Vulvar Cancer: Early Signs, Causes, and Treatment

The female reproductive system is complex, and while many women know the importance of cervical health and regular breast exams, the external parts of the genitals often receive less attention. The vulva, which includes the labia, clitoris, and perineum, is an important part of reproductive and sexual health that deserves care and awareness.

Vulvar cancer is a condition where abnormal cells grow in these tissues. It is relatively rare compared to other gynaecological cancers and most commonly affects older women, though younger women can develop it as well. The cancer usually begins at the edges of the labia but can also appear on the clitoris or the glands around the vaginal opening. Detecting it early greatly improves treatment success. In this blog, we will explore the signs, causes, and ways to manage vulvar cancer to help women stay informed and proactive about their health.

What is Vulva Cancer?

Vulvar cancer develops in the external female genitalia, an area that is often confused with the vagina. Many people use the term “vagina” to describe the whole region, but medically, the vagina is the internal canal. The vulva refers to all the parts on the outside. When abnormal cells form in these tissues, it is called vulvar cancer. This condition usually grows slowly over several years and often starts as a small growth or a sore that does not heal.

Knowing the different parts of the vulva can help with early detection. Doctors check these areas for any unusual changes, and understanding the anatomy makes it easier to notice warning signs. The main parts of the vulva are:

• The labia majora are the outer folds of skin.
• The labia minora, which are the inner folds of skin.
• The clitoris, which is a sensitive piece of tissue.
• The vaginal opening.
• The perineum, which is the space between the vagina and the anus.
• The mons pubis, which is the rounded area of fatty tissue over the pubic bone.

What are the Types of Vulva Cancer?

Not all cases of vulvar cancer are the same. The disease is classified according to the type of cell where it begins. Knowing the type helps doctors choose the most effective treatment. Some forms grow slowly over time, while others can spread more quickly to nearby lymph nodes or other parts of the body. Here are the main types of carcinoma cancer:

• Vulvar Squamous Cell Carcinoma: This is the most common type. It starts in the thin, flat cells that form the surface of the skin and usually develops over many years.
• Vulvar Melanoma: This type begins in the pigment-producing cells called melanocytes. It often appears as a dark spot or mole that changes shape or colour.
• Basal Cell Carcinoma: A very rare form of skin cancer in the vulva. It generally stays in one place and rarely spreads to other organs.
• Bartholin Gland Adenocarcinoma: This cancer starts in the glands near the vaginal opening that help with lubrication.
• Paget Disease of the Vulva: Appears as a red, scaly patch on the skin and may indicate an underlying cancer.
• Sarcoma: A rare type that begins in the connective tissues, such as muscle or fat, under the skin.
• Verrucous Carcinoma: A subtype of squamous cell carcinoma that looks like a large wart and grows very slowly.

What are the Symptoms of Vulvar Cancer?

Vulvar cancer symptoms can be subtle and are often mistaken for common issues like yeast infections or skin irritation. It’s important to pay attention to any changes that last more than a few weeks.

• Colour changes: Skin may appear darker or lighter than usual, or show thin, shiny white patches.
• Thickened or rough skin patches: The area might feel leathery, hard, or different to the touch.
• Growths: Lumps, wart-like bumps, ulcers, or open sores that do not heal even with ointments.
• Itching or burning: Persistent itching that doesn’t improve with standard treatments and may worsen at night.
• Bleeding: Unexplained bleeding not related to periods, which could occur after sex or wiping.
• Tenderness and pain: Soreness in the area, which may be felt during sex or while urinating.

What are the Causes and Factors?

After noticing symptoms, it’s natural to wonder why vulvar cancer develops. The exact cause isn’t always clear, but certain infections and long-term skin conditions can increase the risk. Knowing these factors can help you understand your own risk and take steps for early detection.

Human Papillomavirus (HPV) Infection

Human Papillomavirus (HPV) is a common sexually transmitted infection spread through skin-to-skin contact. Some types cause genital warts and are low-risk, while high-risk strains can change the DNA of skin cells, potentially leading to cancers of the vulva, cervix, and anus. Most younger women diagnosed with vulvar cancer show evidence of HPV infection.

Lichen Sclerosus

This is a chronic skin condition affecting the vulva. It isn’t an infection, but causes the skin to become thin, white, and very itchy. Long-term inflammation can damage cells and slightly increase the risk of cancer. Doctors usually recommend regular check-ups for women with this condition.

Key Factors and Risk Factors

• Age: The risk of developing this condition increases with age. Most cases are diagnosed in women over 60 years old.
• Exposure to HPV: Certain high-risk strains of HPV can cause cellular changes that may become cancerous over time.
• Chronic Vulvar Skin Conditions: Long-term inflammation from conditions such as lichen sclerosus can damage vulvar cells and increase cancer risk.
• Vulvar Intraepithelial Neoplasia (VIN): A precancerous condition where vulvar cells become abnormal. Without treatment, VIN can progress to invasive cancer.
• HIV Infection: HIV weakens the immune system, reducing the body’s ability to detect and destroy cancerous cells.
• Smoking: Tobacco chemicals damage cells throughout the body and significantly increase the risk of developing multiple cancers, including vulvar cancer.

