Vulvar Cancer: Introduction
What is cancer?
Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let's look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body doesn't need them any more.
Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasize).
What is vulvar cancer?
Nearly all vulvar cancers start in the squamous cells. These are called squamous cell carcinoma of the vulva. Squamous cells make up most of the skin and other surfaces and linings of the body.
Other rare types of vulvar cancer include melanoma, basal cell carcinoma, adenocarcinoma, and sarcoma.
Understanding the vulva
The vulva is the outer part of the female reproductive system. It’s also called the external genitalia. The vulva is the fatty tissue and skin that's around the clitoris and the openings of the urethra (the tube that carries urine out of the body) and the vagina. It includes:
The mons pubis. This is the rounded area in front of the pubic bones that becomes covered with hair at puberty. It includes the skin folds under the pubic hair that protect the opening of the urethra and the vagina.
Two folds of skin on each side. The outer folds are called the labia majora. The inner folds are called the labia minora.
The prepuce or the hood of the clitoris. This is made by the inner fold of the vulva.
The clitoris is below the prepuce. It’s a sensitive piece of tissue that swells with blood when stimulated.
The fourchette is at the bottom of the inner folds of the vulva. This is where the labia minora meet.
The perineum is area between the fourchette and the anus.
Most vulvar cancers start in the labia majora.
Talk with your healthcare provider
If you have questions about vulvar cancer, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.
Vulvar Cancer: Prevention
There is no sure way to prevent vulvar cancer. Some risk factors for this cancer, such as your age and family history, are not within your control. But you can do some things that may help lower your risk of getting vulvar cancer.
The best things you can do to prevent vulvar cancer are to lower the risks you can control. You should also get regular gynecological exams. Some healthcare providers may also suggest doing self-exams.
What to do to lower your risk for vulvar cancer
- Don't get infected with human papillomavirus (HPV) or HIV. You can help prevent HPV infection by not having sex as a preteen or young teen. Having sex with a condom can also help. So can not having sex with many people. And not having sex with people who have had a lot of partners. Condoms give some protection against HPV, but not full protection. But if you use them regularly, they help prevent the spread of HIV and many other sexually transmitted diseases. Talk with your healthcare provider about the vaccine for HPV. Ask if it might be right for you.
- Don’t smoke.
Do self-exams. Your healthcare provider may suggest that you do regular self-exams to find any changes in your vulva. You can do this by using a mirror once a month to look for any red, irritated, dark, or white spots on your vulva. You should also look for bumps, ulcers, or moles that are new or have changed. See your healthcare provider if you notice any changes.
Have regular Pap tests and pelvic exams. Women ages 21 and older should have regular pelvic exams. They should also have regular cervical cancer screening tests. These include Pap tests with or without HPV tests.
Cancer screening tests
Screening tests check for signs of disease in people who don't have any symptoms. That's when healthcare providers can treat any precancers. Or they can find cancers very early. This is when they're small, haven't spread, and can be easier to treat.
The American Cancer Society (ACS) says that women should have regular checkups to help spot certain gynecologic cancers. Your healthcare provider will look at your vulva during these checkups. Checkups also include a pelvic exam and maybe a Pap test and HPV testing. During a pelvic exam, your healthcare provider will also feel your uterus, vagina, cervix, and other reproductive organs. This is done to check for any changes.
Here are the ACS recommendations for how often you should have Pap tests, HPV tests, and pelvic exams. These are screening guidelines for gynecological cancers if you’re at average risk. Talk with your provider about your risk. If you're at high risk, you may need a different screening plan.
All women should have Pap tests starting at age 21.
Women between ages 21 and 29 should have a Pap test every 3 years.
Women between ages 30 and 65 should have a Pap test plus an HPV test (called co-testing) every 5 years. This is preferred. But it's also OK to keep having Pap tests alone every 3 years.
Women older than 65 who have had regular screening with normal results in the past 10 years may stop screening for cervical cancer. Once screening is stopped, it should not be started again.
