Risk Factors

Doctors can't always explain why one woman gets vulvar cancer and another doesn't. However, certain risk factors may make a woman more likely than others to develop vulvar cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a woman will get vulvar cancer. Many women who get vulvar cancer have none of these risk factors, and many women who have known risk factors never have cancer. A woman with one or more of these risk factors should talk with her doctor about cancer risk.

Risk factors for vulvar cancer include the following:

• Age: Vulvar cancer is more common in older women.
• Infection with human papillomavirus (HPV): HPV can cause abnormal tissue growth (for example, warts) and other changes to cells. Infection for a long time with certain types of HPV can increase the risk of developing vulvar cancer.

Symptoms

Early vulvar cancer may not cause symptoms. As the cancer grows, the most common symptoms are the following:

• A lump in the vulva
• Abnormal bleeding (not related to menstrual periods)
• Itching in the vulvar area that does not go away
• Tenderness in the vulvar area

Most often, these symptoms are not due to cancer. Women with these symptoms should tell their doctor so any health problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Women are encouraged to get regular pelvic exams to find abnormal changes in the vulvar and surrounding tissues as early as possible. A woman should talk with her gynecologist about how often these exams are recommended for her. Read more about cancer screening here.

If symptoms suggest vulvar cancer, the doctor will try to find out what's causing the problems.

The doctor may order one or more of the following tests:

• Physical exam and history: The doctor will check for signs of disease, such as lumps or anything else that seems unusual.
• Biopsy: The doctor removes cells or tissues from the vulva. Tissue samples are sent to the lab and viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy.

Staging

If vulvar cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.

Staging is a careful attempt to find out if cancer has spread within the vulva or to other parts of the body.

The doctor may order one or more of these staging tests:

• Pelvic exam: This is an exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse 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. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
• Cystoscopy: The doctor inserts a cystoscope (a thin, tube-like instrument with a light and a lens for viewing) through the urethra into the bladder. The doctor uses the cystoscope to check the inside of the bladder and urethra for abnormal areas. The cystoscope may have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Proctoscopy: The doctor inserts a proctoscope (a thin, tube-like instrument with a light and a lens for viewing) into the rectum. The doctor uses the proctoscope to check the rectum and anus for abnormal areas. The proctoscope may have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• X-rays: The doctor may take x-rays of the organs and bones inside the chest and pelvis.
• Intravenous Pyelogram (IVP): A dye that shows up on x-rays is injected into a blood vessel. The dye collects in the urine, which makes the kidneys, ureters, and bladder show up on x-rays. A series of x-rays is taken to find out if cancer has spread to these organs.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the body. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside the body. Sometimes contrast material is given by injection into a blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.

Stages of Vulvar Cancer

Stage 0: Abnormal cells are found only on the surface of the skin of the vulva. These abnormal cells may become cancer and spread into nearby normal tissue. The doctor may call this carcinoma in situ.

Stage I: Cancer is found in the vulva or the vulva and perineum (space between the rectum and the vagina) and the tumor is 2 centimeters or smaller.

Stage II: Cancer is found in the vulva or the vulva and perineum and the tumor is larger than 2 centimeters.

Stage III: Cancer is found in the vulva or the vulva and perineum and may have spread to tissue under the skin, lymph nodes on one side of the groin, or to nearby tissues such as the lower part of the urethra, vagina, or anus.

Stage IV: Cancer has spread to lymph nodes on both sides of the groin; to nearby tissues such as the upper part of the urethra, bladder, rectum, or pelvic bone; or to other parts of the body.

Treatment

At Huntsman Cancer Institute, vulvar cancer is treated by a team of specialists including gynecologic oncologists (doctors who specialize in cancers of the female reproductive system), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Common treatment options for vulvar cancer include the following:

• Laser therapy
• Surgery
• Chemotherapy
• Radiation therapy
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The stage of the cancer
• Whether the cancer has spread to lymph nodes
• Whether the cancer has spread to other parts of the body
• The patient's age and general health

The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next.

Laser therapy

The doctor uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Surgery

Surgery is the most common treatment for vulvar cancer. One of the following surgical procedures may be used:

• Wide local excision: A surgeon cuts out the cancer and some of the healthy tissue around it.
• Radical local excision: A surgeon removes the cancer and a large amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.
• Vulvectomy: A surgeon removes all or part of the vulva.
• Pelvic exenteration: A surgeon removes the cervix, vagina, ovaries, nearby lymph nodes, the lower colon, rectum, and bladder. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, the patient may be given chemotherapy and radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells. Chemotherapy may be taken by mouth or injected into a vein or muscle. Topical chemotherapy for vulvar cancer may be applied to the skin in a cream or lotion.

Learn more about this treatment our introduction to chemotherapy video.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area. The radiation comes from a large machine outside the body. The machine aims beams of radiation at the cancer. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the vulva.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to Huntsman Cancer Institute (HCI) patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.