How is Vulva Cancer Diagnosed?

Noticing unusual changes in the vulva can be worrying, but visiting a gynaecologist promptly is the first step. Early diagnosis improves the chances of successful treatment. To find the cause of symptoms, doctors use a series of examinations and tests.

• Pelvic Exam: The doctor starts with a physical examination of the vulva, looking closely for unusual spots, lumps, or other abnormalities. They may also check the internal reproductive organs.
• Pap Smear: This test is mainly used to screen for cervical cancer, but can sometimes detect abnormal cells from the vulva. It is a routine part of a gynaecological check-up and provides useful information about overall reproductive health.
• Colposcopy: If the doctor notices something suspicious, they may use a colposcope, which is a special magnifying instrument to examine the skin in greater detail. A vinegar-like solution may be applied to make abnormal cells turn white and easier to identify.
• Biopsy: This is the most definitive test for vulvar cancer. The doctor removes a small sample of suspicious tissue under local anaesthesia. A pathologist examines it under a microscope, which is the only way to confirm whether cancer is present.

What are the Stages of Vulvar Cancer?

Staging shows how far vulvar cancer has grown and whether it has spread to other parts of the body. Knowing the stage helps doctors choose the most effective treatment for each patient.

• Stage 1: The cancer is only in the vulva or perineum. It has not spread to the lymph nodes, and the tumour is usually small.
• Stage 2: The tumour is larger and may have reached nearby tissues, such as the lower urethra or anus. It has not spread to the lymph nodes.
• Stage 3: The cancer has spread to one or more lymph nodes in the groin. It may also involve the upper urethra or the vagina.
• Stage 4: The most advanced stage. The cancer has spread to distant parts of the body, such as the lungs, bones, or pelvic area. It may also reach the bladder or rectum.

How is Vulvar Cancer Treated?

Vulvar cancer can be treated in several ways, depending on how advanced it is and the overall health of the patient. The main goal is to remove or destroy the cancer while preserving as much healthy tissue as possible. Doctors often use a combination of treatments to get the best results.

Surgery

• Laser surgery: A high-energy light beam is used to remove precancerous lesions on the surface of the skin with minimal bleeding.
• Local excision: The surgeon removes the cancer along with a small margin of healthy tissue to ensure all cancer cells are gone. Nearby lymph nodes may also be checked for spread.
• Vulvectomy: Part or all of the vulva is removed. Skin grafts from other parts of the body may be used to repair the area.
• Pelvic exenteration: A very extensive surgery used only in advanced cases. It removes the lower colon, rectum, bladder, and reproductive organs if the cancer has spread to multiple organs.

Radiation Therapy

Radiation uses high-energy rays to kill cancer cells. It can shrink a tumour before surgery or destroy any remaining cancer cells afterwards. Radiation is often targeted at the groin area if lymph nodes are affected.

Chemotherapy

Chemotherapy uses medicine to stop cancer cells from growing. It can be taken as a pill or injected into a vein. It is often combined with radiation to shrink large tumours that cannot be removed by surgery alone.

Immunotherapy

This newer treatment helps your immune system recognise and attack cancer cells. It is usually used for advanced cases or when the cancer returns after other treatments.

Wrapping Up

Vulvar cancer may be uncommon, but awareness is essential. Recognising early symptoms, understanding risk factors, and seeking timely medical care can greatly improve treatment outcomes. With the right knowledge and regular check-ups, women can take proactive steps to safeguard their vulvar and overall reproductive health.

Cancer treatment in India is significantly more affordable than in many other countries while maintaining high standards of medical care. To stay financially secure during treatment, Niva Bupa NRI Health Insurance offers dependable coverage and access to quality healthcare. Explore Niva Bupa’s health insurance plans today and ensure peace of mind for you and your family.

Frequently Asked Questions

Can I perform a self-exam for this cancer?

Yes. It is a good idea to check your vulva once a month. Use a mirror to look for any new lumps, sores, or colour changes. If you notice anything unusual, see a doctor.

Is this cancer contagious?

No. Cancer itself cannot be passed from person to person. However, HPV is a virus that can lead to cancer and is contagious. Practising safe sex and getting the HPV vaccine can reduce this risk.

Does a normal Pap smear mean I do not have this cancer?

Not necessarily. A Pap smear is designed to find cervical cancer. While it can sometimes find vulvar cells, it is not a reliable test for the vulva. A physical exam is the best way to check for this specific condition.

Can I still have a sex life after treatment?

Many women can continue to have a sex life after recovery. Some surgeries or radiation may cause changes in sensation or dryness. Talking to your doctor or a specialist can help you manage these changes.