Vulvar and Vaginal Cancers
Vulvar and vaginal cancers are among the rarer cancers of the female genital tract. Because they are uncommon, their symptoms may sometimes be mistaken for infection, irritation, menopausal changes, or chronic skin conditions. However, early recognition and appropriate evaluation can significantly improve treatment options and outcomes.
This article is intended for both patients and healthcare professionals with limited prior knowledge of these diseases. It provides an overview of vulvar and vaginal cancers, including symptoms, diagnosis, treatment options, and follow-up care.
What are the vulva and the vagina?
The vulva refers to the external female genital area. It includes the labia majora, labia minora, clitoral region, and the opening of the vagina.
The vagina is the canal that connects the cervix to the external genital area.
Although vulvar and vaginal cancers arise in nearby anatomical regions, their diagnostic and treatment approaches may differ.
Why are these cancers important?
“Can persistent itching really be a warning sign?”
Yes. In vulvar cancer, persistent itching, burning, skin color changes, thickened areas, sores, lumps, or bleeding should not be ignored. Vaginal cancer may cause no symptoms in its early stages and can sometimes be detected during a routine pelvic examination.
Not every episode of itching, discharge, or bleeding is cancer. However, symptoms that persist, recur, or cannot be clearly explained should be assessed by a gynecologist.
General information about vulvar cancer
Vulvar cancer is most often diagnosed in older women, although it can also occur in younger patients. The most common type is squamous cell carcinoma. Some cases are related to human papillomavirus, or HPV. Others may develop in association with chronic vulvar skin conditions, such as lichen sclerosus.
Possible risk factors include:
Increasing age
HPV infection
Smoking
Immunosuppression
Chronic vulvar skin disease
Previous vulvar intraepithelial neoplasia
A history of HPV-related disease of the cervix, vagina, vulva, or anal region
General information about vaginal cancer
Vaginal cancer is rare among gynecologic cancers. The most common type is squamous cell carcinoma. Less common types include adenocarcinoma, melanoma, and sarcoma.
Vaginal cancer may also be associated with HPV infection. A history of cervical cancer, HPV-related lesions, vaginal intraepithelial neoplasia, increasing age, smoking, and immunosuppression may increase risk.
Which symptoms should be taken seriously?
“Is it just an infection, or should I see a doctor?”
Medical evaluation is recommended if any of the following symptoms occur.
Possible symptoms of vulvar cancer
Persistent vulvar itching
Burning, pain, or tenderness
A sore, crack, or ulcer that does not heal
A wart-like growth
Thickened skin, color change, white or red patches
A lump on the vulva
Bleeding not related to menstruation
Pain or burning during urination
Swelling in the groin
Possible symptoms of vaginal cancer
Bleeding after sexual intercourse
Bleeding after menopause
Bleeding between periods
Watery, foul-smelling, or bloody vaginal discharge
A lump or mass in the vagina
Pain during sexual intercourse
Pelvic pain
New urinary or bowel symptoms
Many of these symptoms can be caused by non-cancerous conditions. However, postmenopausal bleeding, recurrent bleeding after intercourse, and a non-healing vulvar lesion should always be evaluated.
How is the diagnosis made?
“Is a physical examination enough?”
A physical examination is essential, but a biopsy is usually required for a definite diagnosis.
The diagnostic process may include the following steps:
1. Medical history
The clinician will ask about the duration of symptoms, bleeding, pain, itching, discharge, HPV history, Pap smear or HPV test results, previous gynecologic conditions, and current medications.
2. Gynecologic examination
The vulva, vagina, and cervix are carefully examined. The clinician looks for changes in color, thickening, ulcers, masses, or suspicious areas. A speculum examination is used to assess the vagina and cervix.
3. Vulvoscopy or colposcopy
Magnified examination can help identify suspicious areas more clearly, especially when lesions are small or subtle.
4. Biopsy
Cancer is diagnosed by biopsy. A small tissue sample is taken from the suspicious area and examined by a pathologist. Biopsy is one of the most important steps in planning treatment.
5. Imaging tests
Ultrasound, MRI, CT, PET/CT, or chest imaging may be used to assess the extent of disease. Tumor depth, involvement of nearby organs, and lymph node status can all influence treatment decisions.
Why does staging matter?
“Does the extent of disease change treatment?”
Yes. Treatment is not based only on the name of the cancer. Tumor size, depth of invasion, spread to nearby tissues, lymph node involvement, and distant spread all matter.
In vulvar cancer, the status of the groin lymph nodes is particularly important. In vaginal cancer, the location of the tumor within the vagina, involvement of pelvic tissues, and lymph node status are key factors.
