Vulvar Cancer: Symptoms, Diagnosis & Treatment

Understanding Vulvar Cancer

Vulvar cancer is a relatively rare cancer that develops on the outer part of a woman’s genital area. Because it affects such an intimate part of the body, many women feel shy or afraid to talk about their symptoms. As a result, problems are often ignored or treated as “infection” or “allergy” for months, which can delay diagnosis.

In simple terms, what is vulvar cancer? It is the uncontrolled growth of abnormal cells on the skin or mucosal surfaces of the vulva. It can start as long-standing itching or a small patch or lump that slowly changes over time. Most cases occur in older women, but it can also affect younger women, especially those with HPV infection or chronic vulvar skin conditions.

The good news is that when vulvar cancer is detected early, it is often highly treatable, and many women can be cured while maintaining a good quality of life. Awareness, body-awareness, and routine gynaecological check-ups play a huge role in early detection.

What is the Vulva?

The vulva is the external part of the female genitalia. It includes:

• The labia majora (outer lips)
• The labia minora (inner lips)
• The clitoris
• The opening of the vagina
• The urethral opening (where urine comes out)
• The surrounding skin and perineum

Understanding vulva anatomy helps you recognise what’s normal for you and notice early when something looks or feels different.

Defining Vulvar Cancer

In medical terms, vulvar cancer means malignant (cancerous) cells growing in the tissues of the vulva.

Key points:

• Vulvar cancer definition: A malignant tumour arising from the skin or mucosa of the vulva.
• Types of vulvar cancer include:
  • Squamous cell carcinoma (SCC) – by far the most common
  • Melanoma of the vulva
  • Basal cell carcinoma
  • Adenocarcinoma (e.g., from glands or Bartholin gland)
  • Very rare sarcomas and others

The type of cancer influences treatment options and prognosis, which is why biopsy and proper pathology reporting are essential.

Recognizing Vulvar Cancer Symptoms

Early vulvar cancer symptoms may be mild and easy to dismiss. Over time, they tend to become more persistent or troublesome. Common signs of vulvar cancer include:

• Persistent vulvar itching
  • Itching that doesn’t go away with routine creams or home remedies
• Burning or pain in the vulvar area
  • Pain while sitting, walking, urinating or during intercourse
• Visible skin changes
  • A patch that looks white, red, darker than usual, or scaly
  • Thickened, rough or wart-like area
• Lump, bump or ulcer
  • A raised growth, sore, or raw area that doesn’t heal
  • May bleed or ooze
• Vulvar bleeding or discharge
  • Bleeding unrelated to periods
  • Foul-smelling discharge from an ulcerated area
• Swelling or enlargement of one part of the vulva
• Enlarged groin lymph nodes
  • Lumps in the groin that are firm and persistent

Any persistent change in the vulvar area—especially in a woman with long-standing itching or skin problems—should be checked by a gynaecologist or gynecologic oncologist.

Early Warning Signs to Watch For

Some early vulvar cancer symptoms and red flags include:

• Itching that never really settles despite treatment for “infection” or “allergy”
• New patch or spot on the vulva that looks different in colour or texture
• Small lump or thickening that slowly increases in size
• Sore or crack that doesn’t heal in 2–3 weeks
• Mild pain or burning that slowly becomes more frequent

These may not be severe, which is exactly why they get ignored. Think of them as vulvar cancer red flags—signals that you should not postpone your check-up.

Causes and Risk Factors for Vulvar Cancer

The exact causes of vulvar cancer are usually a mix of infection, chronic irritation and individual susceptibility. Important vulvar cancer risk factors include:

• Persistent infection with high-risk HPV (human papillomavirus)
• Increasing age – more common in post-menopausal women
• Chronic inflammatory skin conditions, especially lichen sclerosus
• Smoking – damages local immunity and promotes cancerous changes
• Weakened immune system (HIV, long-term immunosuppressive medication)
• History of cervical, vaginal or vulvar pre-cancer

In some women, vulvar cancer develops in the setting of a pre-cancerous condition called VIN (Vulvar Intraepithelial Neoplasia), where abnormal cells are limited to the surface layers of the skin. Treating pre-cancer early can reduce the chance of invasive cancer later.

