Vulvar Cancer: Symptoms, Stages & Treatment

What Is Vulvar Cancer?

Vulvar cancer is a malignant tumor that develops in the vulva, the external part of the female genitalia including the outer and inner labia, clitoris, urethral opening, vaginal opening, and perineum. It is a rare cancer, accounting for approximately 4% of all gynecologic cancers, and most commonly affects women over 70 years of age.

The vulva is the external portion of the female reproductive system. It includes several structures: the labia majora (outer lips), labia minora (inner lips), clitoris, urethral opening (where urine exits), vaginal opening, and the perineum (the area between the vaginal opening and the anus). Cancer can develop in any of these areas, though it most commonly occurs on the labia.

Vulvar cancer develops when cells in the vulvar tissue begin to grow uncontrollably, forming a tumor. The most common type is squamous cell carcinoma, which accounts for approximately 90% of vulvar cancers and develops from the flat, skin-like cells that cover the vulva. Other less common types include melanoma, adenocarcinoma, and basal cell carcinoma.

While the exact causes of vulvar cancer are not fully understood, research has identified several factors that increase the risk of developing the disease. Understanding these risk factors can help with early detection and prevention strategies.

Risk Factors for Vulvar Cancer

Several factors have been identified that may increase the risk of developing vulvar cancer. Having one or more risk factors does not mean you will develop cancer, but it is important to be aware of these factors and discuss any concerns with your healthcare provider.

• Lichen sclerosus: This chronic skin condition causes thin, white, patchy skin on the vulva and significantly increases vulvar cancer risk over time
• Human papillomavirus (HPV) infection: Certain strains of HPV are linked to approximately 40% of vulvar cancers, particularly in younger women
• Smoking: Tobacco use increases the risk of vulvar cancer, especially in women who also have HPV infection
• Weakened immune system: Conditions or medications that suppress the immune system, such as after organ transplantation or HIV infection, increase cancer risk
• Advanced age: Most vulvar cancers occur in women over 70 years old, though it can occur at any age
• Vulvar intraepithelial neoplasia (VIN): This precancerous condition can progress to vulvar cancer if left untreated

Stages of Vulvar Cancer

Vulvar cancer is classified into stages based on the size of the tumor, whether it has spread to lymph nodes, and whether it has spread to distant parts of the body. Staging helps doctors determine the best treatment approach and provides information about prognosis.

The staging system used for vulvar cancer is the FIGO (International Federation of Gynecology and Obstetrics) system, which divides the disease into four main stages. The most common presentation is when the cancer is confined to the vulva, which has the best prognosis. In later stages, vulvar cancer may spread to lymph nodes in the groin and pelvis, or rarely to other organs such as the bladder or rectum.

What Are the Symptoms of Vulvar Cancer?

The most common symptoms of vulvar cancer include a persistent lump or nodule that feels hard, a non-healing sore or ulcer, bleeding from a vulvar lesion, persistent itching, and burning sensations. Many women first notice itching as an early symptom. However, these symptoms can also be caused by non-cancerous conditions, so proper medical evaluation is essential.

Recognizing the symptoms of vulvar cancer is crucial for early detection and treatment. Unfortunately, many women delay seeking medical attention because symptoms may be mild or attributed to other causes. It is important to see a healthcare provider if you notice any persistent changes in your vulvar area.

The symptoms of vulvar cancer can vary depending on the location and size of the tumor. Some women may have only one symptom, while others may experience several. The most commonly reported symptoms include changes in skin appearance, persistent discomfort, and visible abnormalities.

Common Symptoms to Watch For

• A hard lump or nodule: A firm, raised area that may feel like a bump under the skin, often painless initially
• Non-healing sore or ulcer: An open wound that does not heal within 2-4 weeks, sometimes with raised edges
• Bleeding: Bleeding from a sore or lesion on the vulva, particularly if not related to menstruation
• Persistent itching: Ongoing itching (pruritus) that does not respond to typical treatments and persists for weeks or months
• Burning sensation: A burning or stinging feeling in the vulvar area, especially during urination
• Skin changes: Thickened, lighter or darker patches of skin, or changes in the texture of vulvar skin
• Pain or tenderness: Discomfort in the vulvar area, particularly if associated with a visible change

When Symptoms May Indicate Something Other Than Cancer

Not all vulvar symptoms indicate cancer. In fact, most women who experience itching, burning, or skin changes in the vulvar area have benign (non-cancerous) conditions. Common non-cancerous causes of vulvar symptoms include:

• Yeast infections: Very common and typically cause itching, burning, and discharge
• Bacterial infections: Can cause irritation, discharge, and discomfort
• Lichen sclerosus: A chronic skin condition causing thin, white, patchy skin (though this condition does increase cancer risk)
• Contact dermatitis: Allergic reaction to soaps, detergents, or personal care products
• Hormonal changes: Menopause can cause vaginal dryness and irritation

When Should You See a Doctor for Vulvar Symptoms?

