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Vulva
General Information / Anatomy / Function / Statistics
- Outermost part of the female reproductive system
- Includes the opening of the vagina, the lips (labia majora, labia minora) and the clitoris
- Uncommon
- Mainly affects women in 50-65 age group
- "In situ" vulvar cancer seems to be increasing in the 30-40 age group
Symptoms / Signs
- Early stages there are no symptoms
- Burning
- Itching
- Bleeding
- Pain
- Discharge
- Feeling of a "lump" or ulcer
- Leukoplakia (white patches) may or may not be significant.
Etiology / Carcinogens / Risks
- May be associated in older women with lichen sclerosus
- Risk is primarily related to the exposure to the sexually transmitted human papillomavirus (HPV) (a history of genital warts)
- Commonly a history of chronic vulvar pruritus (itching)
Prevention
Annual gynecologic examination
Diagnosis / Staging / Grading / Types
Pelvic examination
Colposcopy
Biopsy
Lesions may appear on both sides of the vulva (bilateral lesions) before cancer is diagnosed
Tumors spread to nearby lymph nodes
May invade the vagina
Distant metastases are rare, occasionally to lung, liver and bones
Death usually due to infection and hemorrhaging caused by invasion of the cancer
Skin of the vulva also subject to other skin cancers; e.g., basal cell carcinomas, melanomas
Staging
- Stage 0 - intraepithelial carcinomas in situ
- Stage I - tumor is confirmed to the vulva and/or perineum and is less than 2cm (3/4 in); nodes not palpable
- Stage II - tumor is limited to vulvar and is more than 2 cm (3/4 in)
- Stage III - spread to vagina, lower urethra, anus or groin lymph nodes
- Stage IV - invasion of the upper urethra, bladder mucosa, rectal mucosa, pelvic bone, and/or bilateral regional/pelvic node metastasis; distant metastases
Types
- Squamous cell carcinomas - 86% of all vulvar malignancies
- Melanomas - 6%
- Adenocarcinoma of the Bartholin's Gland - 2%
- Sarcomas - 2%
- Basal Cell Carcinomas - 2% and has an excellent rate of cure
Treatment
- Note: Creams and ointment should not be recommended in the absence of an examination and diagnosis
- Standard treatments include surgery, radiation and chemotherapy
Surgery
- Precancerous conditions (carcinoma in situ) are treated with laser or local excision or occasionally more extensive surgery:
- Simple vulvectomy
- Removal of the skin layer of vulva may followed by skin graft
- Total or radical vulvectomy performed for invasive cancer. Labia and clitoris may be removed and nearby lymph nodes from the groin
- In some cases if the cancer is small the surgery will be less radical
- Patient can still become pregnant
- Other surgical procedures may be employed if cancer has spread outside the vulva
Radiation
- Has a role in the management of this disease when advanced, particularly when there is lymph node involvement, usually in combination with surgery
- Radiation may also be used when the location of the cancer is such that excision would require colostomy for advanced or recurrent disease
Chemotherapy
- Has recently been used in combination with radiation
Revised April 2000
March 2007 We are currently reviewing and updating these pages. If you have any questions about your cancer and its treatment, please discuss with your oncologist or physician. Thank you.
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