Vulvar cancer is an uncommon malignancy forming on the vulva, the collective term for the external female genitalia (including the labia, clitoris, and the opening of the vagina and urethra). It is often diagnosed in older adults, typically beginning as abnormal cell growth in the skin tissue. Vulvar cancer is highly treatable, especially when detected early. However, it can be fatal if the disease is allowed to progress without intervention.
Understanding the Mortality Risk and Survival Rates
The outlook for an individual diagnosed with vulvar cancer is directly linked to how far the disease has spread at the time of diagnosis. Survival statistics are commonly expressed as a five-year relative survival rate, which compares people with the condition to the general population. The overall five-year relative survival rate for vulvar cancer across all stages is approximately 71%.
When the cancer is classified as localized, meaning it is confined only to the vulva, the five-year relative survival rate rises substantially to about 86%. The survival rate drops considerably once the cancer has spread beyond the initial site.
For cancer that has spread to nearby lymph nodes or surrounding tissues (categorized as regional), the five-year relative survival rate decreases to around 53%. The lowest survival rate is seen in cases of distant disease, where the cancer has metastasized to remote organs like the lungs or bones. In this distant stage, the five-year relative survival rate drops to approximately 19% to 22.9%.
How Staging Affects Outlook
Cancer staging provides a standardized way to describe the extent of the disease, which is the primary determinant of the long-term outlook. Vulvar cancer is typically staged using the FIGO (International Federation of Gynecology and Obstetrics) system, categorizing the cancer from Stage I (least advanced) through Stage IV (most advanced). Staging relies on the TNM system, which assesses the size of the original Tumor (T), the involvement of nearby lymph Nodes (N), and the presence of distant Metastasis (M).
The progression from a localized tumor to one involving the lymph nodes sharply increases the risk of mortality. Lymph nodes serve as filters for the lymphatic system, and their involvement indicates cancer cells have gained access to a pathway for broader dissemination. Once cancer cells have traveled through these channels, they can establish secondary tumors in other areas, a process known as metastasis.
Metastasis to distant organs, such as the lungs or liver, represents the most advanced stage of the disease. The presence of distant metastasis is classified as Stage IVB disease, which is reflected in the lowest survival statistics.
Recognizing the Signs for Early Intervention
Since early detection is closely tied to a favorable outcome, awareness of the signs of vulvar changes is beneficial. Vulvar cancer often presents with noticeable symptoms, unlike some other gynecological cancers that remain silent in their early stages. A common sign is persistent itching, burning, or soreness of the vulva that does not resolve with standard treatments.
Another important symptom is the appearance of a lump, growth, or a sore on the vulva that fails to heal. These growths may look like warts or ulcers and can occur on any part of the external genitalia. Changes in the skin itself, such as the development of red, white, or dark patches, or areas that become rough or thickened, should also prompt a medical evaluation.
Any bleeding, discharge, or spotting from the vulva that is unrelated to a menstrual period warrants consultation. Pain and tenderness, especially during urination or sexual intercourse, can also be indicators. Individuals should not hesitate to seek medical advice for any persistent or unusual changes in the vulvar area.
Effective Treatment Strategies
The management of vulvar cancer is tailored to the stage of the disease, with the primary goal being the complete elimination of malignant cells. For most stages, surgery is the initial and most common form of treatment. Surgical options range from a wide local excision, which removes the tumor along with a margin of healthy tissue, to a partial or radical vulvectomy, which removes a larger portion or the entire vulva.
The surgical plan often includes the removal of nearby lymph nodes, as this helps determine if the cancer has spread and reduces the chance of recurrence.
In cases where the cancer is more advanced or has spread regionally, radiation therapy is frequently employed. Radiation uses high-energy beams to destroy cancer cells and may be used after surgery to eliminate any remaining cells or before surgery to shrink a large tumor. Chemotherapy, which uses powerful drugs to kill rapidly dividing cells, is often combined with radiation therapy, a process called chemoradiation. Chemotherapy is typically reserved for advanced or recurrent cases of vulvar cancer, or sometimes to enhance the effect of radiation. These combined modalities offer the best chance of controlling the disease and improving the long-term prognosis.