Highlights
- Vulvar cancer awareness is essential for improving prevention and early detection due to rising incidence rates.
- HPV vaccination programs show over 90% efficacy in preventing vulvar premalignant lesions, emphasizing the need for uptake.
- Multidisciplinary treatment approaches and emerging technologies are vital for optimizing care and reducing vulvar cancer's impact.
Summary and Epidemiology
Vulvar cancer, mainly squamous cell carcinoma, is a rare gynecological malignancy with rising incidence and mortality, particularly in high-income countries. In the US, about 7,480 new cases and 1,770 deaths are projected for 2025. HPV infection, especially HPV 16, plays a key role in its development, with vaccination programs showing over 90% efficacy in preventing HPV-associated premalignant lesions. However, no standard screening exists for asymptomatic women, making early diagnosis challenging. Treatment involves surgery for early stages and chemoradiation for advanced disease, with innovations in radiation and immunotherapy expanding options. Awareness campaigns emphasize education, symptom recognition, and timely biopsy to improve outcomes.
Globally, vulvar cancer incidence varies with HPV prevalence, smoking, and immunosuppression factors. Incidence has increased by 14% in several high-income countries. In the US, incidence and death rates have risen annually, mainly affecting women over 65. Europe reports substantial case numbers and deaths. Disease staging, from localized to distant metastases, guides prognosis and treatment strategies.
Risk Factors and Symptoms
Persistent infection with high-risk HPV types, smoking, chronic vulvar inflammation (e.g., lichen sclerosus), and immunosuppression such as HIV increase vulvar cancer risk. Though traditionally a disease of older women, the average age of diagnosis is decreasing due to HPV. Symptoms often include vulvar itching, pain, lumps, ulcers, or abnormal bleeding. Early stages may be asymptomatic, and advanced disease can present with groin lymph node enlargement. Suspicious lesions require biopsy for diagnosis.
Screening, Early Detection, and Prevention
No recommended screening tests exist for asymptomatic women, limiting early detection. Exfoliative cytology can detect morphological features but is not widely used. Diagnosis relies on biopsy of suspicious lesions, supported by clinical history and molecular testing (HPV, p16). Guidelines emphasize consistent, multidisciplinary assessment and care. HPV vaccination remains the primary prevention strategy, showing high efficacy in reducing HPV-related vulvar lesions. Emerging technologies like rapid HPV testing and AI-enhanced diagnostics hold future potential to improve early detection.
Treatment
Management depends on tumor type, stage, and patient factors. Surgery with clear margins is standard for early-stage vulvar cancer, while chemoradiation is used for advanced or inoperable cases. Radiation doses are tailored to disease extent, often including regional lymph nodes. Sentinel lymph node biopsy is not routinely recommended for vulvar melanoma due to recurrence risks. Systemic therapies, including chemotherapy and immunotherapy, are reserved for metastatic or rare subtypes. Treatment advances focus on reducing surgical morbidity and improving radiotherapy precision. Psychosexual counseling is recommended throughout care to address quality-of-life issues.
Awareness Campaigns and Initiatives
In 2025, global efforts, including the ISSVD’s Vulvar Awareness Campaign, promote education on HPV-related vulvar diseases through webinars, publications, and multimedia, culminating in Vulvar Awareness Day on September 18. National programs, such as Poland’s vulvodynia center and the New York State HPV Coalition, support vaccination and public education. Broader cancer awareness events complement these efforts. Technological innovations and vaccination programs are expected to reduce vulvar cancer incidence over time.
Research, Challenges, and Future Directions
Recent advances include standardizing diagnostic criteria, consolidating clinical guidelines, and integrating molecular testing and immunotherapy to personalize treatment. Improved radiation techniques and less invasive surgery reduce morbidity. Despite these gains, challenges remain in provider knowledge, patient awareness, and absence of screening for asymptomatic women. Training gaps and variable access to specialized care hinder optimal management.
Future efforts focus on updating guidelines, expanding HPV vaccination, developing effective screening for high-risk groups, and enhancing psychosocial support. Advocacy and multidisciplinary care remain critical to improving outcomes. Emerging technologies such as AI and rapid HPV assays promise better detection and risk stratification. Overall, a comprehensive approach encompassing prevention, early detection, individualized treatment, and support aims to reduce vulvar cancer’s global burden.
The content is provided by Blake Sterling, Scopewires
