Vulvar Cancer

When vulvar cancer strikes, women are often in shock and scared. Many patients don’t know that cancer can affect the vulva, which is the outer part of a woman’s genitals. Women may be worried about their sexual health in addition to the cancer.

vulva anatomy — The vulva includes the opening of the vagina, the labia minora, the labia majora and the clitoris.

The effective diagnosis and treatment of vulvar cancer requires the expertise of different types of physician specialists. At UChicago Medicine Comprehensive Cancer Center, we have assembled a team — including gynecologic oncologists, radiation oncologists, and plastic surgeons — who are highly experienced in treating all types of gynecologic cancers, including vulvar cancer. Because UChicago Medicine is a large academic health system, we can also bring other specialists onto the team as needed, such as skin cancer experts to treat melanoma of the vulva.

Working together, our team of specialists will recommend a treatment plan aimed at curing a woman’s cancer as well as helping her to preserve or regain her sexual function. We also embrace innovative treatments, including clinical trials of new medicines and surgical approaches to reduce side effects and speed recovery.

What are common risk factors for vulvar cancer?

A number of factors can increase a woman’s risk of developing vulvar cancer:

Being older than age 50
Carrying the human papilloma virus (HPV), a common infection that is transmitted sexually or through skin-to-skin contact. There are many types of HPV. Types linked to vulvar cancer include HPV 16 and HPV 18.
Having a precancerous condition of the vulva called vulvar intraepithelial neoplasia (VIN).
Having a condition called lichen sclerosus, which can cause the skin on the vulva to become thin and itchy
A history of cervical cancer or precancerous cervical conditions
Having a rare skin disease called vulvar Paget’s disease, which causes redness and scaliness.

What are common symptoms of vulvar cancer?

Vulvar cancer does not always cause symptoms in the early stages. That’s why it’s important for women to get regular pelvic exams. During the exam, the gynecologist will check the vulva for any abnormalities. Women can also get an HPV test as part of a pelvic exam to see if they carry the HPV virus.

Women should also see a doctor if they experience any signs of the following symptoms, which may be signs of vulvar cancer:

Itching around the vulva that doesn’t go away
A burning feeling or other pain in the vulva
Any bumps, lumps or other growths
A sore in the vulva that doesn’t heal for a month or longer
A change in color or texture (for example, a part of the vulva appears lighter, darker, or thicker than the area around it)
Unexpected bleeding or discharge.

When vulvar cancer is suspected, we typically conduct a biopsy, or remove a small piece of suspicious tissue. Our experienced pathologists, who are specially trained in diagnosing gynecologic cancers, use various laboratory tests to determine if the cells are cancerous and what subtype of vulvar cancer it is. There are four subtypes:

Squamous cell carcinomas: Most vulvar cancers begin in the squamous cells, which are the primary type of skin cells.
Adenocarcinomas: About 8% of vulvar cancers are adenocarcinomas. These start in gland cells.
Melanoma: About 6% of vulvar cancers are melanomas, which is a skin cancer that grows in pigment-producing cells.
Sarcomas: About 2% of vulvar cancers are sarcomas, which start in tissue, bone and muscle cells.
Basal cell carcinoma: While very rare, basal skin cancer can form in the vulva.

We may also conduct imaging tests, including MRIs and CT scans, to determine how far the cancer has spread and gain other critical information needed to guide treatment.

What does a vulvar cancer treatment plan involve?

Depending on the specific cancer diagnosis, as well as a woman’s treatment preferences, the care plan for vulvar cancer may include some or all of the following:

Surgery
Surgery is the most common treatment for vulvar cancer. Our highly experienced gynecologic-oncologists are experts at operating on the vulva and surrounding organs and tissues. Our primary goal is to remove the tumor, along with a small amount of tissue around it to prevent the cancer from coming back.

If the cancer has spread extensively, part or all of the vulva may need to be removed. This procedure is known as a vulvectomy.

When women are concerned about the appearance of the vulva, our gynecologic-oncologists will partner with plastic and reconstructive surgeons at UChicago Medicine. Our plastic surgeons are experts at taking skin and tissue from other areas of the body to reconstruct the vulva. Reconstruction closes the wound, helps with healing, and provides a semblance of normality.

Our surgeons place a high priority on preventing or limiting pain and other complications from surgery. For instance, not long ago, many women who underwent vulvar cancer operations had numerous lymph nodes in the groin removed to see if cancer had spread beyond the vulva. These procedures sometimes led to lymphedema, which causes chronic leg swelling and other problems. Today, whenever possible, our surgeons use a less invasive approach called a sentinel lymph node biopsy. This involves injecting dye into the cancerous tumor during surgery. The dye naturally travels to the first (or sentinel) lymph node. The surgeon then removes the sentinel node to check for cancer. If the sentinel node is clear, no other nodes need to be removed.

Chemotherapy and Other Drug Therapies
Patients with vulvar cancer may benefit from chemotherapy, which are cancer-fighting drugs.

Women with rare subtypes of vulvar cancer, including melanoma, may also benefit from clinical trials being conducted at UChicago Medicine on immunotherapies, such as Keytruda® (pembrolizumab). Immunotherapies can help the body’s own immune system fight the cancer.

Radiation Therapy
Radiation may be recommended before or after surgery for vulvar cancer. At UChicago Medicine, our experienced radiation oncologists aim to prevent or limit damage to healthy cells and surrounding tissue during radiation. This helps reduce irritation and other side effects.

Patients with vulvar cancer typically get external beam radiation, which is delivered from outside the body. At UChicago Medicine, we use a radiation technique called volumetric modulated arc therapy (VMAT). This technology allows us to deliver radiation to the tumor as well as cancer cells that might be hiding nearby while limiting harm to nearby organs, such as the bladder.

Supportive Services
Our dedicated supportive oncology program provides a range of services, including mental health counseling and social work services. Patients with vulvar cancer and their patients can access these services at any time.

Can vulvar cancer impact sexual health?

Many women with vulvar cancer are naturally concerned about how their sex lives will be affected by the cancer and cancer treatments. UChicago Medicine’s PRISM program is designed to address sexual health problems in female cancer patients and survivors. The PRISM team can help women regain their ability to have sexual intercourse after vulvar surgery and radiation. Various therapies, including the use of vaginal dilators, can be used to rehabilitate the vulvar and vaginal areas. The PRISM team can also help patients who might be struggling with sexual function-related issues after treatment, such as body image issues, physical pain with intercourse, and anxiety about sexual activity.

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Many Women Have Never Heard of Vulvar Cancer. Here's What a Survivor Would Like You to Know

“If I can help one other person to learn what vulvar cancer is, to recognize it, to take care of themselves and make sure they go to the right specialist – then I’ll feel like I’ve given something back to women who may be suffering from this cancer," says Susan Golden, vulvar cancer survivor.

Read Golden's story

Dr. Diane Yamata and patient Susan Golden

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