- Women who had a serious precancer should continue screening for 20 years after that diagnosis, even if it goes beyond age 65.
A woman who has had a hysterectomy with the cervix removed for reasons not related to cervical cancer and no history of cervical cancer, serious precancer, or a damaged immune system, should not be screened.
- A woman who has had a hysterectomy but still has her cervix should follow the above guidelines based on her age.
A woman who has been vaccinated against HPV should still follow the screening guidelines for her age group.
The guidelines for screening tests vary. Annual Pap tests are no longer recommended. But the American College of Obstetricians and Gynecologists recommends that all women older than 21 have yearly pelvic exams.
Vulvar Cancer: Symptoms
What are the symptoms of vulvar cancer?
You can have vulvar cancer without having any symptoms. But some women do have symptoms. These are some symptoms of the most common type of vulvar cancer, squamous cell carcinoma:
Vulvar itching that does not get better
A change in skin color around your vulva. Your skin may become redder, lighter, or darker in color than the surrounding skin.
A change in the feel of your skin around your vulva. Your skin may feel thicker, scalier, rougher, or bumpier than surrounding skin.
Wart-like bump or bumps, cauliflower-like growths, or ulcers or sores on the vulva that last for more than a month
Pain when urinating
Burning or bleeding and discharge that's not related to your menstrual cycle
Enlarged lymph glands in your groin
A much less common type of vulvar cancer, called melanoma of the vulva, may also cause the symptoms above. But it may also show up as a change in a mole that’s been there for years or a new mole. The mole may be asymmetrical. This means that one half doesn’t match the other. It may have an irregular or lacy border. This means that the edges are ragged. Or the mole may also be irregular in color or wider than 1/4 inch.
When to see your healthcare provider
Many of these symptoms may be caused by other health problems. But it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.
Vulvar Cancer: Diagnosis
How is vulvar cancer diagnosed?
Your healthcare provider may find signs of vulvar cancer during a pelvic exam as part of a routine visit. You may not have any symptoms. A Pap test and a human papillomavirus (HPV) test will likely be done. Diagnosing vulvar cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, symptoms, risk factors, and family history of disease.
It’s very important that you see an expert. Gynecologic oncologists are specialists in diagnosing, treating, and checking for female cancers, including vulvar cancer. Your healthcare provider may have you see one of these cancer experts to find out for sure what’s causing the changes in your vulva. If this provider thinks you might have vulvar cancer, you’ll need a biopsy to be sure.
What is a biopsy?
A biopsy is the only way to know for sure if you have cancer. If your healthcare provider sees an abnormal or changed area, you may need a biopsy. A biopsy is done by removing a small piece of tissue from that area. Medicines may be used to make your vulva numb first. If the abnormal area is small, your healthcare provider may completely remove it. If it's big, he or she can remove a small piece of it by using a tool that looks like a tiny apple corer. (This is called a punch biopsy.) You often don’t need stitches after this procedure. You may feel some pressure, but should have little or no pain.
For larger areas, your healthcare provider may cut out a small part of the skin with a scalpel. The edges of your skin may then be sewed together with surgical thread (suture). In most cases, your healthcare provider will also remove some surrounding normal skin along with the abnormal area.
Your healthcare provider may use a magnifying tool called a colposcope to get a close look at the changed area. The colposcope stays outside your body. It lets your provider see even small changes on your vulva. Your provider may put a vinegar-like solution on your vulva to make the changed areas white. This makes them easier to see and remove.
The removed tissue sample is sent to a lab. There, a doctor called a pathologist checks the samples under a microscope to look for cancer cells. It often takes about one week for your healthcare provider to get the results from the lab.
Getting your test results
When your healthcare provider has your biopsy results, he or she will contact you. Your provider will talk with you about other tests you may need if vulvar cancer is found. Make sure you understand the results and know what you need to do next.