Treatment options
Treatment is individualized. Age, general health, tumor type, stage, location, lymph node status, and quality-of-life considerations are all taken into account.
Management should ideally be planned by a multidisciplinary team, including gynecologic oncology, radiation oncology, medical oncology, pathology, radiology, and, when needed, reconstructive surgery specialists.
Treatment of vulvar cancer
Surgery
For early-stage vulvar cancer, surgery is usually the main treatment. The goal is to remove the cancer with clear surgical margins while preserving function and quality of life whenever possible.
Surgical options may include:
Wide local excision
Partial vulvectomy
More radical surgery for extensive disease
Assessment of groin lymph nodes
Sentinel lymph node biopsy in selected patients
Reconstructive surgery when needed
Sentinel lymph node biopsy
In selected patients with early-stage vulvar cancer, sentinel lymph node biopsy may be appropriate. This technique identifies and removes the first lymph node or nodes most likely to receive cancer spread. In suitable patients, it can reduce the need for more extensive lymph node surgery and may lower the risk of complications such as leg swelling.
Radiation therapy and chemoradiation
Radiation therapy may be recommended depending on tumor size, surgical margins, lymph node involvement, or disease extent. In some cases, radiation is given together with chemotherapy. Chemoradiation may also be considered when surgery is not suitable or when tumor shrinkage is desired before surgery.
Systemic treatments
In advanced, recurrent, or metastatic disease, chemotherapy, targeted therapy, or immunotherapy may be considered. The choice depends on tumor biology and the patient’s overall condition.
Treatment of vaginal cancer
Treatment of vaginal cancer is often more centered on radiation therapy and chemoradiation than surgery. This is because of the anatomical location of the vagina, its close relationship with nearby organs, and the potential functional impact of surgery.
Radiation therapy
Radiation therapy is one of the main treatment approaches, especially for squamous cell vaginal cancer. External beam radiation therapy and brachytherapy may be used together. Brachytherapy involves placing a radiation source inside or close to the vagina to deliver focused treatment.
Chemoradiation
In some patients, chemotherapy is given together with radiation therapy. Chemotherapy may help increase the effectiveness of radiation.
Surgery
Surgery may be an option for very early-stage, small, and favorably located tumors. It may also be considered in selected adenocarcinomas or localized lesions. The decision depends on tumor location, size, stage, and the patient’s preferences and goals.
Treatment of vaginal intraepithelial neoplasia
Precancerous changes of the vagina are called vaginal intraepithelial neoplasia. Not all such lesions progress to cancer, but careful follow-up and appropriate treatment are important. Options may include local excision, laser therapy, topical medication, or other selected treatments.
Follow-up after treatment
“Does the process end when treatment is completed?”
Completing treatment is an important milestone, but follow-up care is essential. The goals of follow-up are to detect recurrence early, manage treatment-related side effects, support sexual health and quality of life, and provide psychological support when needed.
Follow-up schedules vary from person to person. Visits are usually more frequent in the first years after treatment and may become less frequent over time. Follow-up may include:
Review of symptoms
Vulvar, vaginal, and pelvic examination
Assessment of groin lymph nodes
Pap smear, HPV testing, or colposcopy when indicated
Biopsy of suspicious areas
Imaging when symptoms or examination findings suggest concern
Evaluation of surgical or radiation-related side effects
Discussion of sexual function, vaginal dryness, pain, and psychosocial needs
When should you seek medical advice without delay?
You should contact a gynecologist or gynecologic oncologist if you experience:
Any vaginal bleeding after menopause
Recurrent bleeding after sexual intercourse
A non-healing vulvar sore
Persistent vulvar itching or burning
Vulvar color change, thickening, or a lump
A lump or mass in the vagina
Bloody or foul-smelling discharge
New swelling in the groin
New pain, bleeding, or ulceration after treatment
HPV vaccination and prevention
HPV is linked to a proportion of vulvar and vaginal cancers. HPV vaccination is an important preventive tool against HPV-related cancers and precancerous lesions. Regular gynecologic care, appropriate cervical screening, HPV testing when indicated, avoiding smoking, and proper management of chronic vulvar skin disease can also help reduce risk.
Conclusion
Vulvar and vaginal cancers are rare, but early recognition can allow more effective and less extensive treatment. Persistent itching, non-healing sores, abnormal bleeding, or a vaginal mass should not be ignored.
The best approach is to avoid assuming that persistent symptoms are harmless, obtain a biopsy when indicated, and plan treatment through an experienced multidisciplinary team.
