Vulvar & Vaginal Cancer

Vaginal and vulvar cancers are rare. These cancers occur when cells of the vulva (the outer part of a woman's genital organs) or the vagina (the hollow channel from the uterus to the outside of the body)grow out of control.

The most common types of vulvar cancer are:

• Vulva squamous cell carcinoma – begins in the cells that line the vulva (most are this type)
• Vulvar melanoma – begins in the pigment producing cells of the vulvar skin

The most common types of vaginal cancer are:

• Vaginal squamous cell carcinoma – begins in the cells that line the vagina (most are this type)
• Vaginal adenocarcinoma – begins in vaginal cells that make mucus and other fluids
• Vaginal melanoma – begins in the pigment-producing cells of the vagina
• Vaginal sarcoma – begins in the connective tissue or muscles in the wall of the vagina

While the exact cause of vulvar and vaginal cancer is unknown, it's linked to several risk factors, including:

• Human papillomavirus (HPV) infection
• Increasing age
• Having taken a drug in the 1950s to prevent miscarriage called diethylstilbestrol (DES)
• Smoking
• Having a history of vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia (VAIN), which are precancerous conditions
• Having a weakened immune system
• Having lichen sclerosus, a skin condition which causes irritation and itchiness

Keep in mind, having one or more risk factor does not mean you will definitely get one of these cancers, and having no risk factors does not mean you won't get them.

Vulvar cancer symptoms include:

• Itching, burning or bleeding on the vulva that does not go away
• Changes in skin color of the vulva — looking abnormally red or white
• Skin changes in the vulva, including what appears to be a rash or warts
• Sores, lumps or ulcers on the vulva that do not heal
• Pelvic pain, especially after urination or intercourse

Vaginal cancer symptoms include:

• Abnormal vaginal discharge or bleeding
• Blood in the stool or urine
• More frequent urination
• Feeling constipated
• Pelvic pain, especially after urination or intercourse

If you are experiencing symptoms of vulvar or vaginal cancer, your doctor will first ask you some questions and perform a physical exam.

If your doctor suspects cancer, he or she may recommend one of the following tests:

• Colposcopy – uses a colposcope (an instrument that magnifies cells, similar to a microscope) to obtain a lighted, magnified view of the tissues of the vulva or vagina. The test should not be painful and can be done in your doctor's office.
• Biopsy – a small amount of vulvar or vaginal tissue is removed so a pathologist can examine the cells for cancer.
• Imaging tests – computed tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan may be used to help visualize the growth to determine if it is cancerous.

Vulvar and vaginal cancer treatment options vary based on the type and stage of the cancer. At Houston Methodist, your gynecologic cancer care team will design the best treatment plan for your specific diagnosis and unique lifestyle needs.

Surgery for Vulvar & Vaginal Cancer

For vulvar cancer, surgery is used to resect the tumor and a small amount of healthy cells surrounding it. For larger vulvar cancers, part or all or the vulva may also be removed, which is called a vulvectomy. Chemotherapy or radiation therapy may be administered before surgery to help shrink the tumor and reduce the amount of tissue removed.

For vaginal cancer, treatment typically includes surgery and radiation. The goal of surgery is to resect the tumor and a small amount of healthy cells surrounding it. In some cases, part or all of the vagina may need to be removed, which is called a vaginectomy. If the cancer is advanced, the uterus and ovaries may also be removed, which is called a hysterectomy. If the cancer has spread to nearby lymph nodes, they will be removed as well. For vaginal cancers that have spread throughout the pelvic area, pelvic exenteration may be required. This may involve removing the bladder, ovaries, uterus, vagina, rectum and the lower colon.

Radiation Therapy for Vulvar & Vaginal Cancer

Radiation therapy uses high-energy rays to kill cancer cells in a specific area.

Radiation therapy may be used prior to vulvar cancer surgery to shrink the cancer, aiding surgical resection of the tumor. It may also be combined with chemotherapy to help make the cancer cells more vulnerable to radiation. After surgery, radiation therapy may also be used to kill cancer cells that may have spread to the surrounding lymph nodes, if this is suspected.

Radiation therapy is often needed to treat vaginal cancer. It's typically administered via external beam radiation, which uses a large machine to direct radiation at your pelvis or other areas where cancerous cells have appeared. For early-stage vaginal cancers, internal radiation therapy, also called brachytherapy, may also be an option. Brachytherapy may also be used after external beam therapy in some cases.

Chemotherapy for Vulvar & Vaginal Cancer

For advanced vulvar and vaginal cancers that have spread, chemotherapy may be used to kill cancer cells that have moved to other areas of the body. It may also be combined with radiation therapy to make this treatment more effective.

Laser Vaporization for Vulvar & Vaginal Pre-Cancers

If caught in the precancerous stage, laser therapy can be used to vaporize the abnormal tissue that makes up a vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia (VAIN).