Vulvar Cancer - Early Signs, Risk Factors, Diagnosis, and Treatment Explained

Vulvar cancer is a rare gynecologic cancer that starts on the outer female genitalia (the vulva), which includes the labia, clitoris, and the opening to the vagina (introitus). Many cases develop slowly from precancerous skin changes, which makes early detection possible and highly effective. When found early and treated by a coordinated, experienced team, outcomes are often excellent, with thoughtful surgical techniques that preserve appearance and function. This article explains what vulvar cancer is, who is affected, symptoms to watch for, how it's diagnosed and staged, modern treatments (including reconstructive options), recovery and follow‑up, and prevention strategies at Apollo Hospitals.

Note: This guide is for education and does not replace medical advice. Personal decisions should be made with a qualified gynecologic oncology team.

Overview: What Is Vulvar Cancer and Why Early Detection Matters

Vulvar cancer begins when cells on the skin or mucosa of the vulva develop DNA changes and start to grow abnormally. Most cases are squamous cell carcinomas (SCC), arising from the skin‑like cells on the vulva. Less often, cancers can start from melanocytes (melanoma), glands (adenocarcinoma, including Bartholin gland tumors and Paget disease), or other connective tissues (sarcomas).

Why early detection matters:

• Precancerous changes in vulvar skin, called VIN (vulvar intraepithelial neoplasia) can be treated before they progress to cancer.
• Early‑stage cancers are often curable with smaller surgeries that preserve appearance, sensation, and sexual function.
• Prompt care prevents larger operations, reduces complications, and shortens recovery.

How common is it?

• Vulvar cancer is rare compared with cervical or uterine cancer. Risk rises with age, but HPV‑related cases can occur in younger adults. With HPV vaccination (which protects against not just cervical cancer, but also vulvar and anal cancers) and regular gynecologic care, many cases can be prevented or caught early.

Types of Vulvar Cancer

Understanding the subtype helps tailor treatment and estimate outcomes.

• Squamous cell carcinoma (most common)
  • Frequently linked to human papillomavirus (HPV) infection, especially in younger patients.
  • In older patients, may arise from chronic inflammatory skin conditions (e.g., lichen sclerosus) and not be HPV‑related.
• Melanoma of the vulva (less common)
  • Arises from pigment‑producing cells; management parallels skin melanoma but requires gynecologic oncology input.
• Adenocarcinomas
  • Bartholin gland carcinoma, sweat gland (apocrine) carcinoma, and extramammary Paget disease of the vulva (a skin adenocarcinoma in situ that can coexist with or hide invasive disease).
• Basal cell carcinoma and sarcomas (rare)
  • Managed individually by a multidisciplinary team.
• Precancer: Precancerous changes in vulvar skin, called VIN (vulvar intraepithelial neoplasia)
  • High‑grade VIN (usual‑type, HPV‑related; differentiated‑type, lichen‑sclerosus‑related) warrants treatment to prevent progression.

Causes: Known or Suspected Contributors

• Persistent high‑risk HPV infection (notably types 16 and 18) is a key cause of many squamous vulvar cancers.
• Chronic inflammatory skin diseases of the vulva (especially lichen sclerosus) can drive non‑HPV pathways to cancer.
• Long‑standing irritation, immune suppression, and tobacco use can reduce local defenses against HPV and promote carcinogenesis.
• Genetic and age‑related DNA changes also contribute.

Most patients did nothing to "cause" vulvar cancer. Prevention focuses on vaccination, smoking cessation, and vigilant skin care.

Risk Factors: Who Is at Higher Risk?

• Persistent high‑risk HPV infection
• Smoking (impairs local immunity and wound healing)
• Immunosuppression (HIV infection, long‑term steroids, post‑transplant medicines)
• Chronic vulvar dermatoses (lichen sclerosus, lichen planus)
• History of cervical, vaginal, or anal dysplasia/cancer (shared HPV risk)
• Increasing age (non‑HPV pathway more common in older adults)
• Prior pelvic radiation (less common risk)

Reducing modifiable risks—especially HPV vaccination and smoking cessation—lowers risk and improves healing.

What Are the Symptoms of Vulvar Cancer?

Early lesions can be subtle and may be mistaken for benign skin problems. If you notice a persistent sore, patch, or itch that doesn't go away in 2–3 weeks, see a doctor.

