Vulvar Cancer

This section will take you through the basics of what you need to know about vulvar cancer. It will introduce you to the people who may be part of your treatment team and identify the different types of treatments for vulvar cancer. Hopefully, this information will help prepare you to talk with your treatment team and to feel more confident about your treatment plan.

View the information in this section in our brochure, Vulvar and Vaginal Cancers: Your Guide available at the links below.

Vulvar Cancer Overview

Vulvar cancer begins in the vulva, which is the external genitalia that comprises of the inner and outer labia (“lips”), clitoris, urethra where urine exits, opening of the vagina and its glands, as well as the area of skin between the vagina and anus. It is a rare cancer that can be associated with smoking, human papillomavirus (HPV) infections, as well as conditions of the vulva associated with chronic irritation and inflammation. Cancer of the vulva is a rare tumor with the most recent cancer statistics reporting that approximately 5,000 people with gynecologic systems in the U.S. are afflicted annually.

Vulvar cancer is highly curable if detected at an early stage; however, treatment can have significant adverse effects on body image, sexual function, as well as bladder and rectal function. Lower extremity lymphedema, a form of chronic swelling which results from the disruption of lymphatic drainage in the groin, is a long-term complication and is, for the most part, irreversible.

Protection from infection with the Human Papillomavirus (HPV), including HPV vaccination, reduces the risk of vulvar cancer. Examination of the vulva for changes by a person at home or by their gynecologist during their annual pelvic examination can lead to the detection of preinvasive disease or early vulvar cancer. Suspicious or unexplained changes on the vulva should be biopsied.

Vulvar Cancer Symptoms

Symptoms or signs of pre-cancer and cancer include:

  • Chronic itching (more than 1-2 weeks)
  • Skin that appears different than usual — different colors (red, pink, black, white), as well as shades (either lighter or darker)
  • A bump or lump, which could be red, pink or white, and could have a wart-like or raw surface
  • Pain or burning
  • Bleeding or discharge not related to the normal menstrual period
  • Ulcer or open sore (especially if it lasts for a month or more)
  • Cauliflower-like growths

Medical Evaluation and Diagnosis

If vulvar cancer is suspected or diagnosed, it is important to seek care first from a gynecologic oncologist—medical doctors with specialized training in treating gynecologic cancers who can manage your care from diagnosis to completion of treatment to surveillance. Use our Seek a Specialist tool to find a gynecologic oncologist in your area.

During your treatment, you will come in contact with many health care professionals—these people make up your treatment team. They will work with each other and you to provide the special care you need. Learn more about your treatment team.

Surgical Staging

In general, cancers are divided into stages, which are categories or stages that denote how far the cancer cells have spread as well as to estimate risk of recurrence. This is found on imaging, surgery, and/or biopsies, and is not the same as grade of cancer, which is how aggressive the cancer cells appear under the microscope.

For vulvar cancer, the final stage depends on the pathologic review of the surgical specimens from the vulva and regional lymph nodes. Assignment of a stage helps guide therapy or surveillance.

Vulvar Cancer Stages

Stage 1:

The cancer is confined to the vulva or perineum—the area between the anus and the vulva.

Stage 2:

The cancer has spread to the urethra, anus or vagina.

Stage 3:

The cancer has spread to the lymph nodes—the presence and extent of lymph node involvement is an important factor in the determining the risk of recurrence.

Stage 4:

In addition to spreading to nearby lymph nodes, the cancer has spread to distant body parts.

Vulvar Cancer Treatment and Side Effects

Surgical resection (removal) is often indicated for patients with vulvar cancer—with additional therapy such as radiation or chemotherapy administered based on the stage.

