Warning Signs of Vulvar Cancer

Unlike some cancers that develop silently, vulvar cancer often produces local symptoms that, when recognised, can lead to earlier diagnosis:

• Persistent itching, burning or soreness in the vulvar area (pruritus vulvae — persistent vulvar itching)

• A visible lump, wart-like growth or ulcer on the vulva

• Skin changes — thickening, roughening or colour change (red, white or dark)

• Bleeding or discharge not related to menstruation.

• Pain or tenderness in the vulvar region

• A swollen lymph node in the groin

When vulvar itching is persistent, progressive and does not respond to simple treatments, specialist evaluation is essential.

Is Vulvar Cancer Linked to HPV?

Yes. HPV infection — particularly high-risk strains HPV 16 and 18 — is a significant risk factor for a subset of vulvar squamous cell carcinomas, predominantly in younger women. A second pathway to vulvar cancer, more common in older women, is through lichen sclerosus — a chronic inflammatory skin condition that is not HPV-driven. Both pathways can progress through vulvar intraepithelial neoplasia (VIN), a pre-cancerous state, to invasive cancer if untreated.

Types of Vulvar Cancer

Vulvar cancers are classified by cell of origin — a distinction that influences treatment planning, particularly surgical extent and the role of radiation.

Squamous Cell Carcinoma (SCC): The most common type, accounting for approximately 90% of all vulvar cancers. It arises from the squamous epithelium of the vulva. Two distinct pathways exist:

• HPV-associated SCC: More common in younger women. Related to high-risk HPV infection (particularly HPV 16) through vulvar intraepithelial neoplasia (VIN). Typically warty or basaloid in appearance.

• Non-HPV-associated SCC: More common in older women. Arises from a background of lichen sclerosus and differentiated VIN (dVIN). Keratinising SCC; carries a less favourable prognosis than HPV-associated SCC.

Melanoma: The second most common vulvar malignancy (approximately 5–10%). Arises from melanocytes in the vulvar skin. Treated with wide surgical excision with adequate margins; sentinel lymph node biopsy is performed. Systemic therapy (immunotherapy, targeted therapy for BRAF-mutated melanoma) is used for advanced disease.

Adenocarcinoma: Rare; may arise from Bartholin glands, accessory mammary tissue, or sweat glands. Bartholin gland carcinomas may also be adenocarcinomas, squamous cell carcinomas, or adenoid cystic carcinomas.

Basal Cell Carcinoma: Rare on the vulva; typically behaves as it does on skin elsewhere — slow-growing, locally invasive, rarely metastatic. Treated with wide local excision.

Paget's Disease of the Vulva: An intraepithelial adenocarcinoma — a pre-invasive or minimally invasive glandular malignancy of the vulvar epithelium. May be associated with an underlying adenocarcinoma of skin appendages or a remote internal adenocarcinoma (rectal, bladder, cervical). Requires wide local excision with close follow-up due to high local recurrence rates.

Sarcoma: Rare; includes leiomyosarcoma and other mesenchymal subtypes. Requires individualised treatment.

​How Is Vulvar Cancer Diagnosed?

Diagnosis requires a punch or incisional biopsy of the suspicious vulvar lesion under local anaesthesia. Histopathological examination confirms the diagnosis and tumour type. Staging investigations include MRI of the pelvis to assess local tumour extent and lymph node involvement, and CT scan of the chest, abdomen and pelvis to evaluate for distant spread. Groin lymph node status is particularly important in vulvar cancer staging, as nodal involvement significantly influences treatment planning and prognosis.

Treatment Options at IOCI Noida

Surgery: Wide local excision or radical vulvectomy — depending on tumour size and location — is the primary treatment for most stages of vulvar cancer. Sentinel lymph node biopsy is the standard approach to assess groin lymph nodes in early-stage disease without palpable nodes, and is appropriate for tumours with stromal invasion greater than 1 mm per standard gynaecological oncology guidelines. It reduces the morbidity associated with complete inguinal lymphadenectomy.

Radiation Therapy: Post-operative radiation to the vulva or groin may be recommended when surgical margins are close or involved, or when multiple lymph nodes contain cancer. Chemoradiation may be used as primary treatment for locally advanced tumours not suitable for upfront surgery.

Systemic Therapy: Chemotherapy — commonly cisplatin-based — is used concurrently with radiation for locally advanced vulvar cancer. The vulvar cancer treatment cost in India varies based on stage and treatment modality.

Recovery After Surgery

Recovery following vulvar surgery depends on the extent of the procedure. Wound healing can take several weeks, and patients require careful wound care, pain management and physiotherapy support. Lymphoedema — swelling of the legs following groin lymph node dissection — is a recognised long-term complication that benefits from early specialist lymphoedema management.