Common early signs:

• Persistent itching, burning, or soreness
• A new lump, thickened patch, or rough/scaly area
• Color change (red, white, or dark patch), or a sore that does not heal
• Pain with urination or sex

Progressive or advanced symptoms:

• Bleeding or ulceration
• Increasing pain, swelling, or foul odor from a lesion
• A palpable groin lump (enlarged lymph node)
• Difficulty sitting or walking due to lesion pain

Any new or changing vulvar spot, especially in the setting of lichen sclerosus or persistent itching, deserves a timely biopsy.

How Is Vulvar Cancer Diagnosed?

Diagnosis confirms the cancer type and depth, and evaluates lymph node risk.

• Medical history and examination
  • Review of symptoms, skin conditions (e.g., lichen sclerosus), HPV history, smoking, and immune status.
  • Careful visual inspection and palpation of the vulva, perineum, perianal area, and groins.
• Vulvoscopy (magnified inspection)
  • Uses dilute acetic acid to highlight abnormal epithelium and guide biopsies.
• Biopsy (key step)
  • Punch or excisional biopsy of the lesion edge/deepest area to measure invasion depth and determine histology and grade.
  • Additional mapping biopsies for multifocal disease or Paget disease.
• Lymph node evaluation
  • Clinical exam of groins; imaging (ultrasound ± needle biopsy) for suspicious nodes.
  • MRI pelvis may help define local extent; CT or PET‑CT is used selectively for nodal/distant staging in larger or advanced tumors.
• Dermatologic assessment
  • For coexisting dermatoses (lichen sclerosus), because controlling inflammation reduces recurrence risk.

Staging and Grading: What They Mean

• Staging (FIGO) considers:
  • Tumor size and depth of invasion
  • Involvement of adjacent structures (urethra, vagina, anus)
  • Lymph node status (unilateral/bilateral, number, size, cancer spreading outside the lymph node capsule)
  • Distant spread (rare at diagnosis)
• Depth of invasion
  • Measured from the epithelial–stromal junction of the most superficial adjacent dermal papilla to the deepest tumor cell.
  • Depth ≥1 mm generally prompts lymph node assessment.
• Grading
  • Reflects how abnormal and fast‑growing the cells appear (well, moderately, poorly differentiated).

Why it matters:

• Tumor size, location (midline vs lateral), and depth inform the need for a special test to find the first lymph node where cancer could spread or groin lymph node removal surgery.
• Node status is the strongest prognostic factor and guides additional treatment after surgery.

Treatment Options for Vulvar Cancer

Treatment is individualized by stage, site, size, depth, histology, and personal goals. The overarching aims are to achieve cure while preserving appearance, sensation, urinary/anal continence, and sexual function. A multidisciplinary team (gynecologic oncology, plastic/reconstructive surgery, radiation oncology, medical oncology, dermatology, physiotherapy, wound/ostomy care, and sexual health counseling) collaborates closely.

Surgery

Surgery is the mainstay for most early and many locally advanced cases.

• Wide local excision (WLE) or partial radical vulvectomy
  • Removes the tumor with an adequate margin of healthy tissue (commonly 1 cm gross, aiming for ≥8 mm histologic margin after fixation).
  • Appropriate for many early, unifocal lesions.
• Radical local excision / radical vulvectomy
  • For larger or multifocal tumors; tailored to preserve as much normal tissue as safely possible.
  • Plastic/reconstructive techniques (advancement, rotational, or perforator flaps; skin grafts) restore contour, reduce wound tension, and support function.
• Sentinel lymph node test
  • If the cancer is more than 1 mm deep, doctors may do a special test to check the first lymph node the cancer could spread to. A small amount of dye or tracer is used to identify this 'sentinel' node. If it is free of cancer, bigger groin surgery can be avoided, lowering the risk of swelling (lymphedema) and wound healing problems.
  • Midline tumors may require bilateral mapping; lateral tumors often map unilaterally.
• Groin lymph node removal surgery (inguinofemoral dissection)
  • For patients with positive sentinel lymph node, clinically/radiologically suspicious nodes, or when sentinel lymph node testing is not feasible.
  • Can be unilateral or bilateral depending on tumor location.
• Multidisciplinary resection
  • If adjacent organs (urethra, vagina, anus) are involved, combined procedures may be needed. Neoadjuvant chemoradiation can sometimes shrink tumors to allow less morbid surgery.

