer vaginal lips.
Vulvar cancer usually develops slowly over many years. It begins as abnormal cells, which can grow on the vulvar skin for a long time. These abnormal cells are precancerous. Terms for them are dysplasia and vulvar intraepithelial neoplasm (VIN). Treating these abnormal cells can help prevent vulvar cancer. Having routine exams can find skin changes early, which makes them easier to treat.
Infection with certain types of human papillomavirus (HPV) cause about half of all vulvar cancers. Vaccines that protect against these types of HPV may lower your risk of getting vulvar cancer.
Signs and Symptoms of Vulvar Cancer
Vulvar cancer often does not cause early symptoms. When symptoms appear, they may be signs of cancer or another condition. Use a mirror to examine your vulva once a month, then tell your healthcare provider what you see. If you have any of the symptoms listed below, do not ignore them.
- A lump, thickening or ulcer (sore) on your vulva.
- A patch of skin that is differently textured or colored than the rest of your skin.
- A change in the appearance of a mole.
- Wart-like growths.
- Itching or burning that does not go away with treatment.
- Bleeding or discharge not related to menstruation (periods).
- Tenderness or pain.
- Pain during intercourse or urination.
- Unusual odor.
There are no screening tests for vulvar cancer. If you notice any changes, tell your healthcare provider. He or she will ask about your medical history and do a physical exam.
During a pelvic exam your healthcare provider will examine your vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. He or she will insert a lubricated gloved finger into your vagina while placing the other hand over your lower abdomen (belly). This will allow him or her to feel the size, shape, and position of your organs to see if anything is abnormal.
If needed, your healthcare provider will take a sample of the tissue, which is called a biopsy. This can be done in your doctor’s office. The tissue is sent to the lab and examined under a microscope to check for signs of cancer.
Your healthcare provider may also do other tests, such as:
- A computed tomography (CT) scan may be done to take pictures of the inside of your body. The pictures are made by a computer linked to an x-ray machine. You may be asked to drink dye or have it injected into a vein to make your organs show more clearly.
- Magnetic Resonance Imaging (MRI) is a scan that uses magnetic fields to make detailed pictures of the inside of your body.
- A positron emission tomography (PET) scan makes images of the entire body. A small amount of radioactive material is injected into a vein. This material is absorbed mainly by tissues that use the most energy, such as cancer. The images your healthcare provider sees from the PET scan can show whether there is cancer.
- Your healthcare provider may also order a PET-CT. This combines the images from a PET scan and a CT scan. They are done at the same time on the same machine.
How Cancer Spreads
When cancer has spread beyond where it started, it is called metastasis. Cancer can spread:
- Into nearby tissue.
- To the lymph system and then to other areas in the body.
- To the blood vessels and then to other areas in the body.
Staging is a way of describing where and how big the cancer is. Staging will help your doctor make the best treatment choice for you.
Stage 0 (carcinoma in situ): The cancer has not spread from where it started. It is on the surface of the vulva only.
Stage 1: The cancer is only in the vulva or perineum. It has not spread to the lymph nodes or other parts of the body. This stage is divided into stage IA and stage IB.
- Stage IA: The cancer is less than or equal to 2 centimeters (less than two-thirds of an inch) and has spread no more than 1 millimeter deep into vulvar tissue.
- Stage 1B: The cancer is more than 2 centimeters deep, has spread more than 1 millimeter deep into vulvar tissue, or both.
Stage II: The cancer has grown into tissues near the vulva and perineum. It can be any size. This tissue can be the lower part of the urethra, vagina, or anus. The cancer has not spread to the lymph nodes or other parts of the body.
Stage III: The cancer has spread to nearby lymph nodes.
Stage IV: The cancer has spread to other places nearby (2/3 upper urethra, 2/3 upper vagina) or distant organs.
- Stage IVA: The cancer has spread to any of the following:
- Upper urethra, vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to the pelvic (hip) bone
- Fixed (meaning they do not move when you feel them) or ulcerated inguina-femoral lymph nodes, which are in your groin
- Stage IVB
- Cancer has spread to distant parts of the body.
Recurrent Vulvar Cancer
Recurrent vulvar cancer is cancer that has come back after it has been treated. It can come back in the area of the vulva or in other parts of the body.Back to top
Treatment for vulvar cancer depends on:
- The size and location of the cancer.
- Whether it has spread.
- Your overall health.
Your surgeon will discuss your treatment options with you.Back to top
Surgery is the main treatment. Cancer often involves several areas, so a large amount of tissue needs to be removed. If the tumor is large (more than 2 centimeters) or has grown deeply into the vulva, the lymph nodes in the groin area may also be removed. The lymph nodes are tiny, bean shaped organs that help fight infection.
- Laser surgery is the use of a focused beam of light that burns the cancer off the skin. It is only used to treat precancerous conditions.
- A wide excision is the removal of the tumor and some nearby tissue. Your surgeon will remove some nearby healthy tissue to make sure all of the cancer is gone.
