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The vulva is the external portion of the female genital organs. It includes:
Labia majora. Two large, fleshy lips, or folds of skin.
Labia minora. Small lips just inside the labia majora and surround the openings to the urethra and vagina.
Vestibule. Space where the vagina opens.
Prepuce. A fold of skin formed by the labia minora that covers the clitoris.
Clitoris. A small protrusion of nerve tissue sensitive to stimulation.
Fourchette. Area beneath the vaginal opening where the labia minora meet.
Perineum. Area between the vagina and the anus.
Anus. Opening at the end of the anal canal.
Urethra. Connecting tube to the bladder.
Vulvar cancer can occur on any part of the external organs, but most often affects the labia majora or labia minora. According to the American Cancer Society, about 4,850 cases of cancer of the vulva will be diagnosed in the U.S. in 2014. Cancer of the vulva is a rare disease, which accounts for 0.6% of all cancers in women, and may form slowly over many years. Most vulvar cancers are squamous cell carcinomas. Melanoma is another common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include:
Basal cell carcinoma
The following have been suggested as risk factors for vulvar cancer:
Age. Of the women who develop vulvar cancer, over 80% are over age 50, and half are over age 70.
Infection with certain types of human papillomavirus (HPV)
Lichen sclerosus. This can cause the vulvar skin to become very itchy and may slightly increase the possibility of vulvar cancer.
Melanoma or atypical moles on nonvulvar skin. A family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer.
Vulvar intraepithelial neoplasia (VIN). There is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer.
Other genital cancers
While each woman may experience symptoms differently, the most common symptoms are:
Changes in the color and the way the vulva looks
Bleeding or discharge not related to menstruation
Severe burning, itching, or pain
An open sore that lasts for more than a month
Skin of the vulva looks white and feels rough
The symptoms of vulvar cancer may look like other conditions or medical problems. Consult a doctor for diagnosis.
The cause of vulvar cancer is not known at this time, however, certain risk factors are thought to contribute to development of the disease. Suggestions for prevention include:
Avoid known risk factors when possible
Delay onset of sexual activity
Do not smoke
Have regular physical checkups
Get vaccinated against HPV
Have routine Pap tests and pelvic exams
Routinely check entire body for irregular growth of moles and check your vulva regularly for any signs of vulvar cancer
Vulvar cancer is diagnosed by biopsy, removing a small piece of tissue for exam in a lab by a pathologist.
Specific treatment for vulvar cancer will be determined by your doctor(s) based on:
Your overall health and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment for cancer of the vulva may include:
Laser surgery. Use of a powerful beam of light to destroy abnormal cells. The beam can be directed to specific parts of the body without making a large incision (cut). This type of therapy is only used for premalignant (noninvasive) disease of the vulva.
Excision. The cancer cells and a margin of normal tissue around the cancer is removed.
Vulvectomy. Surgical removal of part of all of the tissues of the vulvar. The extent of the tissue removed is based on the size and location of the lesion.
It's very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including vulvar cancer.
Bayhealth is Southern Delaware’s healthcare leader with hospitals in Dover and in Milford. Bayhealth provides a wide range of medical services, including cardiovascular, cancer, orthopaedics and rehabilitation, pediatrics, respiratory care, sleep care, surgical weight loss and women’s services.