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Vulva

​This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed June 2016

The basics
  • Guidelines for treating this cancer have been developed by the Gynecology Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines (Vulva).
  • For newly diagnosed patients, we offer Taking it Step by Step: a guide for women diagnosed with gynecological cancer. This BC guide was created by survivors and health care professionals of the BC Cancer Agency. It covers all aspects of the patient journey.
  • Vulva cancer may also be called vulvar cancer. Paget's disease of the vulva is a form of vulvar cancer.
  • The vulva is located in the female groin area or perineum, and is the outer part of the female genitals.
  • The vulva is made up of skin and fatty tissue and includes the opening of the vagina, the outer lips (labia majora), inner lips (labia minora) and the clitoris.
  • The inner and outer labia protect the vaginal opening; the clitoris is highly sensitive and gets swollen with blood during sexual stimulation.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.
 
  • Vulva cancer is a very rare type of cancer.
  • Vulva cancer mainly affects women in their sixties and seventies.
  • Infection with the sexually transmitted human papillomavirus (HPV) is the main risk factor for this cancer.
  • Women who get vulva cancer commonly have a history of chronic vulvar pruritus (itching) and may also have a history of abnormal pap smears.
  • Some older women with lichen sclerosus (a condition that makes that vulvar skin thin and itchy) may develop vulva cancer.
  • Statistics (Vulvar cancers are very rare and statistics are not published separately for this cancer. Instead numbers are included with a group of related cancers under "Genital Cancers."):

Can I help to prevent it?

  • Limit the number of sexual partners you have.
  • Use condoms.
  • Don't smoke.
  • Get the HPV vaccination before beginning sexual activity.

HPV Vaccination

  • A vaccine is available that protects against two types of human papillomaviruses that can cause vulva cancer.
  • The vaccine is recommended for girls and women between the ages of 9 and 26 years before they come in contact with HPV.
  • The vaccine may also benefit women who are sexually active and have not yet been infected with HPV. The vaccine prevents HPV infection but it does not get rid of it once the infection occurs.
  • For more information call your local public health unit or speak to your family physician. You can also find information at www.immunizebc.ca.

Screening for this cancer

Women should have a yearly gynecologic examination. The doctor will examine the area and check for lesions or changes in the skin.

Signs and Symptoms

  • In the early stages of vulvar cancer there may be no symptoms.
  • Symptoms of vulvar cancer may include:
    • Burning
    • Itching
    • Bleeding that is not related to menstruation (your period)
    • Pain
    • Discharge
    • A lump or ulcer
    • Leukoplakia (white patches)
Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.
 
  • Gynecologic / pelvic examination – the doctor will examine the perineal area
  • Biopsy – removal of a small amount of tissue for examination
For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

Types
  • Squamous cell carcinomas are the most common type of vulvar cancer
  • Other less frequent types of cancer that occur in the vulva are:
    • Melanomas
    • Adenocarcinomas of the Bartholin Gland
    • Sarcomas
    • Basal cell carcinomas (has an excellent rate of cure)
    • Paget's disease of the vulva (has an excellent rate of cure)
Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment. 

T describes the site and size of the main tumour (primary) 

N describes involvement of lymph nodes 

M relates to whether the cancer has spread (presence or absence of distant metastases) 

Stage 0
abnormal (precancerous) cells are found on the vulva skin; carcinoma in situ 

Stage I
the tumour is confined to the vulva and/or perineum and is 2cm or less; lymph nodes cannot be felt 

Stage II
the tumour is confined to the vulva and/or perineum and is more than 2 cm; lymph nodes cannot be felt 

Stage III
a tumour of any size has spread to at least one of these nearby sites: the vagina, lower urethra, anus, and/or has metastasized to one side of the groin lymph nodes 

Stage IVA
a tumour of any size has spread to any of the: upper urethra, lining of the bladder, lining of the rectum, pelvic bones, and/or has metastasized to both sides of the groin lymph nodes 

Stage IVB
any distant metastasis including the pelvic lymph nodes
Treatment

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Note: Creams and ointments should only be used under a doctor's direction after a thorough examination of the area.

Surgery
  • Surgery is the primary treatment for vulva cancer.
  • Laser surgery is used to treat pre-invasive (in situ) cancers. It uses a focused beam of light to vapourize the cancer off of the skin.
  • Basal cell carcinoma, Paget's disease and some in situ cancers are treated with a wide local excision (removal of the tumour and some healthy surrounding tissue) or by a simple vulvectomy (removal of the skin of the vulva).
  • Early vulvar cancers may be treated with a radical local excision, removing the cancer and a margin of normal tissue. In addition, a sentinel lymph node procedure (lymph nodes from the groin area are removed and checked for cancer) may be recommended for cancers smaller than three centimeters in size.
  • Advanced invasive forms of vulva cancer are treated by radical vulvectomy (removal of the entire vulva including clitoris and surrounding tissues and frequently the nearby lymph nodes).
  • Other surgical procedures may be used if the cancer has spread outside of the vulva.
  • Reconstructive surgery is an option in cases where surgery has been extensive.
  • It is still possible for younger patients to become pregnant after surgery.
Radiation Therapy
  • Radiation therapy may be used as a primary treatment in the following cases:
    • inoperable cases
    • in cases where the cancer is located close to the anus to avoid a colostomy
    • recurrent disease following surgery
    • in patients who are medically unfit for radical surgery
Chemotherapy
  • Chemotherapy may be used in combination with radiation.

Follow-up after Treatment

  • Guidelines for follow-up after treatment are covered on our website.
  • You will be returned to the care of your family doctor or your specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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SOURCE: Vulva ( )
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