Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let's look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them. They die when your body doesn't need them anymore.

Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasize).

Nearly all vulvar cancers start in the squamous cells. This is called squamous cell carcinoma of the vulva. Squamous cells make up most of the skin and some other surfaces and linings of the body.

Other types of cancer that can start in the vulva include melanoma, basal cell carcinoma, adenocarcinoma, and sarcoma. This is rare.

The vulva is the outer part of the female reproductive system. It’s also called the external genitalia. The vulva is the fatty tissue and skin that's around the clitoris and the openings of the urethra (the tube that carries urine out of the body) and the vagina (birth canal). It includes:

• The mons pubis. This is the rounded area in front of the pubic bones. It becomes covered with hair at puberty.

• The 2 folds of skin on each side. The outer folds are called the labia majora. The inner folds are called the labia minora.

• The prepuce or the hood of the clitoris . This is made by the inner fold of the vulva.

• The clitoris is below the prepuce. It’s a sensitive piece of tissue that swells with blood when stimulated.

• The fourchette is at the bottom of the inner folds of the vulva. This is where the labia minora meet.

• The perineum is the area between the fourchette and the anus.

Most vulvar cancers start in the labia majora or the labia minora.

If you have questions about vulvar cancer, talk with your healthcare provider. Your provider can help you understand more about this cancer.

• Protect against human papillomavirus (HPV) or HIV. You can help prevent HPV infection by not having sex as a teen or preteen. Having sex using a condom and limiting sex partners can also help. Don't have sex with people who have had a lot of partners. Condoms give some protection against HPV, but not full protection. Still, if you use them correctly every time, they help prevent the spread of HIV and many other sexually transmitted infections (STIs).

• Get the HPV vaccine. Talk with your healthcare provider about the vaccine for HPV. Ask if it's right for you. 

• Don’t smoke. Smoking raises your risk for vulvar cancer, as well as many other kinds of cancer. Ask your healthcare provider for help quitting.

• Do self- exams. Your healthcare provider may suggest that you do regular self-exams to find any changes in your vulva. You can do this by using a mirror once a month to look for any red, irritated, dark, or white spots on your vulva. Also look for bumps, ulcers, or moles that are new or have changed. See your provider if you notice any changes.

• Get regular Pap tests and pelvic exams. Women should have regular pelvic exams. They should also have regular cervical cancer screening tests. These include Pap tests with or without HPV tests. Expert groups have different advice for what age to start. Ask your provider what screening tests and schedule is right for you.

The vulva is the outer part of female genitals. You can have vulvar cancer without having any symptoms. But most people do notice changes. These are some symptoms of the most common type of vulvar cancer, squamous cell carcinoma:

• Vulvar itching that doesn't get better

• A change in skin color around your vulva. Your skin may become redder, lighter, or darker in color than the surrounding skin.

• A change in the feel of your skin around your vulva. Your skin may feel thicker, scalier, rougher, or bumpier than the surrounding skin.

• Wartlike bump or bumps, cauliflowerlike growths, or ulcers or sores on the vulva that last for more than a month

• Pain in the vulvar area or pelvis, especially when peeing or having sex

• Burning or bleeding and discharge that isn't related to your period

• Enlarged lymph glands in your groin

A much less common type of vulvar cancer, called melanoma of the vulva, may also cause the symptoms above. But it may also show up as a change in a mole that’s been there for years or a new mole. The mole may be asymmetrical. This means that one half doesn’t match the other. It may have an irregular or lacy border. This means that the edges are ragged. Or the mole may also be irregular in color or more than 1/4 inch across.

Many of these symptoms can be caused by other health problems. But it's important to see your healthcare provider if you have these symptoms. Only a provider can tell if you have cancer.

Your healthcare provider may find signs of vulvar cancer during a routine pelvic exam. You may not have any symptoms. A Pap test and a human papillomavirus test will likely be done. Diagnosing vulvar cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, symptoms, risk factors, and family history of disease.

It’s very important that you see an expert. Gynecologic oncologists are specialists in diagnosing, treating, and checking for female cancers, including vulvar cancer. Your healthcare provider may have you see one of these cancer experts to find out for sure what’s causing the changes in your vulva. If this provider thinks you might have vulvar cancer, you’ll need a biopsy to be sure.

If your healthcare provider sees an abnormal or changed area, you may need a biopsy. It's the only way to know for sure if you have cancer.

A biopsy is done by removing a tiny piece of tissue from the changed area. Medicines will be used to make your vulva numb first. If the abnormal area is small, your healthcare provider may remove all of it. If it's big, a small piece of it can be taken out by using a tool that looks like a tiny apple corer. (This is called a punch biopsy.) You might need stitches after a biopsy. You may feel some pressure, but should have little or no pain.

For larger areas, your healthcare provider may cut out a small part of the skin with a scalpel. The edges of your skin may then be stitched together. In most cases, your healthcare provider will also remove an edge of normal skin around the abnormal area.

Your healthcare provider may use a magnifying tool called a colposcope to get a close look at the changed area. The colposcope stays outside your body. It lets your provider see even small changes on your vulva. Your provider may put a vinegar-like solution on your vulva to make the changed areas white. This makes them easier to see and remove.

The removed tissue sample is sent to a lab. There, a healthcare provider called a pathologist tests the samples to look for cancer cells. It often takes about a week for your healthcare provider to get the results from the lab.

When your healthcare provider has your biopsy results, they will contact you. Your provider will talk with you about other tests you may need if vulvar cancer is found. Make sure you understand the results and know what you need to do next.