Vulvar cancer is an uncommon type of cancer. In its early stages, it has a relatively good prognosis. However, stage 4 vulvar cancer has spread beyond the vulva, which means it is harder to treat.

The 5-year relative survival rate for vulvar cancer is 71% overall. This means that people who have this cancer are 71% as likely to be alive 5 years after diagnosis as people who do not have vulvar cancer.

However, the survival rate for stage 4 is lower. Stage 4A means the cancer has spread to nearby structures such as the urethra, and stage 4B means the cancer has spread to distant structures in the body. The survival rate for stage 4B is lower than for 4A.

Read on to learn more about stage 4 vulvar cancer, including the symptoms, survival rates, and treatments.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Stage 4 vulvar cancer is cancer that started in the vulva but has spread to other areas. Stage 4 is the most advanced stage of cancer.

Two substages of stage 4 vulvar cancer exist. In stage 4A, the cancer has spread to nearby structures such as the urethra or the perineum, which is the area between the vulva and the anus. In stage 4B, the cancer has spread to distant structures in the body, such as the lungs.

The most common type of cancer that may affect the vulva is squamous cell carcinoma, a type of skin cancer. Other types of skin cancer, including melanoma, can also occur in the vulva.

It is possible to survive stage 4 vulvar cancer. Some people may go into remission after treatment, meaning they have no perceptible signs of cancer. This does not guarantee that the cancer will not return, but it can extend a person’s life.

For other people, treatment may not work or may lead to remission for only a short period.

There is no standard or average life expectancy for someone with stage 4 vulvar cancer. Instead, doctors measure cancer survival based on a 5-year relative survival rate. This rate represents the likelihood that a person with a cancer diagnosis will still be alive after 5 years, as compared with the general population.

According to data from the Surveillance, Epidemiology, and End Results (SEER) Program, vulvar cancer with regional spread had a 5-year relative survival rate of 53% in 2008–2014. This includes stage 4A.

For vulvar cancer with distant spread, the 5-year relative survival rate for the same time period was 19%. This includes stage 4B.

However, these data come from several years ago and may not reflect recent improvements in diagnosis and treatment.

Also, these statistics do not account for some of the factors that influence the prognosis, such as:

  • age
  • overall health
  • responsiveness to treatment

Whether vulvar cancer has spread to any lymph nodes is one of the most important factors for determining the outlook. This is because once cancer spreads to lymph nodes, it can enter the lymphatic system and travel farther, to different areas of the body.

Survival rates are higher when vulvar cancer has not reached the lymph nodes. The type of cancer a person has also affects the outlook. For example:

  • Melanoma: This type of cancer has a lower overall survival rate than other types of vulvar cancer, especially in the advanced stages.
  • Sarcoma: This type of cancer rarely affects the vulva, but it is possible. It tends to grow slowly and rarely affects lymph nodes, but a subtype known as epithelioid sarcoma has the lowest survival rate of all vulvar cancers.
  • Basal cell carcinoma: This type has a high risk of recurrence. However, it is rare, and despite the risk of recurrence, the prognosis is often good.
  • Human papillomavirus (HPV)-related cancer: HPV is a sexually transmitted infection that raises the risk of certain cancers. HPV-related vulvar cancer can respond well to treatment.

The symptoms of advanced vulvar cancer can include:

  • sores on the vulva that do not go away or that come back
  • unusual growths of any color on the vulva
  • a rash or warts on the vulva
  • changes in the skin of the vulva
  • pain, bleeding, or itching in the vulva that does not go away on its own or keeps coming back

People can also develop these symptoms inside the vagina in cases of vaginal cancer.

The symptoms of vulvar cancer can be similar to those of other diseases. It is important to consult a doctor for a diagnosis.

Diagnosis of vulvar cancer begins with a medical examination to look at growths that might be cancerous. In some cases, a doctor can rule out cancer based on an exam alone or by diagnosing another condition, such as an injury or a yeast infection.

If the doctor suspects cancer, they will recommend a biopsy. This involves taking a small sample of tissue to send to a laboratory for testing.

If cancer is present, a doctor may recommend additional tests to determine how far it has spread, if at all. This may include surgery to remove the cancer or to check the lymph nodes for signs of cancer.

Treatment for stage 4 vulvar cancer depends on how far the cancer has spread, as well as a person’s overall health and their wishes.

It is not usually possible to remove all cancer at stage 4, but a doctor may still recommend surgery to remove as much cancer as possible.

After surgery, or if surgery is not possible, a doctor may recommend a combination of:

  • targeted therapies
  • chemotherapy
  • radiation
  • medication to manage side effects such as nausea

Learn more about vulvar cancer treatments.

Cancer can be physically, emotionally, and financially difficult, both during and after treatment.

Surviving vulvar cancer can feel exciting but also scary. Additionally, a person may experience complications from treatment or need to adjust to changes in their body.

People can get support from:

Online support groups may be an option for people who cannot attend in person.

Stage 4 vulvar cancer is cancer that began in the vulva and then spread elsewhere. It may affect nearby areas, such as the urethra, or may have spread farther.

The likelihood of long-term survival for people with this diagnosis is lower than for early stage vulvar cancer, but there is no surefire way to predict the outcome. With treatment, people may survive for several years or longer.

The prognosis is better with early detection, so people who have any symptoms that could indicate vulvar cancer should contact a doctor.