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Vulvar Cancer

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What is cancer of the vulva?

Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a womanís vagina. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal.

Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40. Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. A doctor should be seen if there is bleeding or discharge not related to menstruation (periods), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough.

If there are symptoms, a doctor may do certain tests to see if there is cancer, usually beginning by looking at the vulva and feeling for any lumps. The doctor may then go on to cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. A patient will be given some medicine to numb the area when the biopsy is done. Some pressure may be felt, but usually with no pain. This test is often done in a doctorís office.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vulva or has spread to other places) and the patientís general state of health.

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Stages of cancer of the vulva

Once cancer of the vulva is diagnosed, more tests will be done to find out if the cancer has spread from the vulva to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vulva:

Stage 0 or carcinoma in situ

Stage 0 cancer of the vulva is a very early cancer. The cancer is found in the vulva only and is only in the surface of the skin.

Stage I

Cancer is found only in the vulva and/or the space between the opening of the rectum and the vagina (perineum). The tumor is 2 centimeters (about 1 inch) or less in size.

Stage II

Cancer is found in the vulva and/or the space between the opening of the rectum and the vagina (perineum), and the tumor is larger than 2 centimeters (larger than 1 inch).

Stage III

Cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra (the tube through which urine passes), the vagina, the anus (the opening of the rectum), and/or has spread to nearby lymph nodes. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)

Stage IV

Cancer has spread beyond the urethra, vagina, and anus into the lining of the bladder (the sac that holds urine) and the bowel (intestine); or, it may have spread to the lymph nodes in the pelvis or to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vulva or another place.

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Treatment Option Overview

How cancer of the vulva is treated

There are treatments for all patients with cancer of the vulva. Three kinds of treatment are used:

  • Surgery (taking out the cancer in an operation).
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
  • Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of cancer of the vulva. A doctor may take out the cancer using one of the following operations:

  • Wide local excision takes out the cancer and some of the normal tissue around the cancer.
  • Radical local excision takes out the cancer and a larger portion of normal tissue around the cancer. Lymph nodes may also be removed.
  • Laser surgery uses a narrow beam of light to remove cancer cells.
  • Skinning vulvectomy takes out only the skin of the vulva that contains the cancer.
  • Simple vulvectomy takes out the entire vulva, but no lymph nodes.
  • Partial vulvectomy takes out less than the entire vulva.
  • Radical vulvectomy takes out the entire vulva. The lymph nodes around it are usually removed as well.
  • If the cancer has spread outside the vulva and the other female organs, the doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (pelvic exenteration).

A patient may need to have skin from another part of the body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or before or after surgery.

Chemotherapy uses drugs to kill cancer cells. Drugs may be given by mouth, or they may be put into the body by a needle in the vein or muscle. Chemotherapy is called systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Treatment by stage

Treatment of cancer of the vulva depends on the stage of the disease, the type of disease, and the patientís age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

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Stage 0 Vulvar Cancer

Treatment may be one of the following:

  1. Wide local excision or laser surgery or a combination of both.
  2. Skinning vulvectomy.
  3. Ointment containing a chemotherapy drug.

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Stage I Vulvar Cancer

Treatment may be one of the following:

  1. Wide local excision.
  2. Radical local excision plus taking out all nearby lymph nodes in the groin and upper part of the thigh on the same side as the cancer.
  3. Radical vulvectomy and removal of the lymph nodes in the groin on one or both sides of the body.
  4. Radiation therapy alone (in selected patients).

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Stage II Vulvar Cancer

Treatment may be one of the following:

  1. Radical vulvectomy and removal of the lymph nodes in the groin on both sides of the body. Radiation may be given to the pelvis following the operation if cancer cells are found in the lymph nodes.
  2. Radiation therapy alone (in selected patients).

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Stage III Vulvar Cancer

Treatment may be one of the following:

  1. Radical vulvectomy and removal of the lymph nodes in the groin and upper part of the thigh on both sides of the body. Radiation may be given to the pelvis and groin following the operation if cancer cells are found in the lymph nodes or only to the vulva if the tumor is large but has not spread.
  2. Radiation therapy and chemotherapy followed by radical vulvectomy and removal of lymph nodes on both sides of the body.
  3. Radiation therapy (in selected patients) with or without chemotherapy.

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Stage IV Vulvar Cancer

Treatment may be one of the following:

  1. Radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the uterus, cervix, and vagina (pelvic exenteration).
  2. Radical vulvectomy followed by radiation therapy.
  3. Radiation therapy followed by radical vulvectomy.
  4. Radiation therapy (in selected patients) with or without chemotherapy, and possibly following surgery.

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Recurrent Vulvar Cancer

If the cancer has come back, treatment may be one of the following:

  1. Wide local excision with or without radiation therapy.
  2. Radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the uterus, cervix, and vagina (pelvic exenteration).
  3. Radiation therapy plus chemotherapy with or without surgery.
  4. Radiation therapy for local recurrences or to reduce symptoms such as pain, nausea, or abnormal body functions.
  5. Clinical trials of new forms of therapy.

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Vulvar Cancer