Vulvar cancer is uncommon but highly treatable when caught early — yet diagnosis is often delayed because older women are reluctant to seek help for genital symptoms. This article is for patients, families, and primary care doctors who may be the first to recognise the signs.
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Vulvar cancer signs older women — Who gets vulvar cancer
Two distinct patterns:
- Older women (60s–80s): often associated with lichen sclerosus, differentiated VIN. Not HPV-related.
- Younger women (30s–50s): HPV-related (HPV 16, 18), often preceded by VIN (Vulvar Intraepithelial Neoplasia).
Signs to watch for
- Persistent itching that does not respond to creams
- Persistent white, red, or pigmented patches on the vulva
- A lump, nodule, or wart-like lesion
- Ulceration or bleeding
- Pain or burning sensation
- Changes in skin texture (thickening, atrophy)
The single biggest barrier to early diagnosis is patient embarrassment. The single biggest aid is family encouragement to mention symptoms to a doctor.
Diagnosis pathway
- Vulvar examination by gynaecologist or gynae-oncologist
- Vulvoscopy with magnification
- Punch biopsy of suspicious area (office procedure under local anaesthesia)
- Imaging (MRI pelvis) if biopsy confirms cancer
- Examination of inguinal lymph nodes
- Sentinel lymph node biopsy is increasingly used to avoid full groin dissection
Treatment overview
- Small early lesions: wide local excision with inguinal sentinel lymph node biopsy
- Larger lesions: radical vulvectomy with inguinofemoral lymphadenectomy
- Locally advanced disease: chemoradiation
- Reconstructive surgery may be needed for larger resections
Outcomes
Stage 1 disease has 5-year survival above 80%. Stage 2 around 60%. The largest determinant of outcome is whether inguinal lymph nodes are involved. Early diagnosis dramatically improves prognosis.
See vulvar cancer page and vulvar itching evaluation.
FAQs
My mother has lichen sclerosus. Does she need monitoring?
Yes — lichen sclerosus carries a small but real risk of vulvar cancer over years. Annual gynaecology review is appropriate.
Is vulvar cancer painful?
Early-stage often painless. Pain develops with larger tumours or ulceration.
Can it be confused with infection?
Yes — recurrent yeast infections, chronic dermatitis, and lichen simplex can mimic early cancer. Lesions that do not respond to standard treatment within 4–6 weeks should be biopsied.
Will surgery affect sexual function?
Smaller excisions typically allow normal function. Larger resections may need reconstructive surgery. Discussion about outcomes is essential pre-operatively.
Can the HPV vaccine prevent vulvar cancer?
Yes — HPV-related vulvar cancers (younger women) are preventable through vaccination. Lichen-sclerosus-related cancers (older women) are not HPV-driven.
Reviewed by Dr. Nishtha Tripathi Patel, MBBS, DGO, DNB, Fellowship Gynaecological Oncology, ESGO-certified. To book: WhatsApp +91 76988 00333.