Signs and Symptoms of Vulvar Cancer
Medically reviewed by Renita White, MD
Vulvar cancer affects the vulva, the outer part of the female genitalia. It is a rare cancer, accounting for 0.3% of new cancer cases in the United States each year.
Vulvar cancer often develops slowly over time. It begins in the tissues of the vulva when cells grow out of control.
There are several types of vulvar cancer, all of which can share similar symptoms. Some people may not experience symptoms of vulvar cancer in its earlier stages. When symptoms do develop, they can include vulvar itching or discomfort, a red lesion, an ulcer (sore), or a bump.
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Where Symptoms Can Develop
Vulvar cancer can develop on any part of the vulva. The vulva refers to the external female genitalia, including the:
Mons pubis: Rounded fatty tissue where pubic hair grows
Vaginal opening: Canal where menstrual (period) blood exits
Labia majora: The outer skin folds (lips) surrounding the vagina and urethra (where pee exits the body)
Labia minora: The inner skin folds surrounding the vagina and urethra
Clitoris: A highly sensitive organ that sits above the urethra
Perineum: The area between the vaginal opening and the anus
Skene’s glands: Glands near the urethra that release lubricating substances
Bartholin's glands: Glands on both sides of the vaginal opening that release lubricating substances
Vulvar cancer symptoms most commonly develop on the labia majora and minora, as well as the clitoris and perineum.
Common Symptoms
Regardless of the specific type of vulvar cancer you have, common symptoms include:
Itching or discomfort: Persistent itching is the most common symptom of vulvar cancer. You might also experience irritation, burning, or pain in the vulva that does not go away.
Bumps and growths: A bump on the vulva you can see and feel may form. It's also possible to have a growth, possibly in the form of a wart or mole. The growth may be skin-colored, red, pink, white, or dark. In advanced cases when vulvar cancer spreads to the lymph nodes in your groin, you can have a lump in the groin.
Sores: Sores, or ulcers, that form and don't heal is another common sign. The sores can be smooth or rough. They may be red or the same color as your skin. The sore may become scaly, and/or discolored.
Skin changes: The texture or color of your skin could change. The skin might appear thicker. You might also notice your skin looks a different color, such as redder or whiter than usual. If you have a sore, the skin around the sore may begin to look puckered.
Pelvic pain: You might experience pain in the area between your hips, especially when you are urinating or having sex.
Bleeding and discharge: Abnormal blood or discharge can be a sign of vulvar cancer. This could be from a lump or sore that has started to bleed or produce a watery discharge.
Symptoms by Type
Most cancers that affect the vulva are skin cancers. Other types of cancer can affect glands in the vulva. While the different types of vulvar cancer may share similar symptoms, they may also present with slightly varied symptoms.
Vulvar Squamous Cell Carcinoma
Vulvar squamous cell carcinoma (SCC) is the most common type of vulvar cancer, accounting for 90% of cases. SCC is a type of skin cancer that affects cells in the top layer of skin, known as the epidermis.
Vulvar SCC may develop anywhere on the vulva, but it's most commonly found on the labia majora and perineum. Common signs of vulvar SCC include ongoing itching, burning, irritation, or discomfort in the vulva.
While SCC more commonly affects areas of the skin that have been exposed to ultraviolet radiation, it can develop in skin that has not been exposed to the radiation but that has been injured or inflamed About 43% of vulvar SCC cases are due to human papillomavirus (HPV) infection, a sexually transmitted infection.
Verrucous Carcinoma
Verrucous carcinoma is a rare variant of SCC skin cancer, with most cases being unrelated to HPV. It accounts for less than 1% of all vulvar cancers.
Verrucous carcinoma progresses slowly. The word verrucous refers to a growth that looks warty. That means verrucous carcinoma resembles a wart—particularly one that looks like cauliflower. The growth can get quite big, and sometimes it may bleed.
Vulvar Melanoma
Vulvar melanoma is the second most common type of vulvar cancer. Melanoma is a type of skin cancer caused by changes in melanocytes, which are skin cells that produce the skin color pigment melanin.
Vulvar melanoma usually forms on the labia majora, labia minora, or clitoris. The abnormal skin growths can be dark-colored and typically have a diameter larger than 7 millimeters. They can appear in different shapes and may have uneven coloring. Later signs of vulvar melanoma may include pain, itching, genital bleeding, or a lump you can feel.
