Vulvar & Vaginal Cancer
Vulvar and vaginal cancers are rare gynecological cancers that occur more often in older women. Vulvar cancer accounts for about 4-6% of gynecological malignancies and is located on the external genitalia (labia, clitoris, perineum), while vaginal cancer is even rarer. When diagnosed early, the prognosis is favorable — prompt evaluation of any suspicious lesion or persistent symptom by a specialized gynecologist is crucial.
Symptoms of vulvar and vaginal cancer — when to be concerned
Vulvar and vaginal cancer may be asymptomatic in early stages. Many women discover a lesion incidentally or during a routine gynecological examination. When symptoms are present, the main ones include:
- Persistent itching (pruritus) of the vulvar area that does not resolve with moisturizing or antifungal creams.
- Palpable nodule, mass or ulcer on the labia, clitoris or perineum.
- Changes in vulvar skin: whitish, red or pigmented areas, thickening, roughness or wart-like lesions.
- Pain, tenderness or burning sensation in the genital area.
- Bleeding or bloody discharge unrelated to menstruation.
- Foul-smelling vaginal discharge or increased moisture.
- Pain or bleeding during sexual intercourse.
- Enlarged inguinal lymph nodes (groin), often palpable as hard nodules.
- Pain or difficulty urinating in advanced stages with disease extension.
When urgent gynecological evaluation is needed
Any suspicious lesion, ulcer, nodule or skin change of the vulva that persists for more than 2-3 weeks requires gynecological evaluation. Delay in diagnosis is common because lesions are often attributed to inflammation, eczema or fungal infection.
- Persistent itching or burning of the vulva that does not respond to topical treatment.
- Palpable nodule or sore that does not heal.
- Bleeding or spotting after menopause or between periods.
- White, red or hypertrophic patches on vulvar skin.
- Enlarged lymph node in the groin without apparent infection.
- History of lichen sclerosus or vulvar intraepithelial neoplasia (VIN).
Causes and risk factors
Vulvar cancer is a multifactorial disease. The majority of cases are related either to high-risk HPV infection (types 16, 18) or to chronic inflammatory dermatoses of the area.
- Age over 65 — the most common risk factor, although the disease also occurs in younger women.
- High-risk HPV infection, especially types 16 and 18.
- Smoking, which increases the risk of persistent HPV infection and progression to malignancy.
- Lichen sclerosus of the vulva — a chronic inflammatory skin condition that predisposes to vulvar cancer.
- Vulvar intraepithelial neoplasia (VIN) — precancerous lesions requiring monitoring or treatment.
- Immunosuppression (HIV, transplantation, chronic corticosteroid use).
- Previous history of cervical or vaginal cancer.
- Advanced age and low socioeconomic status associated with reduced access to screening.
How diagnosis is made
Diagnosis of vulvar and vaginal cancer is based on clinical examination and histological confirmation through biopsy. Any suspicious lesion must be biopsied before any treatment decision.
- Clinical gynecological examination: Inspection of vulva, perineum, vagina and cervix. Palpation of inguinal lymph nodes to detect enlargement.
- Colposcopy and vulvoscopy: Use of a magnifying lens and special solutions (acetic acid, Lugol) to identify suspicious areas.
- Punch or incisional biopsy: Tissue sample from the most suspicious area. Excisional biopsy (complete removal) is avoided for initial diagnosis as it complicates sentinel lymph node planning.
- Histopathological examination: Confirmation of malignancy, identification of histological type and measurement of depth of invasion.
- Imaging: Pelvic MRI for local extension, CT or PET/CT for detection of lymph node or distant metastases.
- Cystoscopy or proctoscopy: When there is suspicion of extension to the bladder or rectum.
Types of vulvar and vaginal cancer
The most common histological type is squamous cell carcinoma, accounting for over 85% of cases. However, there are also rarer types:
- Squamous cell carcinoma: The most common type, often associated with HPV or chronic inflammation.
- Basal cell carcinoma: Rare on the vulva, usually locally invasive without metastatic tendency.
- Vulvar melanoma: Rare but aggressive, appears as a pigmented lesion.
- Adenocarcinoma (Bartholin gland): Originates from the vestibulovaginal glands.
- Paget disease of the vulva: Superficial epidermotropic adenocarcinoma, often locally recurrent, may be associated with underlying adenocarcinoma.
- Sarcoma and other rare tumors.
Staging of vulvar cancer
Staging is clinico-surgical and based on the FIGO system. It determines the extent of disease and the treatment plan. The main prognostic factor is the status of inguinal lymph nodes.
- Stage I: Tumor confined to the vulva or vagina, without lymph node involvement — the most treatable form.
