Vulvar Cancer

While cancer of the vulva is not one of the most common cancers of the female genital tract, the incidence of in situ vulvar carcinoma has more than doubled over the past 20 years. This, coupled with newer, less radical surgical treatments make it an important part of the reproductive health picture for women globally.

Cancer of the vulva represents approximately 5 percent of all gynecologic cancers, afflicting nearly 4,000 new women each year and claiming 1,000 lives in the United States alone. Applying similar incidence rates to worldwide populations indicates a large number of women live with this illness in developing countries as well, but this remains less well documented.

This type of cancer is seen in two populations of women, those in their 70s and younger women less than 40 to 50 years of age. It is in younger women that the biggest increases in incidence have been seen and it is thought that these cases are related to human papillomavirus (HPV) infection. HPV is the virus that causes cervical cancer. These HPV-related lesions of the vulva tend to be slow growing and have a long preinvasive period during which they can be detected and treated before invasive carcinoma develops. Older women tend to have the non-HPV–related lesions and the etiology for these lesions is unknown.

While the most common symptom is an itching sensation in the vulva, women also complain of burning, bleeding, or pain in the area. Under a physician's exam, a visible lesion is often present and should be biopsied. Once a biopsy has revealed cancer with some indication of the depth of invasion of the lesion, a treatment plan is created.

Years ago, the treatment for vulvar cancer was a massive surgical resection of the groin. Although successful, this procedure often left women feeling badly disfigured, depressed, sexually disrupted, and with long-term problems of swelling and difficult wound healing. Today, there are better surgical options that are appropriate for most patients.

Studies show that it is possible to achieve good survival rates by surgically removing the area of the lesion(s) and a separate incision(s) in the groin to remove lymph nodes that may also harbor cancerous cells. The location of the lesion and depth of invasion indicate whether the lymph node dissection needs to be done only on one side of the groin or both sides. Alternatively, if only unilateral groin lymph node dissection was indicated before surgery but early pathology results indicate positive nodes, then the lymph nodes on the other side of the groin will also need to be removed.

Women with positive lymph nodes or more advanced disease will need postoperative radiation to the groin and pelvis. Some women with inoperable lesions may require chemotherapy as well as radiation.

With these treatments, vulvar cancer is a largely curable condition. In 85 to 90 percent of cases, these techniques will result in control of the disease and no recurrence. For those women who do have recurrences, nearly half will be in the vulva and need to be assessed for treatment.

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