Alternate Names: Cancer - perineum

Causes and Risks: A causative agent has not been identified, but a sexually transmitted disease such as human papilloma virus (HPV - genital warts) may play a role. Vulvar cancer is relatively rare, accounting for about 5% of all gynecological cancers and less than 1% of all new cancers in women. It usually occurs in postmenopausal women with peak incidence between 65 and 75 years of age. However, 15% of the cases occur in women 40 years or younger. Risk factors include previous HPV infection, previous cervical cancer or vaginal cancer, syphillis infection, diabetes, obesity, and hypertension.

Prevention: Safer sex behaviors and reducing or controlling the risk factors may decrease the risk in some women.

Symptoms:

• ulcer, thickening or lump
  • usually on the labia majora but may be anywhere on the vulva
• local itching, pain, burning, bleeding
• pain with urination
• pain with intercourse

Signs and Tests: A routine pelvic examination may be the best means of noting early changes. Skin changes include any color changes and the presence of lesions that may vary in size and shape. Excision and biopsy of the lesion is critical for accurate diagnosis.

Treatment: Surgical removal is the standard treatment. If the tumor is large (more than 2 cm) or has grown deeply into the underlying skin, excision of the lymph nodes in the groin may be necessary as well. Radiation, with or without chemotherapy, may be used to treat advanced tumors or tumor recurrences.

Support Groups: The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group.

Prognosis: Five-year survival rates in women who are diagnosed and treated in the early stages of vulvar cancer can be excellent. The outcome depends on the size of the lesion, the type of cancer, and whether or not spreading (metastases) to the lymph nodes of the region has occurred. Recurrence at or near the original site is fairly common.

Complications: Without treatment, cancer of the vulva may spread to other organs and lead to eventual death.

Call for an appointment with your health care provider if any vulvar lesion, color changes, or local irritation persists longer than 2 weeks.