Signs and Symptoms of Vulvar Cancers and Pre-Cancers
Symptoms depend on whether it is a cancer or pre-cancer and what kind of vulvar cancer it is.
Vulvar intraepithelial neoplasia
Most women with vulvar intraepithelial neoplasia (VIN) have no symptoms at all. When a woman with VIN does have a symptom, it is most often itching that does not go away or get better. An area of VIN may look different from normal vulvar skin. It is often thicker and lighter than the normal skin around it. However, an area of VIN can also appear red, pink, or darker than the surrounding skin.
Because these changes are often caused by other conditions that are not pre-cancerous, some women don’t realize that they might have a serious condition. Some try to treat the problem themselves with over-the-counter remedies. Sometimes doctors might not even recognize the condition at first.
Invasive squamous cell cancer of the vulva
Almost all women with invasive vulvar cancers will have symptoms. These can include:
- An area on the vulva that looks different from normal – it could be lighter or darker than the normal skin around it, or look red or pink.
- A bump or lump, which could be red, pink, or white and could have a wart-like or raw surface or feel rough or thick
- Thickening of the skin of the vulva
- Pain or burning
- Bleeding or discharge not related to the normal menstrual period
- An open sore (especially if it lasts for a month or more)
Verrucous carcinoma, a subtype of invasive squamous cell vulvar cancer, looks like cauliflower-like growths similar to genital warts.
These symptoms are more often caused by other, non-cancerous conditions. Still, if you have these symptoms, you should have them checked by a doctor or nurse.
Patients with vulvar melanoma can have many of the same symptoms as other vulvar cancers, such as:
- A lump
- Bleeding or discharge
Most vulvar melanomas are black or dark brown, but they can be white, pink, red, or other colors. They can be found throughout the vulva, but most are in the area around the clitoris or on the labia majora or minora.
Vulvar melanomas can sometimes start in a mole, so a change in a mole that has been present for years can also indicate melanoma. The ABCDE rule can be used to help tell a normal mole from one that could be melanoma.
Asymmetry: One-half of the mole does not match the other.
Border irregularity: The edges of the mole are ragged or notched.
Color: The color over the mole is not the same. There may be differing shades of tan, brown, or black and sometimes patches of red, blue, or white.
Diameter: The mole is wider than 6 mm (about 1/4 inch).
Evolving: The mole is changing in size, shape, or color.
The most important sign of melanoma is a change in size, shape, or color of a mole. Still, not all melanomas fit the ABCDE rule.
If you have a mole that has changed, ask your doctor to check it out.
Bartholin gland cancer
A distinct mass (lump) on either side of the opening to the vagina can be the sign of a Bartholin gland carcinoma. More often, however, a lump in this area is from a Bartholin gland cyst, which is much more common (and is not a cancer).
Soreness and a red, scaly area are symptoms of Paget disease of the vulva.
Vulvar cancer treatment options
Vulvar cancer may be treated with a number of options, depending on the type and stage of the cancer, as well as the patient’s age and overall health. Surgery is typically a component of the treatment plan. Chemotherapy and radiation therapy may also be recommended in situations where the cancer cannot be completely removed with surgery, if there is a high risk for recurrence or if the cancer has spread to the lymph nodes. A gynecologic oncologist specializing in cancer of the female reproductive system often treats vulvar cancer in concert with other physicians, such as a radiation oncologist and a medical oncologist.
We target vulvar tumors with innovative treatments and technology. Our vulvar cancer program offers radiation, surgery and chemotherapy, with a high quality of care. Your multidisciplinary team of vulvar cancer experts will answer your questions and recommend treatment options based on your unique diagnosis and needs.
Common treatments for vulvar cancer include:
As a gynecologic cancer patient exploring treatment options at Cancer Treatment Centers of America® (CTCA), you’ll meet with a gynecologic oncologist on your first visit. Your gynecologic oncologist will discuss everything going on with your health and spend as much time as needed addressing your questions and concerns.
After reviewing your medical records and health history, and performing a pelvic exam, your gynecologic oncologist will order the appropriate diagnostic tests to determine the best course of treatment. These may include biopsies and imaging scans, as well as blood tests.
You will meet again with your gynecologic oncologist, generally within two to three days of your first visit, to discuss the test results. At that time, we will discuss the treatment options available to you, as well as the ways in which supportive care services may be incorporated into your care plan.
Our gynecologic oncology team individualizes treatment using evidence-based medicine, tailoring a program to each patient. Your treatment plan may include surgery, chemotherapy or therapy with a monoclonal antibody. It all depends on your unique case and preferences.
Once you’ve begun your vulvar cancer treatment, you’ll meet with our gynecologic cancer team approximately every three to four weeks. Each time, you’ll undergo a comprehensive set of blood tests and a physical exam. You’ll also see every member of your treatment team, including your dietitian, naturopathic clinician and care manager.
Our experienced gynecologic oncologist performs numerous surgical procedures to treat vulvar cancers:
Local excision: Also known as a wide excision, the doctor removes the cancer and some of the surrounding normal tissue (the margin). Nearby lymph nodes may also be removed and examined for signs of cancer cells.
Vulvectomy: For this type of surgery, all or part of the vulva is removed. In some cases, the surrounding supporting tissue is also removed (radical vulvectomy).
Pelvic exenteration: During this extensive vulvar cancer surgical procedure, the uterus, cervix, vagina, ovaries, bladder, rectum and nearby lymph nodes may be removed, depending on the extent of the cancer. Tissue from elsewhere in the body is used to reconstruct the vagina, and urine and stool are passed into external bags. This operation is rarely used to treat vaginal cancers, but may be necessary if the cancer comes back after radiation therapy, or in cases where radiation therapy cannot be used.
Chemotherapy may be used to treat vulvar cancer, to slow or stop the cancer cells from growing and dividing.
Radiation treatment for vulvar cancer requires accuracy and precision. With sophisticated radiation therapy delivery systems, our radiation oncologists are better able to target difficult-to-reach tumors in the vulva. Also, our radiation oncologists can direct higher radiation doses at vulvar cancer cells, while reducing exposure to normal, healthy tissue.
Specific technologies used to treat vulvar cancer include:
External beam radiation therapy (EBRT) directs a beam of radiation from outside the body at cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Benefits of EBRT for vulvar cancer may include:
- EBRT is an outpatient procedure. This technique does not carry the standard risks or complications associated with major surgery for vulvar cancer, which can include surgical bleeding, post-operative pain or the risk of stroke, heart attack or blood clot.
- The procedure itself is painless.
- EBRT poses no risk of radioactivity to you or others with whom you have contact. As you undergo EBRT, you may continue normal activities with family and friends.
High-dose rate (HDR) brachytherapy is a type of internal radiation therapy that delivers radiation from implants placed close to, or inside, the tumor(s) in the body. HDR brachytherapy may be combined with other treatments, such as TomoTherapy® or intensity modulated radiation therapy (IMRT), to treat vulvar cancer. Radiation exposure to healthy tissue and nearby organs is limited or eliminated, reducing gastrointestinal and sexual function side effects.
TomoTherapy® combines a form of intensity modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. TomoTherapy may offer the following potential advantage for vulvar cancer patients:
- Advanced scanning technology provides a 3D image of the vagina so the radiation beams can be targeted according to the size, shape and location of the tumor(s) on that day.
- After treatment, side effects, like gastrointestinal or sexual function issues, are limited because it is designed so that less radiation reaches healthy tissues and organs.