Vulvar Sarcoma
Vulvar sarcoma is a type of cancer that begins in cells that develop into connective tissue, blood vessels, and lymphatic tissue. It accounts for 1-3% of vulvar cancers.
Vulvar sarcoma may not have any symptoms. When it does, it may appear as uncomfortable lumps in the clitoris or labia minora. Your vulva might also be itchy. Pain, bleeding, and ulcers are later-stage symptoms.
Vulvar Basal Cell Carcinoma
Vulvar basal cell carcinoma (BCC) is a type of skin cancer that develops when basal cells (cells that shed as new ones form) in the top layer of skin grow out of control. Vulvar BCC often appears as an itchy spot or a lump on the labia majora. It may look similar to a skin tag.
While BCC is the most common type of skin cancer, only 2% of BCC cases affect the vulva.
Vulvar Paget Disease
Vulvar Paget's disease is a skin cancer that accounts for 1%-2% of all vulvar cancers.
Most people with vulvar Paget's disease have itchiness as the primary symptom. During an examination, healthcare providers might notice a weeping lesion—an area of abnormal or damaged tissue that leaks fluid. The weeping lesion may resemble weeping eczema.
Less common symptoms can include vulvar pain, burning, and bleeding.
Adenocarcinoma
Adenocarcinoma is a type of cancer that begins in your glands' cells. Sometimes it's the sweat glands of the vulva skin that may be affected, but usually adenocarcinoma affects the cells of the Bartholin glands. These glands are located near the vaginal opening.
Bartholin gland cancer usually appears as a painless lump in the labia majora. It might resemble an abscess (pocket of pus) or cyst (pocket of fluid).
When to Contact a Healthcare Provider
Consult a healthcare provider if you experience any of the following symptoms in the vulvar area:
Persistent itching, burning, or discomfort
Changes in the color or texture of the skin
Ulcers that don't heal
Lumps, growths, moles, or warts
Bleeding unrelated to menstrual periods
Symptoms that warrant immediate emergency evaluation include:
Severe pain in the vulvar area, especially if it is sudden and intense
Significant bleeding that does not stop
Fever, chills, or severe swelling and redness of the vulvar skin
Questions To Ask Your Provider
If you seek advice from a healthcare provider, don’t be shy about discussing your symptoms. Although it may feel uncomfortable to bring up the symptoms, healthcare providers are used to the following types of questions and want to know your concerns so they can help you:
I've noticed persistent itching and discomfort in the area around my vagina. Could this be a sign of vulvar cancer?
Are there other conditions that could cause vaginal itching and discomfort?
Am I at high risk for vulvar cancer?
What diagnostic tests help determine if my symptoms are vulvar cancer or something else?
If my diagnosis is vulvar cancer, what are the treatment options available, and what are their potential side effects?
A Quick Review
Vulvar cancer symptoms commonly include itching, changes in skin color or texture, and the presence of sores, ulcers, or abnormal growths. Symptoms can vary based on the type of cancer affecting your vulva.
Seek advice from a healthcare provider if you experience any symptoms of vulvar cancer, as early detection and prompt treatment can lead to better outcomes. Some symptoms, such as severe pain and significant bleeding, warrant immediate emergency evaluation.
Frequently Asked Questions
In what age is vulvar cancer common?
Squamous cell carcinoma is the most frequent type of vulvar cancer. It's most common in people aged 60-74, with the average age of diagnosis being 69 years old. However, rare vulvar cancers can occur as early as your 30s.
What is the life expectancy of someone with vulvar cancer?
Life expectancy for vulvar cancer varies by type, stage, and treatment response. The overall five-year survival rate is 69.6%. Squamous cell carcinoma has an 85% five-year survival rate for localized cases, but survival decreases if cancer spreads to lymph nodes. Vulvar melanoma may have lower survival rates.
Can a gynecologist see vulvar cancer during a Pap smear?
A Pap smear mainly looks for cervical cancer and may not directly detect vulvar cancer. However, during the pelvic exam that usually accompanies a Pap smear, the provider will check for any issues on the vulva, like sores, growths, or dry, scaly skin patches. These changes could be signs of vulvar cancer.
If there are concerns, the provider may recommend further testing, such as a biopsy (skin sample).
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