- Stage II: Tumor extending to adjacent structures (lower urethra, perineum, anus) without lymph nodes.
- Stage III: Locally advanced disease with positive inguinal lymph nodes (unilateral or bilateral).
- Stage IV: Extension to bladder mucosa, rectum or distant metastases.
Treatment of vulvar and vaginal cancer
Treatment is individualized based on stage, histological type, tumor location, age and the patient's general condition. The goal is oncologically safe management with maximum preservation of quality of life and function.
- Surgical excision: The cornerstone of treatment for most stages. Involves wide local excision of the tumor with a margin of healthy tissue of at least 1-2 cm.
- Partial or radical vulvectomy: For larger or invasive tumors, part or all of the vulva is removed, often with simultaneous reconstructive surgery.
- Sentinel lymph node biopsy: In early stages, mapping with radioisotope or ICG to locate and biopsy the first lymph node. If negative, complete lymph node dissection is avoided.
- Inguinal lymph node dissection (radical lymphadenectomy): When the sentinel node is positive or there is clinical suspicion of lymph node metastases.
- Radiotherapy: Used preoperatively to shrink the tumor and postoperatively when there are positive margins or lymph node disease.
- Chemoradiotherapy: Combination of radiotherapy with chemotherapy (cisplatin) for locally advanced cases where surgical excision is not immediately feasible.
- Chemotherapy: Used mainly in locally advanced or metastatic disease, often in combination with radiation.
- Targeted therapies and immunotherapy: In recurrent or metastatic disease, checkpoint inhibitors (pembrolizumab) or targeted agents may be used depending on molecular characteristics of the tumor.
Prognosis and follow-up
Prognosis depends mainly on the stage at diagnosis. In early stages (I-II), five-year survival exceeds 80% with appropriate treatment. In advanced stages with lymph node disease, the prognosis is less favorable and a combination of treatments is required.
- Regular follow-up visits with clinical examination of the vulva and palpation of inguinal lymph nodes.
- Imaging (MRI, CT) when there is clinical indication or suspicion of recurrence.
- Immediate contact with the doctor for new lesions, pain, bleeding or lymph node enlargement.
- Monitoring for lower extremity lymphedema after inguinal lymphadenectomy and referral to lymphatic physiotherapy where needed.
- Support for sexual health, body image, psychological burden and quality of life after treatment.
- Care coordination with an oncologist, radiotherapist, physiotherapist and psychologist for holistic support.
Symptoms
Vulvar and vaginal cancer may be asymptomatic in early stages. Many women discover a lesion incidentally or during a routine gynecological examination. When symptoms are present, the main ones include:
- Persistent itching (pruritus) of the vulvar area that does not resolve with moisturizing or antifungal creams.
- Palpable nodule, mass or ulcer on the labia, clitoris or perineum.
- Changes in vulvar skin: whitish, red or pigmented areas, thickening, roughness or wart-like lesions.
- Pain, tenderness or burning sensation in the genital area.
- Bleeding or bloody discharge unrelated to menstruation.
- Foul-smelling vaginal discharge or increased moisture.
- Pain or bleeding during sexual intercourse.
- Enlarged inguinal lymph nodes (groin), often palpable as hard nodules.
- Pain or difficulty urinating in advanced stages with disease extension.
Any suspicious lesion, ulcer, nodule or skin change of the vulva that persists for more than 2-3 weeks requires gynecological evaluation. Delay in diagnosis is common because lesions are often attributed to inflammation, eczema or fungal infection.
- Persistent itching or burning of the vulva that does not respond to topical treatment.
- Palpable nodule or sore that does not heal.
- Bleeding or spotting after menopause or between periods.
- White, red or hypertrophic patches on vulvar skin.
- Enlarged lymph node in the groin without apparent infection.
- History of lichen sclerosus or vulvar intraepithelial neoplasia (VIN).
Vulvar cancer is a multifactorial disease. The majority of cases are related either to high-risk HPV infection (types 16, 18) or to chronic inflammatory dermatoses of the area.
- Age over 65 — the most common risk factor, although the disease also occurs in younger women.
- High-risk HPV infection, especially types 16 and 18.
- Smoking, which increases the risk of persistent HPV infection and progression to malignancy.
- Lichen sclerosus of the vulva — a chronic inflammatory skin condition that predisposes to vulvar cancer.
- Vulvar intraepithelial neoplasia (VIN) — precancerous lesions requiring monitoring or treatment.
- Immunosuppression (HIV, transplantation, chronic corticosteroid use).
- Previous history of cervical or vaginal cancer.
- Advanced age and low socioeconomic status associated with reduced access to screening.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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