Over the past couple of weeks, we’ve discussed 4 of 5 major categories of gynecological cancers. We’ve covered urinary, ovarian, cervical and vaginal cancers. Today, we’ll discuss the fifth category of gynecological cancers – vulvar cancer.

Just to be clear, vulvar cancers are those that occur on labia major, labia minora (outer and inner genital lips), clitoris and vaginal opening. Nearly 6,000 women are diagnosed with vulvar cancer every year in the United States. Approximately 1,110 women die each year from vulvar cancer.

If diagnosed early at stage 1, vulvar cancer has a 5-year cancer survival rate of 98%. The 5-year survival rate for stage 2 is about 85%. That drops to about 74% if discovered at stage 3 and if not diagnosed until stage 4, the 5-year survival rate plummets to only 31%.

Like vaginal cancers, there are two main types of vulvar cancer:

Squamous cell carcinoma is the most common type of vulvar cancer, accounting for over 80 percent of cases. One particular subtype of squamous cell cancer is called Verrucous carcinoma. This form grows slowly, often looks like a large wart, and is associated with a good prognosis (outlook).

Adenocarcinoma accounts for approximately 8 percent of vulvar cancers. These cancers usually begin in the Bartholin glands, which are found just inside the entrance of the vagina and normally produce a mucous-like fluid that acts as a lubricant. Adenocarcinomas can also develop in sweat glands. Another related condition is Paget disease, in which the adenocarcinoma cells are restricted to the top layer of the skin of the vulva. Some patients with this condition may also have an area of invasive adenocarcinoma.

Some vulvar cancers are a form of melanoma (like skin cancer) in cells with pigments and it’s possible that some of these may be related to extended exposure to the sun – nude sunbathing.

Symptoms of vulvar cancer may include symptoms for other forms of cancer and other medical conditions, but the symptoms recommended to watch for include:

• Persistent itching – this is an itch that just doesn’t go away. It often is worse at night, to the point of making sleeping difficult.
• Pain – found at the vulvar areas listed above. The severity of the pain can vary, depending on the location, how far it has spread and what stage of cancer.
• Abnormal patches of skin – These patches are often white, sometimes pink or red, and feel rough to the touch. If the vulvar cancer is a form of melanoma, the patch of skin may be darker.
• Open sore(s) – this is a sore or ulcer that persists for more than a month. The sore may also be associated with a growth or lump.
• Painful urination – generally, painful urination occurs during the early stages and if not a urinary tract infection, see your doctor as soon as possible.
• Discharge or bleeding – any discharge or bleeding not associated with the normal menstrual cycle should be cause for concern.
• Swelling – this is when the vulvar region swells larger than normal and the swelling persists.
• Changes in shape and/or color – if you have a mole in the area of the vulva, any changes in its shape and/or color may be an indication of cancer.
• Thickening of the skin of the vulva

Since a variety of the symptoms are also indicative of other conditions, if you have any of these symptoms, see your doctor. He or she might have to do a biopsy to determine if your symptoms are indicative of vulvar cancer or not. Once diagnosed via a biopsy, your doctor should refer you to a gynecologic oncologist – a person who specializes in female reproductive cancers.

You need to know your body intimately. As awkward as it may sound, you need to regularly look at your genitalia (use a mirror if necessary) and you need to touch and feel yourself regularly. Since some of the symptoms are changes in appearance and texture of the vulva, it’s necessary to know what you look and feel like when normal. Otherwise, you may not detect any changes as early which reduces your chance of surviving.

Risk factors for developing vulvar cancer include:

• Age – about 80% of cases involve women over the age of 50.
• Smoking – smoking has been attributed as increasing the risk of developing vulvar cancer, especially if the woman has been infected with high-risk HPV virus.
• HPV – this is why it is so important to get the HPV vaccine.
• HIV – having HIV increases the risk of developing vulvar cancer.
• VIN – vulvar intraepithelial neoplasia – a precancerous condition where the abnormal cells are still restricted to the surface areas.
• Lichen sclerosus – condition where vulvar skin gets thinner and itches a lot.
• Cervical cancer – having cervical cancer increases the risk of cancer developing in the vulva and vagina.

If you are diagnosed as having vulvar cancer, the treatment will depend upon what stage the cancer was found. As in most other cancers, the three main treatment options are surgery, radiation or chemotherapy. This will depend upon your oncologist and the stage of your cancer.

Know your body and if you suspect anything, see your doctor. Be honest and open with your doctor. Don’t be too embarrassed or try to hide it from your doctor as that will only result in harm to yourself.