Vulvar cancer is a rare diagnosis, accounting for less than one percent of all cancers in women. It develops in the vulva, the collective term for the external female genitalia, including the labia, clitoris, and the opening of the vagina. The prognosis for vulvar cancer is highly dependent on when the condition is identified. Awareness and early detection are significant factors in achieving favorable outcomes.
What is Vulvar Cancer
Vulvar cancer originates in the tissues of the vulva. The overwhelming majority of vulvar cancers, about 90 to 95 percent, are a type called squamous cell carcinoma. These cancers begin in the flat, thin cells that cover the surface of the vulvar skin. Other less common types include melanoma, which starts in pigment-producing cells, and adenocarcinoma, which arises in the glands of the vulva. The median age for diagnosis is around 68 years, though it can occur in younger individuals, often in those with human papillomavirus (HPV) infection.
Survival Rates and Staging
The question of whether vulvar cancer is deadly is best answered by examining the survival statistics, which are strongly tied to the stage at diagnosis. Prognosis is generally measured using the five-year relative survival rate, which compares the survival of people with vulvar cancer to the survival of the general population. The overall five-year relative survival rate across all stages combined is approximately 70 percent.
When the cancer is diagnosed at the earliest stage, when it is still confined to the vulva (localized disease), the five-year relative survival rate is about 86 percent. This illustrates the powerful influence of identifying the cancer before it has spread beyond its original location.
The prognosis changes as the cancer progresses and is categorized as regional or distant disease. Regional cancer means the malignancy has spread to nearby structures, such as lymph nodes in the groin or pelvis. When the cancer is regional, the five-year relative survival rate drops to around 53 percent.
The involvement of lymph nodes is considered the single most important factor influencing the prognosis. Distant disease indicates that the cancer has metastasized to organs far from the vulva, such as the lungs or liver. In these cases, the five-year relative survival rate is reduced to about 19 percent.
Recognizing Symptoms for Early Detection
Recognizing the signs of vulvar cancer is important because early diagnosis is associated with a positive outcome. The most frequently reported and long-lasting symptom is persistent itching, known as pruritus, which does not improve with typical over-the-counter treatments. This symptom is often dismissed as a benign skin irritation, leading to a delay in seeking medical attention and diagnosis.
Other common signs include:
- The presence of a lump, mass, or growth on the vulva, which may appear as a wart-like bump or a firm, red, or white lesion.
- A sore or ulcer that does not heal within a month, which requires immediate medical evaluation.
- Changes in the skin’s appearance, involving areas of thickened, rough skin or patches that change color.
- Pain, tenderness, or a burning sensation, especially during urination.
- Bleeding or discharge unrelated to menstruation.
Any persistent changes in the vulvar area should be discussed with a healthcare provider, as prompt diagnosis can significantly impact treatment success.
Common Treatment Paths
Treatment for vulvar cancer depends on the size and stage of the tumor, as well as the patient’s overall health. Surgery is the primary intervention for most cases of vulvar cancer. For small, early-stage cancers, a wide local excision is often performed to remove the tumor and a margin of healthy tissue. More extensive disease may require a partial or complete vulvectomy.
Since the spread of cancer to groin lymph nodes is a major prognostic factor, surgical removal or sampling of these nodes, often through a sentinel lymph node biopsy, is frequently performed. Radiation therapy uses high-energy X-rays to destroy cancer cells. It may be used after surgery or as a primary treatment if the tumor is large or close to sensitive structures.
Chemotherapy uses drugs to kill cancer cells and is often administered alongside radiation therapy (chemoradiation) to increase effectiveness. Chemotherapy is also used for cancer that has spread widely or for recurrent disease.