General Information About Vulvar Cancer

Vulvar cancer is a rare cancer that starts in the tissues of the vulva.

Vulvar cancer forms in a woman's external genitalia, called the vulva. It occurs when cells in the vulva start to grow out of control. The vulva includes:

• the inner and outer lips of the vagina
• the clitoris (the sensitive tissue above the lips of the vagina)
• the opening of the vagina and its glands
• the mons pubis (the rounded area in front of the pubic bones that becomes covered with hair at puberty)

Vulvar cancer most often affects the outer vaginal lips. Less often, cancer affects the inner vaginal lips, clitoris, or vaginal glands.

Vulvar cancer usually forms slowly over many years. Abnormal cells can grow on the surface of the vulvar skin for a long time. This condition is called vulvar intraepithelial neoplasia (VIN). Because it is possible for VIN to become vulvar cancer, it is important to get treatment.

Having vulvar intraepithelial neoplasia or HPV infection can increase the risk of vulvar cancer.

Anything that increases a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop vulvar cancer, and it will develop in some people who don't have any known risk factors. Talk with your doctor if you think you may be at risk. Risk factors for vulvar cancer include:

• older age
• having a high-risk human papillomavirus (HPV) infection
• having vulvar intraepithelial neoplasia (VIN)
• having a history of genital warts

Other possible risk factors include:

• having many sexual partners
• having first sexual intercourse at a young age
• having a history of abnormal Pap tests (Pap smears)

Signs of vulvar cancer include bleeding or itching in the vulvar area.

Vulvar cancer often does not cause early signs or symptoms. Signs and symptoms may be caused by vulvar cancer or by other conditions. Check with your doctor if you have any of the following:

• a lump or growth on the vulva that looks like a wart or ulcer
• itching in the vulvar area that does not go away
• bleeding not related to menstruation (periods)
• pain in the vulvar area

Tests that examine the vulva are used to diagnose vulvar cancer.

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
• Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal.
• Human papillomavirus (HPV) test: A laboratory test used to check DNA or RNA for certain types of HPV infection. Cells are collected from the vulva and DNA or RNA from the cells is checked to find out if an infection is caused by a type of human papillomavirus that is linked to vulvar cancer. This test may be done using the sample of cells removed during a Pap test. This test may also be done if the results of a Pap test show certain abnormal vulvar cells.
• Biopsy: The removal of cells or tissues from the vulva so they can be viewed under a microscope by a pathologist to check for signs of cancer.
• Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on:

• whether the cancer has spread to nearby areas or other parts of the body
• whether the cancer has spread to the lymph nodes
• whether the cancer has just been diagnosed or has recurred (come back)