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Vulvar Cancer - Stages and Different Types of Vulvar Cancer

Home> Vulvar cancer> Overview and Types

What is Vulvar Cancer?

Vulvar cancer, or vulvar carcinoma, is a malignancy that occurs in the external female genitalia, known as the vulva. It occurs when the vulvar cells undergo mutations and start dividing abnormally to form a mass. Based on the cell type that it arises from, there are different types of vulvar cancer.

Parts of Vulva

Vulvar carcinoma can form in various parts of the vulva, including the labia, clitoris, and Bartholin's glands. Understanding the anatomy of the vulva is crucial to recognizing and addressing potential issues, including cancer. The following are the different parts of the vulva:

Mons Pubis: Mons pubis refers to the rounded, fatty pad covered with pubic hair at the front of the vulva.

Labia Majora: Labia majora refers to the outer folds of skin surrounding the vulva, resembling lips.

Labia Minora: Labia minora refers to the inner folds of skin within the labia majora, varying in size and shape.

Clitoris: Clitoris is the sensitive, pea-sized erectile organ below the mons pubis.

Vestibule: It is the space between the labia minora, leading to the vaginal opening and urethral opening.

Bartholin's Glands: Two pea-sized glands located on either side of the vaginal opening that produce lubricating fluid during sexual arousal.

How Common is Vulvar Cancer?

Though vulvar cancer is less common than other cancers in India, its impact on women's health cannot be underestimated. The data available from regional registries suggests that the annual incidence stands at 1.5-2 new cases per 100,000 women, primarily affecting those women who are in their postmenopausal stage.

That said, a few reports suggest that the incidence of vulvar cancer may be underreported in India due to the lack of a national registry, regional disparities in registry maintenance, and the stigma associated with the disease.

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What are the Most Common Types of Vulvar Cancer?

Based on the cell type that it arises from, different types of vulvar cancer have been identified. Some of these types are more common than others. The growth rate and aggressiveness also vary from one type to another. The following are the different types of vulvar cancer:

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the most prevalent type of vulvar cancer. This type of vulvar cancer arises from the thin, flat squamous cells that line the vulva's surface. Often associated with a human papillomavirus (HPV) infection, squamous cell carcinoma of the vulva typically presents as a bumpy, ulcerated lesion.

Vulvar (Mucosal) Melanoma

Vulvar melanoma is a rare but aggressive type of vulvar cancer arising from pigment-producing cells (melanocytes). Unlike skin melanoma, vulvar melanoma often occurs in non-sun-exposed areas.

Sarcoma

Vulvar sarcoma forms in the connective tissues of the vulva. It is a rare type of vulvar carcinoma and has various subtypes with distinct characteristics. Vulvar sarcoma demands a multidisciplinary care approach due to its rare occurrence.

Adenocarcinoma

Adenocarcinoma arises from the glandular cells of the vulva. It may arise from Bartholin's glands or other glandular structures.

Basal Cell Carcinoma (BCC)

Basal cell carcinoma on the vulva is rare. However, it is usually seen in the outer parts of the vulva. It is a slow-growing type of vulvar carcinoma and often has a favorable prognosis.

Verrucous Carcinoma

Verrucous carcinoma is a subtype of squamous cell carcinoma characterized by slow growth and a wart-like appearance. It is a less aggressive type of vulvar carcinoma.

Bartholin’s Gland Carcinoma

Arising from Bartholin's glands, Bartholin’s gland carcinoma is rare and aggressive. It is mistaken for a cyst or abscess, and this makes its diagnosis challenging.

It is necessary to obtain a brief understanding of the different types of vulvar cancer, as it plays a crucial role in treatment planning and disease prognosis evaluation.

What are Vulvar Cancer Stages?

Vulvar cancer stages are a crucial aspect of understanding the extent and progression of the disease, guiding healthcare professionals in determining appropriate treatment plans. The International Federation of Gynecology and Obstetrics (FIGO) has devised a standard vulvar cancer staging system.

FIGO Stages for Vulvar Cancer

The FIGO staging system is the most widely accepted staging method to categorize the different vulvar cancer stages. The FIGO system considers the unique anatomy and lymphatic drainage of the vulva. While staging, this system takes crucial parameters, such as its type, tumor size, depth of invasion, and lymph node involvement, into consideration.

Stage 1

In stage 1 vulvar cancer, which is also referred to as early-stage vulvar cancer, the tumor size is small and the disease is localized. It is further classified into stages 1A and 1B.

Stage 1A

The cancer is confined to the vulva or perineum, not exceeding 2 cm in size.

Stage 1B

Stage 1B is similar to stage 1A; however, the tumor size is more than 2 cm and has grown more than 1 cm deeper into the skin.

Stage 2

In stage 2, the cancer has spread to adjacent perineal structures but has not spread to the nearby organs, such as the urethra, vagina, or anus.

Stage 3

In stage 3, vulvar carcinoma has spread to the lymph nodes and the nearby organs. Stage 3 is further classified into Stages 3A, 3B, and 3C.

Stage 3A

In stage 3A, the disease has spread to the urethra, lower vagina, or anus.

Stage 3B

In stage 3B, the cancer has spread to the pelvic sidewall or involves inguinal lymph nodes.

Stage 3C

In stage 3C, the disease has extensively spread to pelvic organs or lymph nodes on both sides.

Stage 4

Stage 4 refers to the advanced stage of vulvar carcinoma. In this stage, the disease has spread to distant organs, along with nearby organs. It is further classified into stages 4A and 4B.

Stage 4A

In stage 4A, the disease has spread to adjacent organs like the bladder or rectum.

Stage 4B

In stage 4B, there is distant metastasis to distant organs or lymph nodes.

Understanding the different vulvar cancer stages is crucial; it is one of the crucial steps for patients to be aware of their condition and make informed health decisions.



Conclusion

Learning about the different aspects of vulvar cancer is pivotal for timely diagnosis and effective management. There are different types of vulvar cancer based on the cell type it arises from. Specialists use the FIGO staging system to accurately classify the different vulvar cancer stages. This information will play a critical role in planning the right course of treatment for each patient.

Frequently Asked Questions

What is the most common type of vulvar cancer?

Squamous cell carcinoma is the most common type of vulvar cancer.

The initial signs of vulvar cancer may be visible to the naked eye, as they include changes in skin color, persistent itching, or the appearance of a lump or sore.

The rate at which vulvar cancer spreads varies from one patient to another, and it depends on various factors like the type, the stage, the tumor grade, and the patient’s overall health condition.

While stage 4 vulvar cancer indicates advanced disease, it is not necessarily terminal. Treatment options, including surgery, radiation, and chemotherapy, can help delay the disease progression, prolong survival, and improve the quality of life in patients with stage 4 vulvar cancer.

High-grade vulvar tumors are relatively more aggressive than low-grade tumors. Certain types of vulvar carcinoma are relatively more aggressive than others. That said, even aggressive vulvar cancers can be managed effectively with early detection and timely intervention.

The level of pain associated with vulvar cancer varies from one patient to another. Some patients may not experience any pain in the early stages. While some patients experience discomfort, itching, or pain.