Vulvar Cancer

What is Vulvar Cancer

Vulvar cancer is a malignancy that develops in the external female genitalia (vulva), most often affecting the labia majora or labia minora. It is relatively uncommon but is the fourth most common gynecologic cancer.

Types

Squamous Cell Carcinoma (SCC):

~90% of cases.
Can be HPV-related (younger women) or non-HPV-related (older women, often with lichen sclerosus).

2. Melanoma: ~5%.

3. Basal Cell Carcinoma: Rare.

4. Adenocarcinoma: Rare, arises from Bartholin’s gland or sweat glands.

5. Sarcoma: Very rare.

Risk Factors

Persistent HPV infection (especially HPV 16, 18, 31, 33).
Vulvar intraepithelial neoplasia (VIN).
Lichen sclerosus (chronic vulvar skin disorder).
Chronic vulvar irritation or inflammation.
Smoking.
Immunosuppression (e.g., HIV).
Older age (peak >65 years).

Symptoms

Pruritus vulvae (itching) – most common symptom.
Vulvar lump, ulcer, or wart-like growth.
Burning, pain, or tenderness.
Bleeding or discharge.
Enlarged inguinal lymph nodes (if spread).

Diagnosis

Careful vulvar examination (visual + palpation).
Biopsy of suspicious lesion → definitive diagnosis.
Colposcopy with acetic acid/lugol’s iodine (to detect VIN).
Imaging (CT/MRI/PET) → staging and metastasis evaluation.

Staging (FIGO)

Stage I: Confined to vulva.
Stage II: Spread to lower urethra, vagina, or anus.
Stage III: Spread to regional lymph nodes.
Stage IV: Spread to upper urethra, bladder, rectum, or distant organs.

Treatment

Early-stage disease (Stage I):

Wide local excision or radical vulvectomy (removal of vulva).
Sentinel lymph node biopsy (inguinal nodes).

2. Stage II–III:

Radical vulvectomy + bilateral inguinal lymphadenectomy.
Radiotherapy ± Chemotherapy for node-positive disease.

3. Stage IV / Inoperable disease:

Chemoradiation for local control.
Palliative care in advanced cases.

Prognosis

Strongly depends on lymph node status.
5-year survival:
Stage I: ~70–90%.
Stage III–IV: ~20–50%.
Early detection and treatment → excellent outcomes.