Medical Treatment

• Chemotherapy
  • Often used with radiation (chemoradiation) for node‑positive disease or when surgery is not feasible.
  • Cisplatin is commonly used as a radiosensitizer; other combinations are used in recurrent/metastatic settings.
• Targeted therapy and immunotherapy
  • For advanced/recurrent settings, checkpoint inhibitors may be considered in biomarker‑selected patients (e.g., PD‑L1 expression, MSI‑high).
  • Targeted agents are considered for rare histologies (e.g., HER2, BRAF in melanoma) per tumor profiling.
• Dermatologic therapy
  • For lichen sclerosus or other chronic dermatoses, high‑potency topical steroids and maintenance regimens reduce symptoms and lower recurrence risk.

Radiation Therapy

Radiation is essential in several scenarios:

• Additional treatment after surgery
  • For positive or close margins not amenable to further resection, multiple positive lymph nodes, large nodal metastasis, or cancer spreading outside the lymph node capsule.
• Definitive therapy
  • For patients unfit for surgery or when organ preservation is prioritized in select cases.
• Neoadjuvant chemoradiation
  • To downstage locally advanced tumors, potentially enabling less extensive surgery.
• Techniques
  • IMRT/IGRT shapes dose to protect skin folds, femoral vessels, bowel, and bone marrow.
  • Brachytherapy is occasionally used for small, superficial recurrences or boost doses in specialized centers.

Common side effects include skin redness and skin peeling and soreness in skin folds, fatigue, and temporary urinary/anal irritation. Meticulous skin care, nutrition, and symptom management speed healing.

Proton Therapy

• Proton therapy minimizes exit dose and may be considered in highly selected situations—re‑irradiation, large fields near dose‑sensitive structures (femoral heads, bowel), or complex pelvic re‑irradiation plans.
• Most vulvar cancers are effectively treated with advanced photon IMRT/IGRT; suitability for protons is individualized.

Reconstruction, Wound Care, and Rehabilitation

• Reconstructive planning at the time of tumor removal reduces wound breakdown, improves comfort, and supports sexual and urinary function.
• Specialized wound care minimizes infection and supports healing in moist, mobile skin areas.
• Pelvic floor physiotherapy and desensitization techniques address discomfort, scarring, and dyspareunia.
• Stoma care education is provided if temporary diversions are needed in very complex resections.

Prognosis: Survival, Function, and What Influences Outcomes

• Early‑stage, node‑negative disease has a high cure rate with surgery (often with sentinel lymph node testing).
• Lymph node status is the most important prognostic factor. Additional treatment after surgery for nodal involvement improves control.
• Tumor size, depth, margins, perineural/lymphovascular invasion, and cancer spreading outside the lymph node capsule influence the need for additional therapy.
• Control of chronic dermatoses and smoking cessation reduce recurrence and improve wound healing.
• With modern surgery, sentinel lymph node testing, and tailored additional treatment after surgery, many patients maintain excellent function and quality of life.

Screening and Prevention: Protecting Vulvar Health

• HPV vaccination
  • Strongly recommended in eligible age groups; reduces the risk of HPV‑related vulvar, cervical, and anal cancers.
• Routine gynecologic and dermatologic care
  • Regular exams detect VIN and early lesions; biopsy any persistent or changing area.
• Manage chronic skin conditions
  • Treat lichen sclerosus and maintain long‑term follow‑up; report new thickening, erosions, or color change.
• Quit smoking
  • Improves local immunity, lowers HPV‑related risks, and enhances healing.
• Self‑awareness
  • Check the vulvar area for new lumps, sores, or color changes; seek evaluation for symptoms lasting beyond 2–3 weeks.