There are several surgical operations to treat vulvar cancer:

  • Removal of the cancer and a margin of healthy tissue (excision): cutting out the cancer and at least 3/4 inch (2 centimeters) of the normal tissue all the way around it.
  • Removal of a portion of the vulva (partial vulvectomy): removing the superficial portion of the vulva
  • Removal of more of the vulva (radical vulvectomy): removing the superficial and deep portions of the vulva. This may involve removal of the portions of the vulvar close the tumor or possibly the entire vulva, including the clitoris and perineum.
  • Removal of lymph nodes (inguinofemoral lymphadenectomy): removing the lymph nodes in the groin that receives lymphatic fluid flow from the vulva. This may be done with the same incision as a radical vulvectomy or via separate incisions.
  • Sentinel lymph node biopsy (SLNB): this is a relatively new procedure that involves identifying and removing the lymph node(s) into which the channels near the tumor drains. Removing these select lymph nodes, rather than all of the lymph nodes in the groin, decreases risk or severeity of lymphedema, seroma and other complications associated with full lymphadenectomy. If the cancer has not spread to these lymph node(s), it is unlikely to have spread to other lymph nodes.

Depending on the extent of your surgery, reconstructive surgery may be recommended. This is something to discuss with your treatment team if you have undergone a partial or radical vulvectomy.

Side Effects of Surgery

Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing pain. Other possible side effects are:

  • Nausea and vomiting
  • Infection or fever
  • Wound problems
  • Anemia
  • Swelling caused by lymphedema, usually in the legs
  • Blood clots (in the legs, lungs, heart — i.e., heart attack or angina, or brain — i.e., stroke)
  • Difficulty urinating or constipation
  • Pain (tingling or shock-like sensation) down the legs and or weakness of the legs

Most of these side effects are temporary. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.

Chemotherapy are drugs used to kill cancer cells. Chemotherapy usually injected into a vein, but sometimes can be given as a pill. Chemotherapy may be recommended for some people with advanced vulvar cancer.

Side Effects of Chemotherapy

Each person responds to chemotherapy differently. Some people may have very few side effects while others experience several. Most side effects are temporary. They include:

  • Nausea
  • Loss of appetite
  • Mouth sores
  • Increased chance of infection
  • Bleeding or bruising easily
  • Vomiting
  • Hair loss
  • Fatigue

Most of these side effects are temporary. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.

Radiation therapy (also called radiotherapy) uses high-energy x-rays, or other types of radiation, to kill cancer cells or stop them from growing. Radiation is frequently used for more advanced stages of the disease (Stage II-IVA).

For people being treated for vulvar cancer, the radiation can be delivered in several ways.

  • External radiation: uses a machine that directs the radiation toward the entire abdomen or just the pelvis, depending on the location of the cancer. This is usually done every weekday for a few minutes and it should feel similar to getting an x-ray or CT scan.
  • Internal radiation (also called brachytherapy): involves placing radioactive beads in the vagina, vulva or surrounding tissue for a specified period of time.
  • Proton beam: Proton therapy, also called proton beam therapy, uses protons rather than x-rays to treat cancer. The extent of the cancer dictates which, or whether, both of these delivery systems are used and in what order.

Side Effects of Radiation

The side effects of radiation therapy depend on the dose used and the part of the body being treated. Common side effects include:

  • Anemia
  • Blood in urine or stool
  • Diarrhea
  • Dry, reddened skin in the treated area
  • Discomfort when urinating
  • Fatigue
  • Narrowing of the vagina
  • Pain with intercourse

Most of these side effects are temporary. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.

Importance of Participation in Clinical Trials

There are many ongoing clinical trials studying new and better ways to treat endometrial cancer. Many treatment options are available today because women diagnosed with endometrial cancer were willing to participate in prior clinical trials.

Clinical trials are designed to test some of the newest and most promising treatments for endometrial cancer. The Foundation for Women’s Cancer (FWC) partners with NRG Oncology (formerly Gynecologic Oncology Group), part of the National Cancer Institute cooperative group working only on gynecologic cancer clinical trials, and others to make information about current clinical trials available. For more information about clinical trials available for enrollment, visit