Vaginal & Vulvar Cancer

Understanding Vulvovaginal Cancer

Vulvovaginal cancer describes two types of cancer that affect the vulva or the vagina, or the female genitalia. These conditions are very rare. Vaginal cancer makes up less than 2% of all female cancers seen each year and vulvar cancer represents less than 6%. Patients with these cancers are often referred to IU Health, where our specialists have experience treating them.

Vaginal cancer affects the vagina, which is the internal female genitalia. The vagina is the muscular tube that connects the uterus and cervix to the outside of the body. It is also called the birth canal. Most vaginal cancers are caused by the spread of vulvar or cervical cancers.

Vulvar cancer affects the vulva, or the area outside the vagina. This includes the labia, clitoris, vaginal opening, urethra opening and the skin surrounding this area.

There are some risk factors that can make it more likely for someone to develop vulvovaginal cancer. You are at higher risk for vulvovaginal cancer if you have experienced:

• The Human Papillomavirus (HPV), a common virus that causes about half of vulvar cancers and two-thirds of vaginal cancers.
• Advanced age. Vulvovaginal cancer is likely to affect older women. The average age to be diagnosed is 70.
• Skin conditions, such as the inflammatory skin disease vulvar lichen sclerosus. These can increase the risk of vulvar cancer.
• A weakened immune system. People who have had organ transplants, who take immunosuppressant medications or who have AIDS or HIV have compromised immune systems. This makes it difficult for the body to fight off infections like HPV, which cause vulvovaginal cancers.
• Mothers who were given the medication diethylstilbestrol, or DES, when they were pregnant. Children of these pregnancies have a risk of a very rare type of vaginal cancer. DES was a synthetic form of estrogen given to pregnant women between 1940 and 1971.

Diagnosis

There is no screening available for vulvovaginal cancers. They are often diagnosed through a doctor’s examination after symptoms appear. Symptoms of vulva or vaginal cancers can look and feel like:

• Itching or burning in the female genitals
• Abnormal discharge
• Abnormal bleeding that’s heavier than normal or happening between periods or after menopause
• Skin changes on the vulva, such as bumps, sores or discoloration
• Pelvis pain

If your doctor notices any concerning symptoms during a pelvic exam, they may take a biopsy. This involves removing tissue from the vagina or vulva and examining it under a microscope to look for cancerous cells. Your doctor may perform a pap test if they are concerned about vaginal cancer.

Treatment

Vulva and vaginal cancer is treated in different ways, depending on the type of cancer you have and whether it has spread to other parts of the body, like the lymph nodes. These types of cancer are often treated using:

• Surgery
• Radiation therapy
• Chemotherapy

Surgery removes cancerous tissue, which may include removing the lymph nodes in the groin. However, sentinel lymph node biopsy is a less invasive option that can sometimes spare the lymph nodes. In this procedure, lymph nodes are biopsied surgically using a smaller incision than is normally needed. This helps your doctor determine if your lymph nodes need to be removed.

IU Health has radiation oncologists with specialized experience providing therapy for these types of cancer. They can offer you treatment specific to your type of cancer.

Research

Clinician researchers at IU Health and the IU School of Medicine are exploring new treatment options for vulvar cancer. The most common place for vulvar cancer to spread is into nearby lymph nodes in the groin. Vulvar cancer is usually removed using surgery followed by chemotherapy and radiation therapy. Surgery can have serious side effects, like infection, lymphedema (swelling), urination or bowel movement problems and sexual changes.

In a current clinical trial, researchers are studying whether treating patients with only chemotherapy and radiation therapy is an effective way to treat vulvar cancer that has spread to the lymph nodes. Researchers want to know if avoiding surgery can help patients feel better with fewer surgical side effects.