For International Patients: Seamless Access and Support at Apollo

Apollo Hospitals provides coordinated, patient‑centered services to help international patients begin care quickly and confidently:

• Pre‑arrival medical review for a preliminary opinion and planning
• Priority scheduling with gynecologic oncology, plastic/reconstructive surgery, radiation oncology (IMRT/IGRT; brachytherapy where applicable), medical oncology, dermatology, physiotherapy, and sexual health support
• Assistance with medical visa invitations, airport pickup on request, nearby accommodation guidance, and local transport
• Interpreter services, written care plans, and patient navigators for clear, compassionate communication
• Transparent estimates, billing guidance, insurance coordination, and support with international payments
• Detailed discharge summaries, wound‑care and rehabilitation plans, sexual health guidance, and teleconsultations for follow‑up with home‑country clinicians

Recovery, Side Effects, and Follow‑Up: What to Expect

• After surgery
  • Most people recover well after surgery with proper wound care. Expect soreness, swelling, and tightness for days to weeks. Wound care, sitz baths, meticulous hygiene, and pain control promote healing.
  • Avoid friction (tight clothing, prolonged sitting), manage bowel habits to prevent straining, and follow restrictions on intercourse until fully healed.
• During/after radiation or chemoradiation
  • Skin reactions peak near the end of treatment and improve over 2–4 weeks. Moisturizers, barrier creams, and gentle cleansing help. Report fever, severe pain, or extensive skin breakdown promptly.
• Sexual health and intimacy
  • Sexual health support, counseling, and reconstructive surgery can help preserve intimacy. Early counseling, lubricants/moisturizers, scar massage, dilators if advised, and pelvic physiotherapy preserve comfort and function. Open communication with partners and clinicians is encouraged.
• Lymphedema prevention (swelling of the legs due to fluid build-up after groin treatment)
  • After nodal surgery or radiation, learn early signs of leg swelling. Compression therapy, skin care, and physiotherapy can help prevent or manage lymphedema.
• Follow‑up schedule
  • Typically every 3–4 months for the first 2 years, every 6 months for years 3–5, then annually. Visits include symptom review, exam of the vulva, perineum, perianal area, and groins; imaging as indicated by findings.

Frequently Asked Questions (FAQs)

Is vulvar cancer curable?

• Yes. Many early‑stage cases are cured with surgery, often with sentinel lymph node mapping to avoid full groin dissection. When nodes are involved, adding radiation improves control and cure rates.

What are the early warning signs?

• Persistent itching, a new lump or sore that doesn't heal, color/texture change, pain with urination or sex, or bleeding/oozing. Any persistent change should be checked and biopsied.

How is vulvar cancer treated?

• Most patients have surgical removal of the tumor with adequate margins. Depending on depth and location, sentinel lymph node mapping or groin node dissection may be recommended. Radiation (often with low‑dose chemotherapy) is added when indicated by tumor or node features.

Will treatment affect sexual function?

• Your doctor will plan surgery to remove the cancer while preserving as much normal tissue as possible. It can, depending on tumor location and extent of surgery or radiation. Reconstructive surgery, pelvic physiotherapy, lubricants/moisturizers, dilator therapy, and sexual counseling help preserve comfort and intimacy.

What are common treatment side effects?

• After surgery: wound soreness, delayed healing in skin folds, and temporary urinary or bowel discomfort. After radiation: skin irritation, fatigue, and, long‑term, dryness or narrowing. Lymphedema risk increases when groin nodes are treated; early management helps.

Can vulvar cancer come back (recurrence)?

• Regular follow-up helps detect recurrence early, when it is often treatable. Yes, especially within the first 2–3 years. Regular follow‑up is essential. Recurrences may be treated with further surgery, re‑irradiation in selected cases, or systemic therapy, depending on site and prior treatment.

Does HPV vaccination help prevent vulvar cancer?

• Yes. Vaccination significantly reduces HPV‑related dysplasia and cancers of the anogenital tract, including the vulva. It's most effective when given before exposure but still beneficial for many adults.

Next Steps

• Arrange a gynecologic evaluation for persistent itching, a new vulvar lump or sore, non‑healing ulcer, color/texture change, or pain with sex/urination.
• Bring prior pathology reports, dermatology notes (if lichen sclerosus or other dermatoses), imaging, and a current medication list.
• Ask about margin goals, suitability for sentinel lymph node mapping, reconstructive options, strategies to prevent lymphedema, sexual health support, and a personalized follow‑up plan.
• Discuss HPV vaccination for eligible family members and resources for smoking cessation if applicable.

With early recognition, precise biopsy, expert surgery (often with sentinel node mapping), advanced radiation planning when needed, and comprehensive supportive care, most people with vulvar cancer achieve excellent control while maintaining comfort, function, and confidence. A compassionate, experienced team will guide every step—prioritizing cure, healing, and long‑term well‑being.