HPV Infection and Vulvar Cancer

Certain high-risk types of HPV are strongly linked to vulvar cancer, especially in younger women. Persistent HPV infection can cause abnormal changes in the vulvar skin (VIN) that may progress to cancer if not treated.

The HPV vaccine offers protection against common high-risk HPV types and is mainly promoted for cervical cancer prevention, but it may also reduce the risk of some vulvar and vaginal cancers. Vaccination, safe sexual practices and regular gynaecological exams form a strong prevention trio.

Other Contributing Factors

Beyond HPV, other contributors include:

• Lichen sclerosus
  • A chronic skin condition causing thin, white, fragile vulvar skin and intense itching. It increases the risk of vulvar cancer over time if not monitored and treated.
• Smoking
  • Smoking lowers local immune defence and increases the risk of many HPV-related cancers, including vulvar cancer. Quitting is one of the simplest yet most powerful preventive steps.

Types of Vulvar Cancer

There are several types of vulvar cancer, each with different behaviour patterns:

• Squamous cell carcinoma (SCC)
  • The most common form, arising from the squamous cells that make up the outer skin of the vulva.
• Vulvar melanoma
  • Arises from pigment-producing cells; tends to be more aggressive, similar to skin melanoma elsewhere.
• Basal cell carcinoma
  • Usually slower-growing, but still requires proper treatment.
• Adenocarcinoma
  • Including Bartholin gland cancers and Paget’s disease of the vulva.
• Very rare sarcomas or lymphomas

Understanding the type helps doctors tailor surgery, radiation and systemic therapy to your specific situation.

Squamous Cell Carcinoma of the Vulva

SCC of the vulva is the most common vulvar cancer. It often starts as a chronic itchy patch or thickened area that gradually changes in colour or texture, then forms a lump or ulcer. It may be associated with HPV in younger women or with chronic conditions like lichen sclerosus in older women.

Early detection usually allows for more limited surgery and better preservation of appearance and function.

Melanoma and Other Rare Types

Vulvar melanoma typically appears as a pigmented (dark) spot or growth that changes in size, shape, or colour. It’s rarer but can be more aggressive, making early detection essential.

Other rare vulvar cancers (basal cell carcinoma, adenocarcinoma, sarcoma) are uncommon, but they underline why any persistent or unusual change in the vulvar area should be properly assessed and biopsied when needed.

Diagnosing Vulvar Cancer

Diagnosing vulvar cancer begins with a detailed history and careful examination of the vulva and groin by a trained clinician. Because many benign conditions can mimic cancer, visual inspection alone is not enough to confirm the diagnosis.

If an area looks suspicious—such as a persistent ulcer, thickened patch, or abnormal pigmented lesion—the doctor will usually perform a biopsy. This is a minor procedure in which a small piece of tissue is taken and examined under a microscope by a pathologist.

Further tests (imaging, blood work, sometimes examination under anaesthesia) may be done to understand:

• How deep the tumour has grown
• Whether nearby lymph nodes are involved
• Whether there is spread to other organs

This information is used to stage the disease and plan the best treatment.

Diagnostic Procedures at Onco Life Cancer Centre

At Onco Life Cancer Centre, diagnostic steps for suspected vulvar cancer may include:

• Vulvar biopsy
  • Punch or excisional biopsy from the abnormal area to confirm cancer and type.
• Colposcopy / vulvoscopy
  • Examination of the vulva with magnification and special light to identify subtle abnormal areas and guide biopsies.
• Imaging for vulvar cancer
  • Ultrasound of groin nodes, MRI or CT scan of pelvis and abdomen, and sometimes PET-CT to evaluate lymph nodes and distant spread.

All findings are discussed in a multidisciplinary tumour board to create a clear, individualised treatment plan.

Staging of Vulvar Cancer

Vulvar cancer stages describe how far the disease has spread. Below is a simplified overview of the commonly used staging system (FIGO-based), meant for patient understanding:

Your doctor will explain your vulvar cancer staging in detail, what it means for treatment, and what outcomes can be expected.

Understanding VIN (Vulvar Intraepithelial Neoplasia)

VIN (Vulvar Intraepithelial Neoplasia) refers to pre-cancerous changes limited to the surface layers of the vulvar skin. The abnormal cells have not yet invaded deeper tissues.

