Vulvar Cancer
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Description
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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 woman’s 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 doctor’s 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 patient’s general state of health.
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Stage Explanation
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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:
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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.
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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.
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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).
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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.)
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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.
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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
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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.
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Treatment by stage
Treatment of cancer of the vulva depends on the stage of the disease, the type
of disease, and the patient’s 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. Clinical trials are ongoing in most parts of the
country for stages III and IV of cancer of the vulva. To learn more about
clinical trials, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
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Stage 0 Vulvar Cancer
Treatment may be one of the following:
- Wide local excision or laser surgery or a combination of both.
- Skinning vulvectomy.
- Ointment containing a chemotherapy drug.
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Stage I Vulvar Cancer
Treatment may be one of the following:
- Wide local excision.
- 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.
- Radical vulvectomy and removal of the lymph nodes in the groin on one or
both sides of the body.
- Radiation therapy alone (in selected patients).
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Stage II Vulvar Cancer
Treatment may be one of the following:
- 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.
- Radiation therapy alone (in selected patients).
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Stage III Vulvar Cancer
Treatment may be one of the following:
- 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.
- Radiation therapy and chemotherapy followed by radical vulvectomy and
removal of lymph nodes on both sides of the body.
- Radiation therapy (in selected patients) with or without chemotherapy.
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Stage IV Vulvar Cancer
Treatment may be one of the following:
- 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).
- Radical vulvectomy followed by radiation therapy.
- Radiation therapy followed by radical vulvectomy.
- 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:
- Wide local excision with or without radiation therapy.
- 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).
- Radiation therapy plus chemotherapy with or without surgery.
- Radiation therapy for local recurrences or to reduce symptoms such as
pain, nausea, or abnormal body functions.
- Clinical trials of new forms of therapy.
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Changes to This Summary (06/06/2003)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
