Vulval Cancer

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This blog is for informational purposes only and should not be taken as medical advice. Content is sourced from third parties, and we do not guarantee accuracy or accept any liability for its use. Always consult a qualified healthcare professional for medical guidance.

What is Vulval Cancer?

Vulval cancer is a rare malignancy of the external female genitalia, including the labia, clitoris, or vaginal opening, typically squamous cell carcinoma (90%, often HPV-related) or melanoma (5%). It is staged from I (confined) to IV (metastatic). In 2025, it accounts for 4% of gynecologic cancers, with approximately 6,300 US cases annually, primarily in women over 65, though HPV-related cases occur in younger women. Vulval intraepithelial neoplasia (VIN) is a precursor, progressing in 10-15% of cases if untreated.

Symptoms

Symptoms include persistent vulval itching (60% of cases), pain or burning, a visible lump or ulcer, thickened or discolored skin (red, white, or dark patches), bleeding or discharge (not menstrual), and enlarged groin lymph nodes. Advanced disease causes urinary obstruction, leg swelling, or symptoms from metastases (e.g., lung cough). Symptoms may be mistaken for eczema, infections, or benign cysts, delaying diagnosis by 6-12 months in 40% of cases, particularly in elderly women reluctant to seek care.

Causes

High-risk HPV (types 16, 18) drives 50-70% of squamous cell carcinomas, with risks including smoking, multiple sexual partners, immunosuppression (HIV, transplants), and prior cervical/vaginal cancer. Non-HPV cases link to chronic vulval irritation (e.g., lichen sclerosus, increasing risk 5-fold) and age. Melanomas involve BRAF or KIT mutations. In 2025, HPV vaccination prevents 80% of cases in younger cohorts, and genetic studies highlight immune evasion as a key factor in progression.

Diagnosis

Diagnosis involves vulval inspection, colposcopy with acetic acid to identify lesions, and biopsy for histological confirmation. HPV testing differentiates etiology. Imaging (MRI, CT, PET) assesses local invasion and lymph node/distant metastases. Sentinel lymph node biopsy reduces morbidity compared to full lymphadenectomy. In 2025, AI-enhanced colposcopy improves lesion detection by 25%, and molecular profiling (e.g., PIK3CA mutations) guides therapy.

Treatment

Early-stage (I-II) treatment includes wide local excision or partial vulvectomy with sentinel node biopsy, achieving 85% local control. Advanced stages (III-IV) use radical vulvectomy with lymphadenectomy, chemoradiation (cisplatin-based, 70% response), or immunotherapy (pembrolizumab for MSI-high or PD-L1-positive, 25% response). Melanomas may use targeted therapies (dabrafenib for BRAF mutations). In 2025, minimally invasive surgery and HPV-targeted therapies reduce recurrence by 15%. Palliative care manages pain and lymphedema in advanced cases.

Future Outlook

In 2025, 5-year survival is 70% overall, 90% for stage I, 50% for stage III, and 15% for metastatic disease. HPV vaccination and screening reduce incidence by 70% in vaccinated populations. Research on therapeutic vaccines, checkpoint inhibitors, and robotic surgery aims to improve outcomes and reduce morbidity. By 2030, survival could reach 80% overall, with metastatic survival at 25%, driven by precision therapies and early VIN detection.

Sources

NCI’s “Vulvar Cancer Treatment (PDQ®)”; Mayo Clinic’s “Vulvar Cancer: Symptoms and Causes”; Cleveland Clinic’s “Vulvar Cancer”; PMC’s “Vulval Cancer: Advances in 2025”; Cancer Research UK’s “Vulval Cancer”.