Vulvar Cancer Care
Vulvar Cancer: Symptoms, Diagnosis, Stages & Treatment
Vulvar cancer develops in the tissues of the vulva, the external female genital area. Persistent itching, skin changes, a lump, ulcer or unusual bleeding should be medically evaluated. Diagnosis usually requires examination and biopsy, while treatment depends on the tumour type, location, stage and individual patient factors.
What Is Vulvar Cancer?
Vulvar cancer is a cancer that begins in the tissues of the vulva. The vulva includes the external female genital structures. Vulvar cancer is uncommon compared with some other gynecologic cancers, and its management should be individualized according to pathology, tumour location, size, stage and patient factors.
Types of Vulvar Cancer
Squamous cell carcinoma is the most common type of vulvar cancer. Less common cancers can arise from other vulvar tissues. The exact histologic diagnosis from pathology is important because different tumour types may require different treatment approaches.
Risk Factors
Risk can be associated with increasing age, persistent infection with high-risk human papillomavirus (HPV), vulvar precancerous changes, smoking, weakened immune function and certain chronic vulvar skin conditions. Having one or more risk factors does not mean that a person will develop vulvar cancer.
HPV and Vulvar Cancer
Some vulvar cancers are related to persistent high-risk HPV infection, while others develop through HPV-independent pathways. HPV vaccination can reduce the risk of several HPV-related diseases, but patients with persistent vulvar symptoms or visible changes still require appropriate clinical evaluation.
Signs & Symptoms of Vulvar Cancer
Possible symptoms include persistent vulvar itching, burning or pain; a lump or growth; an ulcer or sore that does not heal; changes in skin colour or thickness; unusual bleeding or discharge; or tenderness in the vulvar area. These symptoms can also occur with non-cancerous conditions, but persistent or changing symptoms should be assessed by a healthcare professional.
Diagnosis & Biopsy
Evaluation generally begins with medical history and careful examination of the vulva and surrounding areas. A biopsy of a suspicious lesion is important for confirming the diagnosis. Additional examinations, imaging or other investigations may be recommended to assess the extent of disease and plan treatment.
Vulvar Cancer Stages
Staging describes the size and local extent of the tumour and whether cancer has spread to nearby lymph nodes or distant sites. Vulvar cancer is broadly classified from Stage I through Stage IV using current gynecologic oncology staging criteria. Treatment planning should be based on the confirmed stage and pathology rather than stage number alone.
Treatment of Vulvar Cancer
Treatment depends on tumour size, location, depth of invasion, lymph-node involvement, stage, pathology, general health and patient-specific considerations. Depending on the situation, treatment may include surgery, radiation therapy, chemotherapy or combined approaches. More advanced or recurrent disease may require individualized systemic treatment planning.
Vulvar Cancer Surgery
Surgery is an important treatment for many vulvar cancers. The goal is to remove the cancer with an appropriate margin while preserving normal anatomy and function whenever oncologically safe. The extent of surgery can range from local excision to more extensive procedures depending on the disease. Not every patient requires the same operation.
Lymph Node Assessment
Assessment of groin lymph nodes can be an important part of vulvar cancer staging and treatment for selected patients. Depending on tumour characteristics and clinical circumstances, sentinel lymph-node assessment or other lymph-node procedures may be considered. The appropriate approach should be determined by a gynecologic oncology team.
Radiation Therapy & Systemic Treatment
Radiation therapy may be used in selected patients as part of primary treatment, after surgery, or for recurrent or advanced disease. Chemotherapy may sometimes be combined with radiation, and systemic therapies may be considered according to disease characteristics and current oncology guidance.
Recovery & Follow-Up
Recovery depends on the extent of treatment. After surgery, attention may be required for wound care, pain management, mobility and prevention or management of complications. Follow-up is important to assess recovery, monitor for recurrence and evaluate any new vulvar symptoms or treatment-related concerns.
Multidisciplinary Vulvar Cancer Care
Vulvar cancer care may involve gynecologic oncology, pathology, radiology, radiation oncology, medical oncology and other specialists as required. Multidisciplinary planning is particularly important when treatment may affect urinary, sexual, lymphatic or other aspects of quality of life.
When to Consult a Gynecologic Oncologist
Specialist evaluation may be appropriate when a vulvar lesion is suspicious or biopsy confirms cancer, when precancerous or recurrent vulvar disease requires specialist assessment, when surgery or multimodality treatment is being considered, or when a patient wants a second opinion.
Personalized Treatment & Second Opinion
Treatment should be individualized according to pathology, stage, tumour location, lymph-node status, overall health and patient preferences. A specialist second opinion can help clarify the diagnosis, staging and available treatment approaches before major treatment decisions.
Frequently Asked Questions
What is vulvar cancer?
Vulvar cancer is a cancer that develops in the tissues of the external female genital area, known as the vulva.
What are the symptoms of vulvar cancer?
Possible symptoms include persistent itching, pain or burning, a lump or growth, an ulcer or sore that does not heal, skin changes, or unusual bleeding or discharge.
Does vulvar itching mean cancer?
No. Vulvar itching has many possible causes and is often not due to cancer. Persistent, unexplained or changing symptoms should nevertheless be medically evaluated.
Is vulvar cancer related to HPV?
Some vulvar cancers are associated with persistent high-risk HPV infection, while other vulvar cancers develop through HPV-independent pathways.
Can HPV vaccination help prevent vulvar cancer?
HPV vaccination can reduce the risk of HPV-related disease and cancers caused by vaccine-covered HPV types. It does not prevent every type of vulvar cancer.
How is vulvar cancer diagnosed?
Diagnosis generally involves clinical examination and biopsy of a suspicious vulvar lesion. Imaging or other tests may be required for staging.
What are the stages of vulvar cancer?
Vulvar cancer is broadly staged from Stage I through Stage IV according to tumour extent, lymph-node involvement and spread to other areas.
How is vulvar cancer treated?
Treatment may include surgery, radiation therapy, chemotherapy or combined approaches depending on the tumour and individual clinical factors.
Does every patient with vulvar cancer need major surgery?
No. The extent of surgery depends on tumour size, location, stage and other clinical factors. Treatment aims to achieve cancer control while preserving normal anatomy and function when oncologically safe.
Are lymph nodes removed in vulvar cancer surgery?
Lymph-node assessment may be needed for selected patients, but the approach varies. Sentinel lymph-node assessment or other procedures may be considered according to tumour characteristics and current guidelines.
Can vulvar cancer come back after treatment?
Recurrence can occur, which is why appropriate follow-up is important. Individual recurrence risk depends on the disease and treatment factors.
When should I consult a gynecologic oncologist?
Consultation is appropriate when vulvar cancer is suspected or confirmed, a suspicious lesion requires specialist assessment, complex treatment is being planned, or a second opinion is desired.