What are the signs and symptoms of cervical, vulvar, vaginal, and labial cancer?

Signs and Symptoms of Cervical, Vulvar, Vaginal, and Labial Cancer

The most common presenting symptom across these gynecologic malignancies is abnormal vaginal bleeding, including post-coital bleeding, intermenstrual bleeding, and post-menopausal bleeding, though many early cancers remain asymptomatic, making clinical vigilance essential. 1

Cervical Cancer Presentation

Abnormal vaginal bleeding is the hallmark symptom requiring investigation, manifesting as: 1

• Post-coital bleeding (bleeding after intercourse) 1
• Intermenstrual bleeding (bleeding between periods) 1
• Post-menopausal bleeding 1
• Intermittent spotting, particularly in early-stage disease 1

Critical Clinical Pitfall

Many early cervical cancers are completely asymptomatic, which is precisely why screening programs exist—symptoms often indicate more advanced disease. 1 When symptoms do occur, various forms of abnormal vaginal bleeding predominate over pelvic pain and abnormal vaginal discharge. 1

Vulvar Cancer Presentation

Vulvar cancer presents with widely varied symptoms, though pruritus and pain/irritation are the most common complaints. 2

Location and Appearance

• Most commonly located on the labia majora, but can occur on labia minora, clitoris, mons, or perineum 2
• HPV-negative tumors: typically present as a single mass or ulcer on the labia majora or minora 2
• HPV-positive tumors: more likely to show multifocal lesions and concurrent cervical neoplasia 2

Specific Symptoms

• Vulvar pruritus (itching) 3
• Pain or irritation 2, 3
• Vulvar bleeding or discharge 2
• Noticed lump or ulcer 3
• Many cases may be asymptomatic 2

Important Clinical Note

Most patients present with early-stage (localized) disease, and many vulvar cancers are initially misdiagnosed as inflammatory conditions, delaying diagnosis and worsening prognosis. 2, 4

Vaginal Cancer Presentation

Vaginal cancer shares similar presentation patterns with cervical cancer but is relatively rare (approximately 1,070 cases annually in the United States). 5

• Abnormal vaginal bleeding is the primary symptom 1
• Median age at diagnosis is 69 years, significantly older than cervical cancer 5
• HPV 16 is the most common causative type 5

Inner Labia (Labia Minora) Cancer

Inner labia involvement represents a subset of vulvar cancer presentations:

• Can present as mass or ulcer on the labia minora 2
• Same symptom profile as other vulvar cancers: pruritus, pain, bleeding, or discharge 2
• May be part of multifocal disease in HPV-positive cases 2

Diagnostic Approach

Any suspicious vulvar, vaginal, or cervical lesion should be biopsied to exclude invasion. 3

Essential Workup Components

• Biopsy of suspicious areas followed by pathologic review 2, 3
• Examination of vulva, vagina, AND cervix with cytologic smears, due to the multifocal nature of squamous cell intraepithelial neoplasia 2
• History and physical examination 2
• Examination under anesthesia with cystoscopy or proctoscopy as indicated 2

Shared Risk Factors Across All Sites

• HPV infection (particularly types 16 and 18) 5, 6
• Previous cervical intraepithelial neoplasia or cervical cancer 6
• Current smoking 6
• Immunosuppression 2, 6
• Multiple sexual partners 5

Key Clinical Pearls

The probability of cervical cancer in a woman with post-coital bleeding ranges from 1 in 44,000 for women aged 20-24 years to 1 in 2,400 for women aged 45-54 years, yet abnormal vaginal bleeding remains the hallmark symptom requiring investigation. 1

HPV-positive tumors across all these sites are more likely to present with multifocal lesions, necessitating comprehensive examination of all lower genital tract sites. 2