Patients with advanced vulvar cancer do not all show signs of internal ulceration. This is because, for most patients with vulvar cancer, the progression of the disease can lead to invasion of the surrounding tissues or distant metastasis. Some patients may experience heavy local infiltration, leading to tissue ulceration. However, most patients in the advanced stages primarily show symptoms related to lymphatic and hematogenous metastasis. When patients with advanced vulvar cancer develop lymph node metastasis and distant metastasis, they may experience symptoms of metastatic lesions, such as inguinal lymph node metastasis causing limb swelling and pain. If there are distant metastases to the lungs, liver, or other areas, patients may exhibit respiratory symptoms such as coughing and expectoration, or liver-related symptoms such as pain in the liver area or decreased appetite.