The vulva is part of a woman’s external genital area, that forms the opening to the urethra and vagina. It includes the vestibule (vaginal opening), the skin folds protecting the vestibule (known as the labia majora and labia minora), and the clitoris.
Cancers of the vulva typically develop on the inner sides of the labia majora and/or the labia minora. Less commonly, cancers can also develop on the clitoris or in the Bartholin glands – the glands just inside the vaginal opening that produce lubrication during sex.
Vulvar cancer is quite rare, comprising only about 0.6% of cancers in women in the U.S.
Types of Vulvar Cancer
Cancer is a complex disease that can manifest in several different ways. There are five main types of vulvar cancer.
Squamous cell carcinoma
Squamous cells are the primary type of skin cells in the body. Squamous cell carcinomas are cancers that begin in these cells. Squamous cell cancer can be further broken down into three subcategories.
- Keratinizing. This is the most common type of squamous cell vulvar cancer and generally develops in women ages 55-80. Unlike some genital cancers, keratinizing carcinomas are not associated with HPV.
- Basaloid. This type is found in younger women and is linked to HPV infections.
- This type is also more common in young women and linked to HPV. This carcinoma appears as a large wart. It grows gradually and generally has a good prognosis for recovery.
Adenocarcinomas of the vulva usually originate in the Bartholin glands – the tiny glands that are located on either side of the vaginal opening. They may be difficult to diagnose, because they often look like Bartholin gland cysts. Some adenocarcinomas can begin in the sweat glands near the vulva. About 8% of vulvar cancers are adenocarcinomas.
Sarcomas are carcinomas that start in the bone, muscle, or ligament tissues. They are rare, comprising only about 2% of cases of vulvar cancer. Sarcomas can occur in women of all ages, including young children.
About 6% of vulvar cases are melanomas, which are cancers of the cells that produce the pigment melanin. Melanin is what gives the skin it’s color.
Basal cell carcinoma
This type of cancer is very rare for the vulva, but it is possible. Basal cell carcinomas are the most common form of skin cancer, and usually develop due to overexposure to the sun.
Symptoms of Vulvar Cancer
Some cancers have very few symptoms. For example, pre-cancerous conditions, such as VIN (vulvar intra-epithelial neoplasia) usually won’t present with any outward symptoms. However, over time they can become malignant. Attending your regular pelvic exams is essential to detecting potential problems.
Other more invasive cancers will almost certainly involve some symptoms, such as:
- A bump, wart, rough, or raised area of the vulvar skin, which may be white, pink, or red in color
- A lump under the skin in the vaginal opening
- Thickening or thinning of the vulvar skin
- A discoloration or irregular texture on the vulva
- Genital itching, burning, or pain
- Sores, especially if they last longer than 30 days
- Abnormal bleeding
- Vaginal discharge
Risk Factors for Vulvar Cancer
The precise cause of cancer is very difficult to pinpoint. However, medical research has uncovered a few risk factors for developing vulvar cancer. Some of these include:
Vulvar cancers that aren’t linked to HPV and those typically found in older patients have been shown to have a genetic component.
The risk of vulvar cancer increases with age. More than 80% of vulvar cancers occur in women over the age of 50, and more than 50% occur in women over 70.
HPV, or the human papillomavirus, is a sexually transmitted infection than can sometimes lead to cancerous changes in the genitals. More than half of all cases of vulvar cancer can be linked to an infection of HPV. HPV is spread through skin-to-skin contact with an infected person, and it is particularly easy to transmit because so many people are not aware that they are infected. Vulvar cancers that are associated with HPV are more common in younger women, precisely because the virus is so commonly transmitted and undetected.
The human immunodeficiency virus, or HIV, damages the immune system and makes it harder for the body to fight off an infection of HPV.
Cigarettes expose smokers to dozens of harmful, carcinogenic chemicals, which can be absorbed through the lungs and spread to other bodily tissues. Moreover, smoking weakens the immune system, which hurts the body’s ability to fight cancer-causing HPV.
VIN, or vulvar intra-epithelial neoplasia, refers to pre-cancerous cell changes that occur on the vulvar skin. Not all cases of VIN develop into cancer. However, if left untreated, some VIN cases can become cancerous.
Women with a history of cervical cancer are also at an increased risk for vulvar cancer. This is because these cancers share similar risk factors, including an HPV infection. Atypical moles and melanomas can also increase your chance of developing vulvar cancer.
Diagnosing and Treating Vulvar Cancers
If you are experiencing symptoms listed here, you should make an appointment with your gynecologist. Your doctor can perform a variety of tests, including:
- Physical exam
- Cystoscopy (viewing the inside of the bladder through a narrow, lighted tube inserted through the urethra)
- Proctoscopy (viewing the inside of the rectum through a tube inserted though the anus)
- MRI (Magnetic resonance imaging)
If your gynecologist suspects vulvar cancer, you may be referred to a specialist (oncologist) to determine your particular diagnosis and the best course of treatment.