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 just inside the labia majora surrounding the openings to the urethra and vagina.

• Vestibule: space where the vagina opens

• Prepuce: a fold of skin formed by the labia minora that covers the clitoris

• Clitoris: a small protrusion of nerve tissue 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 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, accounting for 0.6 percent of all cancers in women, and it may form slowly over many years. Most vulvar cancers are squamous cell carcinomas. Melanoma is another common type of vulvar cancer that is usually found in the labia minora or clitoris. Other types of vulvar cancer include:

• Adenocarcinoma

• Paget disease

• Sarcomas

• Basal cell carcinoma

Vulvar Cancer Prevention

The cause of vulvar cancer is not known at this time. However, certain risk factors are thought to contribute to development of the disease. Suggestions for prevention include:

• Avoiding known risk factors when possible

• Delaying onset of sexual activity

• Using condoms

• Not smoking

• Having regular physical checkups

• Getting vaccinated against HPV

• Having routine Pap tests and pelvic exams

• Routinely checking entire body for irregular growth of moles and checking your vulva regularly for any signs of vulvar cancer

The HPV vaccine can prevent the strains of HPV responsible for most cervical, vaginal and vulvar cancers. HPV vaccines can only be used to prevent certain types of HPV. They cannot be used to treat an existing HPV infection. To be most effective, one of the vaccines should be given before a person becomes sexually active.

Vulvar Cancer Risk Factors

The following factors may increase a woman’s risk of developing vulvar cancer:

• Age: Of the women who develop vulvar cancer, over 80 percent are over 50, and half are over 70.

• Infection with certain types of HPV

• HIV infection

• Lichen sclerosus: This can cause the vulvar skin to become very itchy and may slightly increase the possibility of vulvar cancer.

• Melanoma or atypical moles on nonvulvar skin: A family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer.

• Vulvar intraepithelial neoplasia (VIN): VIN occurs when there are abnormal cells on the surface layer of vulvar skin. These cell changes are a precancerous condition, so there is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer.

• Other genital cancers

• Smoking

Vulvar Cancer Symptoms

While each woman may experience symptoms differently, the most common symptoms are:

• Constant itching

• Changes in the color and the way the vulva looks

• Bleeding or discharge not related to menstruation

• Severe burning, itching or pain

• An open sore that lasts for more than a month

• Skin of the vulva looks white and feels rough

The symptoms of vulvar cancer may look like other conditions or medical problems. Always consult a doctor for diagnosis.

Vulvar Cancer Diagnosis and Treatment

Vulvar cancer is diagnosed by biopsy, removing a small piece of tissue for exam in a lab by a pathologist.

Treatment for Vulvar Cancer

Specific treatment for vulvar cancer will be determined by your doctor(s) based on:

• 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

Treatment for cancer of the vulva may include:

• Surgery:

  • Laser surgery: This surgery uses a powerful beam of light to destroy abnormal cells. The beam can be directed to specific parts of the body without making a large incision (cut). This type of therapy is only used for premalignant (noninvasive) disease of the vulva.

  • Excision: The cancer cells and a margin of normal tissue around the cancer are removed.

  • Vulvectomy: All tissues of the vulvar are surgically removed. The extent of the tissue removed is based on the size and location of the lesion.

• Radiation therapy: X-rays, gamma rays and charged particles are used to fight cancer.

• Chemotherapy: Anticancer drugs are used to treat cancerous cells.

It's very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment and surveillance of female cancers, including vulvar cancer.