Vulvar cancer is a relatively uncommon malignancy that develops in the vulva, which comprises the external structures of the female genitalia, including the labia majora, labia minora, and clitoris.
Is Vulvar Cancer Inherited?
Vulvar cancer is generally not categorized as a hereditary cancer in the same way that certain breast or ovarian cancers are linked to specific inherited gene mutations. Most cases of vulvar cancer arise from DNA changes, known as somatic mutations, that occur during an individual’s lifetime rather than being passed down through a family’s germline. These acquired genetic changes are typically triggered by external factors or chronic conditions that damage the cells of the vulva over time.
Familial risk for vulvar cancer remains very low for the average person, and there is no widespread recommendation for genetic testing based solely on a family history of this disease. While researchers have identified genetic alterations, such as TP53 gene mutations, these usually manifest in the tumor cells themselves and are not inherited.
Primary Causes and Non-Genetic Risk Factors
The primary drivers of vulvar cancer are not inherited but are instead related to environmental exposures and chronic medical conditions. The disease develops through two distinct pathways, with the most recognized being associated with the Human Papillomavirus (HPV) infection. High-risk HPV types, particularly types 16 and 18, are implicated in approximately 60 to 70 percent of vulvar squamous cell carcinomas. The infection leads to precancerous changes called Vulvar Intraepithelial Neoplasia (VIN), which can progress to cancer if left untreated.
This HPV-related pathway tends to affect younger women and is compounded by factors such as a history of smoking, which further increases the risk of cellular damage. Smoking introduces carcinogens that impair the body’s ability to clear the HPV infection and repair damaged cells.
The second major pathway is independent of HPV and is typically seen in older women, often those over the age of 65. This non-HPV-related cancer is strongly linked to chronic inflammatory skin conditions of the vulva, such as Lichen Sclerosus. The precursor lesion in this non-HPV pathway is known as differentiated VIN (dVIN), and it is associated with a different type of genetic damage, including mutations in the TP53 tumor suppressor gene.
Other acquired risk factors include advanced age, as more than half of cases occur in women over 70, and a weakened immune system due to conditions like HIV or immunosuppressive medications. These factors compromise the body’s ability to monitor and eliminate abnormal cells, regardless of the initial cause.
Recognizing Early Warning Signs
The most frequently reported early symptom is persistent itching, which does not respond to common over-the-counter creams or treatments and may last for weeks or months. Other localized discomforts can include a chronic sensation of burning, tenderness, or unexplained pain in the genital region. Abnormal bleeding or discharge unrelated to the menstrual cycle should also be reported to a healthcare provider.
Physical changes in the skin texture or color are also significant warning signs that should prompt a medical evaluation. These changes can manifest as patches of skin that appear lighter, darker, or discolored compared to the surrounding tissue. The skin may also become noticeably thickened, raised, or rough, sometimes presenting as a firm lump or a wart-like growth. The presence of a sore or an ulcer that fails to heal within a few weeks is another serious symptom to monitor.
Prevention Strategies and Screening
The HPV vaccine is the most effective tool for primary prevention, as it protects against the high-risk types responsible for the majority of vulvar cancer cases. The vaccine is routinely recommended for preteens and young adults, but catch-up vaccination is available for individuals up to age 26, and sometimes up to age 45 after consultation with a physician. Adopting lifestyle changes, such as smoking cessation, significantly reduces the risk of vulvar cancer, especially for those who have been exposed to HPV.
Managing chronic vulvar skin conditions is another important prevention measure, requiring regular monitoring and appropriate treatment from a specialist to control inflammation and prevent cellular changes. While there is no routine population-wide screening test specifically for vulvar cancer, like the Pap test for cervical cancer, early detection relies on regular check-ups and self-awareness. Routine gynecological exams include a visual inspection of the vulva, and many healthcare providers recommend monthly vulvar self-exams using a mirror to quickly identify any new or changing lumps, sores, or skin discoloration.