You should see a healthcare provider if you notice a lump, sore, or skin changes on your vulva that persist for more than 2-3 weeks. Seek prompt attention if you have bleeding from a vulvar lesion, a non-healing wound, or symptoms that do not respond to typical treatments for common conditions like yeast infections.

Many women feel embarrassed or uncomfortable discussing vulvar symptoms, but prompt evaluation is important for ruling out serious conditions and obtaining appropriate treatment. Healthcare providers regularly evaluate these concerns and can provide confidential, professional care.

If you are uncertain whether your symptoms warrant a medical visit, it is generally better to err on the side of caution. Early detection of vulvar cancer dramatically improves outcomes, and even if your symptoms turn out to be caused by a benign condition, you will benefit from proper diagnosis and treatment.

Schedule an Appointment If You Have:

• A lump, bump, or thickened area on the vulva that persists for more than 2-3 weeks
• A sore or ulcer that does not heal
• Persistent itching that does not respond to over-the-counter treatments
• Changes in the color or texture of vulvar skin
• Pain or burning that persists beyond normal causes

How Is Vulvar Cancer Diagnosed?

Vulvar cancer is diagnosed through a combination of physical examination, biopsy (tissue sample), and imaging studies. The diagnosis process typically begins with a gynecological examination, followed by a biopsy if any suspicious areas are found. If cancer is confirmed, additional tests help determine the stage and guide treatment planning.

The diagnostic process for vulvar cancer involves several steps designed to confirm the diagnosis, determine the type of cancer, and assess whether it has spread. Your healthcare provider will explain each step of the process and what to expect.

Early in the diagnostic process, your doctor will take a detailed medical history, asking about your symptoms, how long you have had them, and any risk factors you may have. This information helps guide the examination and any tests that may be needed.

Gynecological Examination

The first step in diagnosis is a thorough physical examination of the vulva, vagina, and cervix. During this examination, the doctor will carefully inspect the vulvar area for any abnormalities such as lumps, sores, or changes in skin color or texture. The doctor may also feel for enlarged lymph nodes in the groin area, as vulvar cancer can spread to these nodes.

A magnifying instrument called a colposcope may be used to get a closer look at any suspicious areas. This allows the doctor to see details that might not be visible to the naked eye and helps identify the best location for a biopsy if one is needed.

Biopsy

If any suspicious areas are found during the examination, a biopsy will be performed. During a biopsy, a small sample of tissue is removed and sent to a laboratory for analysis under a microscope. This is the only way to definitively diagnose vulvar cancer.

The biopsy is usually performed in the doctor's office using local anesthesia to numb the area. Most people experience minimal discomfort during the procedure. The tissue sample is examined by a pathologist, who can determine whether cancer cells are present and, if so, what type of cancer it is.

In some cases, if the suspicious area is large or in a difficult location, you may need to be sedated briefly for a more extensive biopsy. You will typically be able to go home the same day and recover quickly.

Additional Tests If Cancer Is Found

If the biopsy confirms vulvar cancer, additional tests may be needed to determine the extent (stage) of the cancer and whether it has spread. These tests help doctors plan the most appropriate treatment.

• Imaging studies: CT scan, MRI, or PET scan may be used to look for spread to lymph nodes or other organs
• Lymph node evaluation: Ultrasound of the groin area to assess lymph nodes, possibly with needle biopsy if nodes appear abnormal
• Cystoscopy: In some cases, examination of the bladder may be needed if the cancer is near the urethral opening
• Proctoscopy: Examination of the rectum if the cancer is located near the anus

How Is Vulvar Cancer Treated?

Surgery is the primary treatment for vulvar cancer, involving removal of the tumor along with a margin of healthy tissue. Depending on the cancer's stage and spread, treatment may also include removal of lymph nodes, radiation therapy, and/or chemotherapy. A national panel of specialists typically reviews each case to recommend the optimal treatment approach.

The treatment for vulvar cancer depends on several factors, including the stage of the cancer, the location and size of the tumor, your overall health, and your personal preferences. Treatment is typically coordinated by a team of specialists including gynecologic oncologists, radiation oncologists, and other healthcare professionals.

In many healthcare systems, cases of vulvar cancer are reviewed by a multidisciplinary team of specialists who together recommend the best treatment plan for each individual patient. Your doctor will discuss the team's recommendations with you and answer any questions you may have.

