National Cancer Institute


Posted Date: Jul 19, 2005

TABLE OF CONTENTS


Description

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What is cancer of the vulva?

Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a woman's vagina. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal.

Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40. Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. A doctor should be seen if there is bleeding or discharge not related to menstruation (periods), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough.

If there are symptoms, a doctor may do certain tests to see if there is cancer, usually beginning by looking at the vulva and feeling for any lumps. The doctor may then go on to cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. A patient will be given some medicine to numb the area when the biopsy is done. Some pressure may be felt, but usually with no pain. This test is often done in a doctor's office.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vulva or has spread to other places) and the patient's general state of health.


Stage Explanation

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Stages of cancer of the vulva

Once cancer of the vulva is diagnosed, more tests will be done to find out if the cancer has spread from the vulva to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vulva:


Stage 0 or carcinoma in situ

Stage 0 cancer of the vulva is a very early cancer. The cancer is found in the vulva only and is only in the surface of the skin.


Stage I

Cancer is found only in the vulva and/or the space between the opening of the rectum and the vagina (perineum). The tumor is 2 centimeters (about 1 inch) or less in size.


Stage II

Cancer is found in the vulva and/or the space between the opening of the rectum and the vagina (perineum), and the tumor is larger than 2 centimeters (larger than 1 inch).


Stage III

Cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra (the tube through which urine passes), the vagina, the anus (the opening of the rectum), and/or has spread to nearby lymph nodes. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)


Stage IV

Cancer has spread beyond the urethra, vagina, and anus into the lining of the bladder (the sac that holds urine) and the bowel (intestine); or, it may have spread to the lymph nodes in the pelvis or to other parts of the body.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vulva or another place.


Treatment Option Overview

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How cancer of the vulva is treated

There are treatments for all patients with cancer of the vulva. Three kinds of treatment are used:

Surgery is the most common treatment of cancer of the vulva. A doctor may take out the cancer using one of the following operations:

  • Wide local excision takes out the cancer and some of the normal tissue around the cancer.
  • Radical local excision takes out the cancer and a larger portion of normal tissue around the cancer. Lymph nodes may also be removed.
  • Laser surgery uses a narrow beam of light to remove cancer cells.
  • Skinning vulvectomy takes out only the skin of the vulva that contains the cancer.
  • Simple vulvectomy takes out the entire vulva, but no lymph nodes.
  • Partial vulvectomy takes out less than the entire vulva.
  • Radical vulvectomy takes out the entire vulva. The lymph nodes around it are usually removed as well.
  • If the cancer has spread outside the vulva and the other female organs, the doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (pelvic exenteration).

A patient may need to have skin from another part of the body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or before or after surgery.

Chemotherapy uses drugs to kill cancer cells. Drugs may be given by mouth, or they may be put into the body by a needle in the vein or muscle. Chemotherapy is called systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.


Treatment by stage

Treatment of cancer of the vulva depends on the stage of the disease, the type of disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for stages III and IV of cancer of the vulva. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


Stage 0 Vulvar Cancer

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Treatment may be one of the following:

  1. Wide local excision or laser surgery or a combination of both.
  2. Skinning vulvectomy.
  3. Ointment containing a chemotherapy drug.


Stage I Vulvar Cancer

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Treatment may be one of the following:

  1. Wide local excision.
  2. Radical local excision plus taking out all nearby lymph nodes in the groin and upper part of the thigh on the same side as the cancer.
  3. Radical vulvectomy and removal of the lymph nodes in the groin on one or both sides of the body.
  4. Radiation therapy alone (in selected patients).


Stage II Vulvar Cancer

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Treatment may be one of the following:

  1. Radical vulvectomy and removal of the lymph nodes in the groin on both sides of the body. Radiation may be given to the pelvis following the operation if cancer cells are found in the lymph nodes.
  2. Radiation therapy alone (in selected patients).


Stage III Vulvar Cancer

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Treatment may be one of the following:

  1. Radical vulvectomy and removal of the lymph nodes in the groin and upper part of the thigh on both sides of the body. Radiation may be given to the pelvis and groin following the operation, if cancer cells are found in the lymph nodes, or only to the vulva if the tumor is large but has not spread.
  2. Radiation therapy and chemotherapy followed by radical vulvectomy and removal of lymph nodes on both sides of the body.
  3. Radiation therapy (in selected patients) with or without chemotherapy.


Stage IV Vulvar Cancer

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Treatment may be one of the following:

  1. Radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the uterus, cervix, and vagina (pelvic exenteration).
  2. Radical vulvectomy followed by radiation therapy.
  3. Radiation therapy followed by radical vulvectomy.
  4. Radiation therapy (in selected patients) with or without chemotherapy, and possibly following surgery.


Recurrent Vulvar Cancer

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If the cancer has come back, treatment may be one of the following:

  1. Wide local excision with or without radiation therapy.
  2. Radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the uterus, cervix, and vagina (pelvic exenteration).
  3. Radiation therapy plus chemotherapy with or without surgery.
  4. Radiation therapy for local recurrences or to reduce symptoms such as pain, nausea, or abnormal body functions.
  5. Clinical trials of new forms of therapy.


Changes to This Summary (07/19/2005)

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The PDQ® cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Links to the NCI Dictionary of Cancer Terms have been added to this summary.


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ®

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PDQ® is a comprehensive cancer database available on NCI's Web site.

PDQ® is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ® is available online at NCI's Web site. PDQ® is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ® contains cancer information summaries.

The PDQ® database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ® cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ® also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ® and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ®. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


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