Cancer - perineum

Definition

Vulvar cancer is cancer that starts in the vulva, the outside part of the female reproductive system that includes the labia and clitoris. The vulva opens into the vagina.

Alternative Names

Causes

Vulvar cancer most often affects the labia, the folds of skin found outside the vagina. In some cases, vulvar cancer may start on the clitoris or in glands on the sides of the vaginal opening. The majority of vulvar cancers begin in skin cells called squamous cells. The others are classified as melanoma, adenocarcinoma, sarcoma, and basal cell carcinoma.

Vulvar cancer is relatively rare. The cause is unknown, but a sexually-transmitted disease such as human papilloma virus (HPV, or genital warts) may play a role.

Cancer of the vulva usually occurs after menopause, typically in women age 50 or older. However, 15% of cases occur in women age 40 or younger.

Risk factors include previous HPV infection, previous cervical cancer or vaginal cancer, syphilis infection, diabetes, obesity, and high blood pressure

Women with a condition called vulvar intraepithelial neoplasia (VIN) have a greater risk of developing vulvar cancer that spreads. However, most cases of VIN never lead to cancer.

Symptoms

• Ulcer, thickening or lump
  • Usually on the labia majora
  • May be anywhere on the vulva
• Local itching, pain, burning, bleeding
• Pain with urination
• Pain with intercourse
• Unusual odor

Exams and Tests

The following are used to diagnose vulvar cancer:

• Pelvic examination to look for any skin changes
• Excision and biopsy of the lesion to make an accurate diagnosis

Treatment

Treatment involves surgery to remove the cancer cells. If the tumor is large (more than 2 cm) or has grown deeply into the underlying skin, the lymph nodes in the groin area may also be removed.

Radiation, with or without chemotherapy, may be used to treat advanced tumors or vulvar cancer that comes back.

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group.

Outlook (Prognosis)

Most women with vulvar cancer who are diagnosed and treated at an early stage do well. However, a woman's outcome depends on the size of the tumor, the specific type of vulvar cancer, and whether the cancer has spread. The cancer commonly comes back at or near the site of the original tumor.

Possible Complications

Complications may include:

• Spread of the cancer to other areas of the body
• Side effects of radiation, surgery, or chemotherapy

When to Contact a Medical Professional

Call your health care provider if any vulvar lesion, skin color change, or local irritation persists longer than 2 weeks.

Prevention

Safe sex behaviors may decrease your risk of vulvar cancer. This includes using condoms to protect against sexually transmitted diseases.

A new vaccine is available to protect against certain forms of HPV infection. The vaccine is approved to prevent cervical cancer and pre-cancers, but it may help prevent other cancers linked to HPV, such as vulvar cancer. The vaccine is given to young girls before they become sexually active.

Routine pelvic exams can help diagnose vulvar and other cancers at an earlier stage, which improves treatment.

American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006.

Society of Gynecologic Oncologists Clinical Practice Guidelines: Vulvar cancer. Oncology. 1998;12:275-282.