Surgical Treatment

Surgery is the most common treatment for vulvar cancer and is often curative when the cancer is detected early. The type of surgery depends on the size, location, and stage of the cancer. The goal is to remove all cancer cells while preserving as much healthy tissue and function as possible.

During surgery, the tumor is removed along with a margin of healthy tissue surrounding it. This margin helps ensure that no cancer cells are left behind. The size of the surgery depends on the extent of the cancer—some women require only a small local excision, while others may need more extensive surgery.

The surgical wound is usually closed immediately. In cases where a larger area of tissue is removed, the surgeon may need to use skin from another part of the body (such as the thigh or buttock) to close the wound. This is called a skin graft or flap reconstruction.

Lymph Node Surgery

Because vulvar cancer can spread to lymph nodes in the groin, surgery may also involve evaluation or removal of these lymph nodes. There are two main approaches:

• Sentinel lymph node biopsy: When it is unclear whether cancer has spread, the surgeon may remove only the first lymph node(s) that drain the tumor area (sentinel nodes). If these nodes are cancer-free, no further lymph node removal may be needed.
• Complete lymph node dissection: If cancer is known or suspected to have spread to lymph nodes, all lymph nodes in one or both groins may be removed.

Before sentinel node surgery, a radioactive substance and/or blue dye is injected near the tumor. This travels to the lymph nodes the same way cancer cells would, helping the surgeon identify which nodes to remove and examine.

What to Expect After Surgery

Recovery time varies depending on the extent of surgery. Most people stay in the hospital for 1-5 days after surgery. If lymph nodes were also removed, the hospital stay may be slightly longer.

After surgery, the medical team will help you care for the surgical site, which typically involves keeping the area clean and allowing it to heal. Wound healing usually takes 2-6 weeks. During this time, you should avoid bathing (showers are usually fine) and sexual activity involving the surgical area.

• Pain management: You will receive pain medication prescriptions for use at home as needed
• Wound care: Healthcare staff may need to check and care for the wound several times during healing
• Drainage tubes: If lymph nodes were removed, small tubes may be placed in the groin to drain fluid, sometimes remaining in place even after hospital discharge
• Urinary catheter: Some patients need a bladder catheter for a few days to weeks after surgery
• Antibiotics: May be prescribed to prevent infection
• Blood clot prevention: Blood-thinning injections may be given to prevent blood clots

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be used after surgery to destroy any remaining cancer cells and reduce the risk of recurrence, or as an alternative to surgery in some cases.

When used after surgery, radiation therapy is typically given every weekday for 5-6 weeks, with each treatment session lasting about 15 minutes. Radiation may also be the primary treatment for large tumors or tumors in locations where surgery would be difficult or would significantly affect quality of life, such as near the urethra or anus.

Side effects of radiation therapy may include:

• Skin irritation: The treated area may become red, irritated, or develop sores after 1-2 weeks of treatment
• Urinary symptoms: Difficulty holding urine or urgency may occur
• Bowel changes: Loose stools or diarrhea are common during treatment
• Fatigue: Many people feel tired during radiation treatment

Most side effects improve within a few weeks after completing treatment. Your healthcare team will provide creams and medications to help manage side effects.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. For vulvar cancer, chemotherapy is often given together with radiation therapy to make the radiation more effective. This combined approach is called chemoradiation.

Side effects of chemotherapy may include fatigue, nausea, changes in blood counts, and difficulty concentrating. Anti-nausea medications can help prevent or reduce nausea. Most side effects improve after treatment ends.

Preparing for Treatment

If you smoke, quitting before treatment provides significant benefits. Wounds heal faster, circulation improves, and you recover more quickly from surgery. Ideally, you should stop smoking at least 4-8 weeks before surgery and continue abstaining for at least 4-8 weeks afterward.

Alcohol consumption should also be avoided for 4 weeks before and 4 weeks after surgery to reduce the risk of complications.

What Happens After Treatment for Vulvar Cancer?

After completing treatment, you will have regular follow-up appointments for approximately 5 years to monitor for cancer recurrence. Follow-up typically includes physical examinations and symptom review, with appointments more frequent in the first 1-2 years. Seek care promptly if new symptoms develop between appointments.

Follow-up care is an essential part of vulvar cancer treatment. Regular appointments allow your healthcare team to monitor your recovery, check for any signs of cancer recurrence, and address any concerns or side effects you may be experiencing.

The frequency of follow-up visits varies, but appointments are typically more frequent in the early years after treatment when the risk of recurrence is highest. During each visit, your doctor will perform a physical examination and ask about any new symptoms.

