What is vulval cancer?
The vulva is the part of a woman’s genitalia which is on the outside (external).
Cancer of the vulva (vulval cancer) is not a common type of cancer. It is very rare. It can occur on any part of your vulva. It most commonly develops on the inner edges of your labia majora and your labia minora. It can also sometimes affect your clitoris or Bartholin’s glands (small glands on each side of the vagina). It can also occasionally start on the skin between your vulva and your anus (your perineum).
It usually affects women over the age of 60, but is most common in those who are 90 or over. The numbers of younger women with vulval cancer have increased, but are still small.
Most vulval cancers are squamous cell carcinoma cancers. This means they have developed from the skin cells in the outer layer of your vulva. Around 4 in 100 cases of vulval cancers are due to a melanoma which develops from cells in your skin that cause pigmentation.
What does vulval cancer look like?
In some cases there may not be any visible changes in the skin but it itches. Some other changes you might notice include thickened or raised, red,
white or dark patches on the skin of the vulva. Or you might have an open sore or warty growth that does not go away, or a lump or swelling. You might notice burning pain when you pass urine, or have vaginal discharge or bleeding. If the cancer is a melanoma type, you might notice that a mole on the vulva that has changed shape or colour.
What causes vulval cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’. In many cases, the reason why a vulval cancer develops is not known. However, there are factors which are known to alter the risk of vulval cancer developing.
These include:
- Increasing age. Most cases develop in people over the age of 60, with the highest risk in women over the age of 90.
- A condition called vulval intraepithelial neoplasia (VIN) can occur in the skin of the vulva. The most common symptom of VIN is a persistent itch. Areas of skin affected by VIN can look thickened and swollen, with red, white or dark coloured patches. Around one third of vulval cancers develop in women who have VIN. Read more in the
separate leaflet called Vulval Intraepithelial Neoplasia. - Human papillomavirus (HPV) is an infection which is passed between people during sex. Some types of HPV, including types 16 and 18, can lead to VIN developing. HPV vaccination will reduce that risk. However, more than half of all vulval cancers are not related to HPV infection.Lichen sclerosus is a skin condition that causes long-term inflammation of the skin in your vaginal area. Having lichen sclerosus can increase your risk of developing vulval cancer; however, the vast majority of women with lichen sclerosus do not develop vulval
cancer in the future.
Smoking. Smoking increases the risk of developing both VIN and vulval cancer.
Note: vulval cancer is not an inherited condition and does not usually run in families.
Vulval cancer symptoms
The symptoms of cancer of the vulva (vulval cancer) can vary between women. Some women may not have any symptoms but most do. They may include:
- A persistent itch.
- Pain or soreness in the vulval area.
- Changes on the skin of the vulva.
- An open sore or ulcer that does not improve.
- Burning pain when you pass urine.
- Vaginal discharge or bleeding after the menopause.
- A lump or swelling in the vulva.
- A mole on the vulva that changes shape or colour.
Note: all these symptoms can be caused by other conditions which are not cancer. If you have any of these symptoms then you should see your doctor.
Vulval cancer can take many years to develop, as it usually grows slowly. As with other cancers, it is easier to treat and cure if it is diagnosed at an early stage.
How is vulval cancer diagnosed and assessed?
Anyone who has an abnormal growth or sore on their vulva will have a thorough examination by their doctor. This may include feeling for any enlarged lymph glands (nodes) in the groin. You will then be referred to see a specialist (a gynaecologist) in the hospital.
It is likely that further tests in the hospital will be arranged. These may include:
A biopsy where a small sample of tissue is removed from the affected area of your vulva. The tissue is then looked at under a microscope and can help to show if you have VIN or cancer of the vulva (vulval cancer). If you do have vulval cancer, the biopsy will show which type of vulval cancer you have. Results of a biopsy usually take around two weeks.
One or more of: a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan of the tummy (abdomen) and chest, a chest X-ray, blood tests, and sometimes other tests.
This assessment is called ‘staging’ of the cancer. The aim of staging is to find out:
Whether the cancer has spread to local lymph glands.
Whether the cancer has spread to other parts of the body (metastasised).
Finding out the stage of your cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).
Vulval cancer treatment
Treatment options which may be considered include surgery, radiotherapy and chemotherapy. The way vulval cancer is treated depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), the exact subtype or ‘grade’ of the cancer, and your general health.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible
side-effects, and other details about the various possible treatment options for your type of cancer.
Surgery
Surgery to remove the cancerous cells is the main treatment for vulval cancer. The operation performed depends on the size and position of the cancer.
If the cancer is small then the cancer and a small amount of surrounding normal tissue can be removed. For larger cancers, an operation for removal of the vulva (called a vulvectomy) may be performed. This may be a partial vulvectomy in which only part of the vulva is removed.
Alternatively, this may be a radical vulvectomy in which the entire vulva including the inner and outer labia and the clitoris are removed, usually with the surrounding lymph glands (nodes). If a large amount of skin is removed in the operation then you may need to have a skin graft or skin flaps. Your surgeon will be able to talk to you about this in more detail. Generally surgeons will try to perform surgery that will give the best possible result for the least scarring procedure.
In most cases the lymph glands in your groin are usually also removed.
Radiotherapy
Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. Radiotherapy may be advised in addition to surgery. Radiotherapy aims to kill any cancerous cells which may have been left behind following an operation.
Radiotherapy is sometimes given before an operation, to shrink the cancer so a smaller operation can then be performed. Alternatively it may be given after an operation. See the separate leaflet called Radiotherapy for more details.
Chemotherapy
Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying.
Chemotherapy may be used in three different ways: before an operation, to shrink a large tumour, to give a better chance of the operation being successful; after the operation to give a better chance of cure; if a cancer returns (recurs).
There are many different types of chemotherapy. Which type depends on many factors, including your age, general health and your particular stage of cancer. Your specialist can discuss this with you, if you wish.
What is the prognosis?
The outlook (prognosis) is best in those who are diagnosed when the cancer of the vulva (vulval cancer) is at an early stage. Surgical removal of a small vulval cancer gives a good chance of cure. The outlook is particularly good if the cancer has not spread to the glands in your groin or elsewhere (your lymph nodes).
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer are likely to respond to treatment.