Carcinoma of the Vulva

Vulvar cancer is a rare gynecologic malignancy with a higher incidence in postmenopausal women. Squamous cell carcinoma is the most common histologic subtype (>90% of cases). The majority of affected patients are symptomatic and present with vulvar pruritus, bloody discharge, pain, and/or a palpable mass. The disease is staged by using the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was most recently revised in 2021. The characteristic pattern of local vulvar cancer spread involves infiltrative tumor extension to the urethra, anorectum, vagina, and urinary bladder (less commonly). Lymphatic spread is the primary route of metastasis and a critical prognostic factor. The authors review the vulvar anatomy, as well as the pathogenesis, routes of spread, and key imaging findings of vulvar malignancy. In addition, the roles of multiple imaging modalities including lymphoscintigraphy, MRI, fluorine 18-fluorodeoxyglucose PET/CT, and PET/MRI in diagnosing vulvar cancer and acquiring the information needed for accurate staging, treatment planning, determining the prognosis, and assessing treatment response are outlined. ^©RSNA, 2026 Supplemental material is available for this article.