Vaginal and Vulvar Cancer

The vulva and vagina represent the external female genital organs and the muscular and elastic tubular tract that connects the cervix to the vulva. Cancers of these organs typically arise from the surface lining, and most commonly are squamous cell cancers. Both vulvar and vaginal squamous cell cancers typically develop from precursor lesions referred to vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia (VAIN).

Much less common are other types of cancers, including melanoma, Bartholin’s gland cancers, and basal cell cancers.

Symptoms

Several clinical signs may suggest the development of a vulvar cancer. These include:

A lump or ulceration on the vulva
Itching or irritation
Bleeding or discharge

Vaginal cancers are more commonly asymptomatic, and are found on routine gynecologic examinations or may result in an abnormal Pap smear. Advanced, large vaginal cancers may result in bleeding or abnormal discharge.

Risk Factors

Factors that are associated with a higher risk of developing vulvar cancer include human papillomavirus (HPV) infection and smoking. These factors may also increase the risk of vaginal cancers; chronic irritation from vaginal pessaries or exposure to diethylstilbestrol (DES) in utero may also increase risk.

Diagnosis

Women should undergo examination and biopsy by their health care provider for any concerning lesion, especially if accompanied by itching, pain, or bleeding. Biopsy is crucial to differentiate vulvar cancers from other benign vulvar lesions, which may also have symptoms of itching and/or a lump.

Vaginal colposcopy, the magnified examination of the vagina after application of dilute acetic acid (or table vinegar) may also identify lesions concerning for VAIN or vaginal cancer that can be biopsied.

Treatments

Women with a known or suspected vulvar or vaginal cancer should be evaluated by a gynecologic oncologist. For vulvar dysplasia (VIN) and invasive cancer, surgery is typically the initial intervention, with local removal of the lesion. Resection of the inguinal lymph nodes may also be indicated with invasive vulvar cancers. Chemotherapy may be utilized to shrink large vulvar cancers not amenable to surgery.

The treatment of vaginal dysplasia (VAIN) may involve surgery, or alternatively use of topical chemotherapy creams. Invasive vaginal cancer is most often treated with radiation therapy.