- A vulvectomy is the removal of all or part of the vulva.
- A partial vulvectomy removes the part of the vulva where the cancer is.
- A simple vulvectomy removes the entire vulva.
- A radical vulvectomy removes part or all of the vulva and nearby tissue.
- Lymph node dissection is the removal of one or more lymph nodes. There are different types of lymph node dissections. Your surgeon will talk with you about which type may be right for you, and your nurse will give you written information about the type you’re having.
- During a sentinel node dissection only the first nodes that drain the area near the cancer are removed.
- During a complete lymph node dissection all the lymph nodes are removed. It can be done on 1 or both sides of the perineum. It increases the risk of lymphedema (swelling) in the leg on the side the nodes were removed.
If you’re having vulvar reconstruction, you will meet with a plastic surgeon to help plan your care.
You will need time to heal and recover. Some women need longer to heal than others. Ask your healthcare provider what you should expect. They can tell you more based on the surgery you had and how much tissue was removed.
For the first 3 to 4 weeks, you will be able to lie down or stand. You will not be able to sit. If you had major surgery or reconstructive surgery, you may not be able to sit for up to 8 weeks. Most people find the position they have to be in after surgery uncomfortable.
The area where you had the surgery will be sore for a few weeks. You will get pain medication while you’re in the hospital and a prescription for pain medication before you go home. You may go home with drains. If so, your nurse will teach you how to care for them before you leave the hospital.
You will see your surgeon 7 to 10 days after surgery to check the surgery site and remove the stitches and drains.
Call your surgeon’s office sooner if you have:
- Increased pain
- Increased swelling
- Drainage or foul odor
- A temperature of 101º F (38.3º C) or higher
- Difficulty urinating
If the cancer has spread to other areas in your body, such as your lymph nodes and other organs, radiation therapy may be given. It can also be given before surgery to shrink the tumor.
The most common type of radiation is called external beam. It is given by a machine from outside of the body. Radiation can also be given internally with implants, which is called brachytherapy. If you’re having radiation you will be given information about how to prepare for radiation, the treatments, and the side effects.Back to top
If chemotherapy is planned for your treatment, your nurse will give you written information about the chemotherapy drugs you will receive.Back to top
Biologic therapy is a treatment that uses the your immune system to fight cancer. Substances made by the body or in the laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. It is also called biotherapy or immunotherapy.
Imiquimod is a biologic therapy that is applied to the skin as a cream.
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Clinical trials are research studies that study the best ways to improve outcomes for people with vulvar cancer. Ask your healthcare provider about clinical trials for vulvar cancer, or go to www.cancer.gov/clinicaltrials/education/what-is-a-clinical-trial for more information.Back to top
Coping with vulvar cancer can be difficult. You may want help dealing with the emotional impact on you and your family and friends. If you have questions or worries, talk with the members of your healthcare team. Let them know if you’re feeling anxious or depressed. There are many counselors who can help you express, understand, and cope with your feelings.
There are also support groups for people with cancer. Groups can help you support each other and understand your feelings and experiences. Talk to your healthcare provider about support groups that are available to you.
You may have questions about sex. You can discuss them with your doctor, nurse or social worker. At Memorial Sloan Kettering (MSK) we also have a Female Sexual Health Program to help you. For more information or to make an appointment call 646-888-5076.
A social worker can provide emotional support, suggest resources for financial aid, transportation, and home care. He or she can keep in touch with the rest of your healthcare team, including also refer you our Case Management Department.
You may also wish to call Integrative Medicine at 646-888-0800.
- Visualization and other mind-body therapies
- Music therapy
- Nutritional counseling
- Classes in yoga, t’ai chi, and aerobics
When your treatment ends, your healthcare provider will give you a follow-up care plan. The plan explains what exams and tests you should have in the future and how often you should have them. Following the plan can help to detect a returning or new cancer. Call in between check-ups if you have any symptoms. Ask your nurse to show you where to look using a mirror. You should examine your perineal area monthly.
Anyone who has had cancer should:
- Get to and remain at a healthy weight.
- Stop smoking.
- Eat a balanced diet.
- Exercise to build strength and energy.
Having cancer can cause many emotions. Recovering from cancer treatments can take time. Please take advantage of our staff’s experience. They can help you at every step and can refer you to other professionals if needed. Let us know how you are feeling and what we can do to help.Back to top
American Cancer Society(ACS)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
275 Seventh Avenue (Between 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
National Cancer Institute
Provides information about specific types of cancer, updates on cancer treatments, and news about research advances.
The Wellness Community
Provides professionally led support groups nationwide and education, stress management, and social networking in a home-like community setting with a focus on enhancing health and well-being.
Gynecologic Cancer Foundation
This foundation of the Society of Gynecologic Oncologists. Their mission is to support research, education and public awareness of gynecologic cancer prevention, early diagnosis and optimal treatment.