Vulvar cancer — causes, symptoms, diagnosis, and treatment

Types and characteristics

Most vulvar cancers are squamous cell carcinomas arising from the skin-like epithelium of the vulva. Other, less common types include melanomas, basal cell carcinomas, and adenocarcinomas (for example, those originating in the Bartholin glands). Lesions may appear as lump(s), ulceration, thickened areas of skin, or persistent sores that do not heal. Some tumors develop slowly over areas of chronic skin change; others are associated with viral infection and may arise more quickly.

Risk factors and causes

Several factors are associated with increased risk of developing vulvar cancer. Persistent infection with oncogenic human papillomavirus (HPV) contributes to many cases, particularly in younger patients. Chronic inflammatory skin conditions such as lichen sclerosus, advancing age (most cases occur in older, postmenopausal women), smoking, and weakened immune systems are also important risk factors. Family history and prior vulvar intraepithelial neoplasia may influence risk as well.

Signs, diagnosis and staging

Common symptoms include itching, pain, burning, bleeding, a visible mass or non-healing sore, and changes in skin color or texture. Clinical assessment typically begins with a careful vulvar examination and may include anoscopy or colposcopy to inspect nearby tissues. Definitive diagnosis requires a biopsy of the suspicious area. Imaging studies such as ultrasound, CT, or MRI help assess local extent and lymph node involvement. Staging depends on tumor size, depth of invasion and spread to regional lymph nodes or distant sites.

Treatment options

Therapy is planned according to the tumor type, stage, location and patient factors. Surgical removal is the main curative approach: options range from wide local excision to partial or radical vulvectomy, often combined with assessment or removal of inguinal lymph nodes. Sentinel lymph node biopsy has reduced the need for extensive groin dissection in selected patients, lowering complications.

• Radiation therapy is used for locally advanced disease or as adjuvant treatment when margins or nodes are involved.
• Chemotherapy may be used with radiation for advanced disease or as palliative care.
• Systemic targeted therapies and immunotherapies are active areas of research and may be considered for recurrent or metastatic disease under guideline recommendations or clinical trials.

Prognosis, prevention and follow-up

Outcomes depend on stage at diagnosis, tumor biology and nodal involvement; earlier detection generally leads to better results. Preventive measures include HPV vaccination to reduce HPV-associated cases and prompt treatment and monitoring of precancerous conditions. Long-term follow-up addresses recurrence surveillance, wound healing, sexual function and psychosocial support. Distinguishing vulvar cancer from vaginal cancer and other gynecologic malignancies is important because treatment and prognosis differ by site of origin.

Notable facts

Although relatively uncommon compared with other gynecologic cancers, vulvar cancer requires multidisciplinary care involving gynecologic oncology, dermatology, radiation oncology and supportive services. Patients benefit from individualized treatment plans that balance cancer control with preservation of function and quality of life. For concise anatomical information and patient resources, see links on the vulvar and related anatomy: vulva, vagina, vaginal cancer, and uterus.