VIN can cause itching, burning or visible skin changes, but sometimes it is found only on examination. Treating VIN (through topical therapy, laser or limited surgery) aims to prevent progression to invasive vulvar cancer, especially in high-risk areas. Regular follow-up is essential.

Vulvar Cancer Treatment Approaches

Vulvar cancer treatment is highly individualised and depends on stage, tumour size/location, lymph node status, age, overall health and personal priorities. At a high level, treatment often includes:

• Surgery to remove the tumour with clear margins
• Lymph node assessment (sentinel node biopsy or lymph node dissection)
• Radiation therapy, sometimes combined with chemotherapy
• Systemic treatments (chemotherapy, targeted therapy, immunotherapy) for advanced or recurrent disease

The goal is always to achieve the best chance of cure while preserving function, appearance, and quality of life as much as possible. A specialist gynecologic oncology team is crucial for balancing these factors.

Surgical Options for Vulvar Cancer

Surgery is often the mainstay of early-stage treatment. Options include:

• Wide local excision
  • Removal of the tumour with a rim of normal tissue around it.
  • Used for smaller, well-localised lesions.
• Partial or radical vulvectomy
  • Removal of part or all of the vulva in more extensive disease.
  • Techniques have evolved to be more conservative than in the past, whenever safely possible.
• Lymph node assessment / dissection
  • Sentinel lymph node biopsy or groin (inguinal/femoral) lymph node dissection to check if cancer has spread.

Reconstructive techniques may be used to preserve appearance and function. Your surgeon will discuss expected scars, healing time and impact on sexual and urinary function.

Radiation and Chemotherapy for Vulvar Cancer

Radiation therapy may be used:

• Before surgery (to shrink tumours) in selected cases
• After surgery (adjuvant) when lymph nodes are involved or margins are close/positive
• As primary treatment when surgery is not possible or would be too mutilating

Chemotherapy is sometimes combined with radiation (chemoradiation) to enhance the effect of radiation, or used alone in advanced or recurrent disease. The exact drugs and schedule depend on tumour characteristics and overall health.

Side effects (skin reactions, fatigue, bowel/bladder changes) are monitored carefully, and supportive care is provided to keep you as comfortable as possible.

Immunotherapy and Targeted Therapies

For some women with advanced or recurrent vulvar cancer—especially when standard treatments are no longer effective—immunotherapy or targeted therapy may be considered based on tumour markers, clinical trials and evolving guidelines.

These treatments aim to help the body’s own immune system recognise and attack cancer cells or block specific growth pathways. Your oncologist will discuss whether these are suitable options in your specific case.

Life After Vulvar Cancer: Recovery and Support

Vulvar cancer recovery is not just physical; it also involves emotional, sexual and psychological healing. Women may worry about body image, intimacy, urinary or bowel habits, and fear of recurrence.

Recovery may include:

• Wound care and gradual return to routine activities
• Pelvic floor physiotherapy and rehabilitation if needed
• Pain and symptom management
• Guidance on resuming sexual activity and addressing discomfort
• Emotional support, counselling and support groups

Vulvar cancer survivorship is absolutely possible. Many women go on to live full, active lives after treatment. Regular follow-ups help detect any recurrence early and manage long-term side effects promptly.

Why Choose Onco Life Cancer Centre for Vulvar Cancer Care?

At Onco Life Cancer Centre, vulvar cancer is managed by an experienced gynecologic oncology team that understands the medical complexity and the emotional sensitivity of this diagnosis. Care is tailored to the whole person, not just the tumour.

You can expect:

• Expert evaluation by specialists in women’s cancers
• Access to modern surgical techniques, lymph node mapping, and advanced radiation planning
• Multidisciplinary discussions involving surgeons, medical oncologists, radiation oncologists, radiologists and pathologists
• Thoughtful communication about fertility, sexuality, body image and relationships

“From my first visit, I was treated with dignity, not embarrassment. The doctors at Onco Life explained each step, respected my privacy, and involved me in decisions. Knowing that my cancer was handled by a dedicated women’s cancer team gave me the confidence to move forward with treatment and, eventually, with my life.”

For women facing vulvar cancer, having a compassionate, specialised team by your side can make the journey less frightening and far more hopeful.

Frequently Asked Questions (FAQ)