If Cancer Returns

If vulvar cancer returns after treatment, it is not necessarily the end of treatment options. Recurrent cancer may appear as a new tumor in a different area of the vulva, and it is sometimes possible to achieve long-term remission again with additional treatment.

Your doctor will perform a new evaluation to determine the best treatment approach for recurrent cancer. Options may include surgery, radiation therapy, or chemotherapy, depending on the location and extent of the recurrence and what treatments you received previously.

If Cancer Cannot Be Removed

In some cases, if vulvar cancer has spread widely or cannot be completely removed, treatment focuses on controlling the disease and maintaining quality of life. This is called palliative care. Chemotherapy may help slow disease progression, and other treatments can help manage symptoms such as pain.

What Is Life Like After Vulvar Cancer Treatment?

Recovery from vulvar cancer treatment varies based on the type and extent of treatment received. Many women experience a good quality of life after treatment, though some may face challenges related to physical changes, sexuality, or emotional well-being. Support is available to help address these concerns.

Vulvar cancer and its treatment can affect your life in various ways, and recovery is a process that takes time. The impact varies greatly from person to person, depending on factors such as the extent of surgery, whether additional treatments were needed, and your overall health.

It is important to be open with your healthcare team about how you are feeling, both physically and emotionally. Almost all concerns have solutions or ways to help, and you do not need to face challenges alone.

Physical Changes and Complications

Urinary and Bowel Function: Radiation therapy can sometimes cause long-term changes in bladder or bowel function, such as urinary incontinence or looser stools. A physical therapist can help with exercises to strengthen the pelvic floor muscles. Medications are also available to help manage these symptoms. Incontinence supplies are available free of charge through healthcare systems in many countries.

Lymphedema: If lymph nodes were removed, you may develop lymphedema—swelling caused by buildup of lymph fluid. This can affect the groin, legs, or lower abdomen. Lymphedema can be prevented and treated with compression stockings, compression garments, massage, and exercises. Report any new swelling to your healthcare provider promptly.

Fatigue: Many cancer survivors experience persistent tiredness that does not improve with rest. This fatigue can have multiple causes, including the cancer itself, treatment effects, anemia, or depression. Exercise in appropriate doses often helps reduce fatigue. Multiple short rest periods during the day are more helpful than one long rest. If fatigue is severe or persistent, discuss it with your healthcare team.

Sexuality and Intimacy

Sexual function and intimacy can be affected by vulvar cancer treatment. Surgery may change the appearance of the vulva, and the clitoris may have been partially or completely removed. Radiation therapy can cause changes in vaginal tissue. Beyond physical changes, the emotional impact of cancer and treatment can also affect desire and intimacy.

If you are experiencing concerns about sexuality, know that help is available. You can speak with a counselor, psychotherapist, or sex therapist—either alone or with your partner. These professionals can help you explore new ways of being intimate and address emotional concerns.

To prevent vaginal narrowing from radiation therapy, you may be advised to use a dilator—a smooth device inserted into the vagina to maintain its opening. Your healthcare team will provide guidance on proper use.

Emotional Well-being

A cancer diagnosis and treatment can trigger a range of emotions including fear, sadness, anger, and grief. These feelings are normal, and it is common for them to fluctuate over time. The genital area is often closely tied to identity and self-image, which can make vulvar cancer particularly emotionally challenging.

If you are struggling emotionally, you have the right to speak with a counselor, social worker, or psychologist. Many people also find support from connecting with others who have had similar experiences through patient support organizations.

Quality of Life

Despite the challenges, many women report a good quality of life after vulvar cancer treatment. With appropriate support and time to adjust, most are able to return to their normal activities and find ways to manage any ongoing effects of treatment.

Where Can You Find Support?

Support is available through your healthcare team, including oncology nurses, social workers, and counselors. Patient support organizations provide connections with others who have experienced gynecologic cancer. Your loved ones can also benefit from support resources.

Receiving a cancer diagnosis is overwhelming, and you do not need to face it alone. Multiple sources of support are available to help you through diagnosis, treatment, and recovery.

Healthcare Team Support

Your healthcare team can connect you with various support services. Many cancer treatment centers have dedicated oncology nurses or patient navigators who can answer questions and help coordinate your care. Social workers can assist with practical concerns and provide emotional support.

Talking to Children

If you have children, they have the right to receive age-appropriate information and support when a parent is seriously ill. Healthcare providers can help you decide what and how to tell children. Involving children appropriately, rather than shielding them from all information, often helps them cope better.

Support for Loved Ones

Being close to someone with cancer can be difficult. Partners, family members, and friends may experience their own worries and fears. It is normal to want to help while also feeling overwhelmed. Loved ones can also access support through healthcare social workers, counselors, and support groups.