Cancer - vulva

Answer 1

Definition

Vulvar cancer is cancer that starts in the vulva. Vulvar cancer most often affects the labia, the folds of skin outside the vagina. In some cases, vulvar cancer may start on the clitoris or in glands on the sides of the vagina opening.

Alternative Names

Cancer - perineum

Causes, incidence, and risk factors

Most vulvar cancers begin in skin cells called squamous cells. Other vulvar cancers are:

• Adenocarcinoma
• Basal cell carcinoma
• Melanoma
• Sarcoma

Vulvar cancer is relatively rare. Risk factors include:

• Human papilloma virus (HPV, or genital warts) infection in women under age 50
• Chronic skin changes such as lichen sclerosis or squamous hyperplasia in women over age 50
• History of cervical cancer or vaginal cancer
• Smoking

Women with a condition called vulvar intraepithelial neoplasia (VIN) have a greater risk of developing vulvar cancer that spreads. However, most cases of VIN never lead to cancer.

Symptoms

Women with this condition will often have itching around the vagina for years. They may have used different skin creams. They may also have bleeding.

Other skin changes that may occur around the vulva:

• Mole or freckle, which may be pink, red, white, or gray
• Skin thickening or lump
• Skin sore (ulcer)

Other symptoms:

• Pain or burning with urination
• Pain with intercourse
• Unusual odor

Almost 20% of women with vulvar cancer have no symptoms.

Signs and tests

The following tests are used to diagnose vulvar cancer:

• Biopsy
• CT scan or MRI of the pelvisto look for cancer spread
• Pelvic examination to look for any skin changes

Treatment

Imiquimod 5% cream may be used to treat vulvar intraepithelial neoplasia (VIN).

Treatment involves surgery to remove the cancer cells. If the tumor is large (more than 2 cm) or has grown deeply into the skin, the lymph nodes in the groin area may also be removed.

Radiation, with or without chemotherapy, may be used to treat advanced tumors or vulvar cancer that comes back.

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Most women with vulvar cancer who are diagnosed and treated at an early stage do well. However, a woman's outcome depends on:

• The size of the tumor
• The type of vulvar cancer
• Whether the cancer has spread

The cancer commonly comes back at or near the site of the original tumor.

Complications

Complications may include:

• Spread of the cancer to other areas of the body
• Side effects of radiation, surgery, or chemotherapy

Calling your health care provider

Call your health care provider if you have any of these symptoms for more than 2 weeks:

• Local irritation
• Skin color change
• Sore on the vulva

Prevention

Practicing safe sex may decrease your risk of vulvar cancer. This includes using condoms to protect against sexually transmitted diseases.

A vaccine is available to protect against certain forms of HPV infection. The vaccine is approved to prevent Cervical cancer and precancers. It may help prevent other cancers linked to HPV, such as vulvar cancer. The vaccine is given to young girls before they become sexually active, and to adolescents and women up to age 26.

Routine pelvic exams can help diagnose vulvar and other cancers at an earlier stage. Earlier diagnosis improves the odds of treatment success.

References

Zhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 91.

Kumar S, Shah JP, Bryant CS, et al. A comparison of younger vs older women with vulvar cancer in the United States. Am J Obstet Gynecol. 2009;200:e52-e55.

van Seters M, van Beurden M, ten Kate FJ, Beckmann I, Ewing PC, Eijkemans MJ, et al. Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med. 2008;358:1465-1473.

Answer 2

Definition

Vulvar cancer is cancer that starts in the vulva. Vulvar cancer most often affects the labia, the folds of skin outside the vagina. In some cases, vulvar cancer may start on the clitoris or in glands on the sides of the vagina opening.

Alternative Names

Cancer - perineum

Causes, incidence, and risk factors

Most vulvar cancers begin in skin cells called squamous cells. Other vulvar cancers are:

• Adenocarcinoma
• Basal cell carcinoma
• Melanoma
• Sarcoma

Vulvar cancer is relatively rare. Risk factors include:

• Human papilloma virus (HPV, or genital warts) infection in women under age 50
• Chronic skin changes such as lichen sclerosis or squamous hyperplasia in women over age 50
• History of cervical cancer or vaginal cancer
• Smoking

Women with a condition called vulvar intraepithelial neoplasia (VIN) have a greater risk of developing vulvar cancer that spreads. However, most cases of VIN never lead to cancer.

Symptoms

Women with this condition will often have itching around the vagina for years. They may have used different skin creams. They may also have bleeding.

Other skin changes that may occur around the vulva:

• Mole or freckle, which may be pink, red, white, or gray
• Skin thickening or lump
• Skin sore (ulcer)

Other symptoms:

• Pain or burning with urination
• Pain with intercourse
• Unusual odor

Almost 20% of women with vulvar cancer have no symptoms.

Signs and tests

The following tests are used to diagnose vulvar cancer:

• Biopsy
• CT scan or MRI of the pelvisto look for cancer spread
• Pelvic examination to look for any skin changes

Treatment

Imiquimod 5% cream may be used to treat vulvar intraepithelial neoplasia (VIN).

Treatment involves surgery to remove the cancer cells. If the tumor is large (more than 2 cm) or has grown deeply into the skin, the lymph nodes in the groin area may also be removed.

Radiation, with or without chemotherapy, may be used to treat advanced tumors or vulvar cancer that comes back.

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Most women with vulvar cancer who are diagnosed and treated at an early stage do well. However, a woman's outcome depends on:

• The size of the tumor
• The type of vulvar cancer
• Whether the cancer has spread

The cancer commonly comes back at or near the site of the original tumor.

Complications

Complications may include:

• Spread of the cancer to other areas of the body
• Side effects of radiation, surgery, or chemotherapy

Calling your health care provider

Call your health care provider if you have any of these symptoms for more than 2 weeks:

• Local irritation
• Skin color change
• Sore on the vulva

Prevention

Practicing safe sex may decrease your risk of vulvar cancer. This includes using condoms to protect against sexually transmitted diseases.

A vaccine is available to protect against certain forms of HPV infection. The vaccine is approved to prevent cervical cancer and precancers. It may help prevent other cancers linked to HPV, such as vulvar cancer. The vaccine is given to young girls before they become sexually active, and to adolescents and women up to age 26.

Routine pelvic exams can help diagnose vulvar and other cancers at an earlier stage. Earlier diagnosis improves the odds of treatment success.

References

Zhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 91.

Kumar S, Shah JP, Bryant CS, et al. A comparison of younger vs older women with vulvar cancer in the United States. Am J Obstet Gynecol. 2009;200:e52-e55.

van Seters M, van Beurden M, ten Kate FJ, Beckmann I, Ewing PC, Eijkemans MJ, et al. Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med. 2008;358:1465-1473.

Reviewed By

Review Date: 01/31/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.