Vulval Cancer

Cancer of the vulva (also called vulval cancer or vulvar cancer) is one of the rarer cancers with just over 1,000 cases diagnosed in the UK each year.

What is vulval cancer?

The vulva is a woman’s external genitals. It includes the lips surrounding the vagina (labia minora and labia majora), the clitoris (sexual organ that helps women reach sexual climax), and the Bartholin’s glands (two small glands each side of the vagina).

Around 80% of vulval cancers are diagnosed in women over 60, but the non-invasive precancerous condition vulval intraepithelial neoplasia (VIN) which is the stage before a cancer has developed, tends to be diagnosed earlier i.e. 30s – 50s.

How does it develop?

Some vulval cancers develop from a condition called vulval intraepithelial neoplasia (VIN).

This does not mean you have vulval cancer – it is the stage before a cancer has developed. Some of these cell changes will go away without the need for any treatment; however, finding these abnormal cells early can help to prevent vulval cancer.

Key signs and symptoms

Signs and symptoms of cancer of the vulva can include:

  • a lasting itch
  • pain or soreness
  • thickened, raised, red, white or dark patches on the skin of the vulva
  • an open sore or growth visible on the skin
  • a mole on the vulva that changes shape or colour
  • a lump or swelling in the vulva

All these symptoms can be caused by other more common conditions, such as infection, but if you have any of these symptoms, you should see your GP.  It is unlikely that your symptoms are caused by a serious problem but it is important to be checked out.

Risk Factors

The exact reason why this happens in cases of vulval cancer is unknown, but certain things can increase your chances of developing the condition. These include:

Increasing age
The risk of developing vulval cancer increases as you get older. Most cases develop in women aged 65 or over, although very occasionally women under 50 can be affected.

Vulval intraepithelial neoplasia (VIN)
Vulval intraepithelial neoplasia (VIN) is a pre-cancerous condition. This means there are changes to certain cells in the vulva that aren’t cancerous, but could potentially turn into cancer at a later date. This is a gradual process that usually takes well over 10 years.

Symptoms of VIN are similar to those of vulval cancer, and include persistent itchiness of the vulva and raised discoloured patches. See your GP if you have these symptoms.

There are two types of VIN:

  • Usual or undifferentiated VIN – this usually affects women under 50 and is thought to be caused by an HPV infection
  • Differentiated VIN (dVIN) – this is a rarer type, usually affecting women over 60, associated with skin conditions that affect the vulva

Human papilloma virus (HPV)
HPV is a group of viruses, rather than a single virus, of which there are more than 100 different types. It is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas).

There are many different types of HPV, and most people are infected with the virus at some time during their lives. In most cases, the virus goes away without causing any harm and doesn’t lead to further problems.

However, HPV is present in at least 40% of women with vulval cancer, which suggests it may increase your risk of developing the condition. HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer. It’s thought the virus could have a similar effect on the cells of the vulva, which is known as VIN.

Skin conditions
Several skin conditions can affect the vulva. In a small number of cases these are associated with an increased risk of vulval cancer.

Two of the main conditions associated with vulval cancer are lichen sclerosus. These conditions cause the vulva to become itchy, sore and discoloured.

Smoking
Smoking increases your risk of developing VIN and vulval cancer. This may be because smoking makes the immune system less effective, and less able to clear the HPV virus from your body and more vulnerable to the effects of the virus.

How is it diagnosed?

Your GP will ask you about your symptoms, look at your medical history, and examine your vulva to look for any lumps or unusual areas of skin.

Referral to a gynaecologist
If your GP feels some further tests are necessary, they will refer you to a gynaecologist.

The National Institute for Health and Care Excellence (NICE) recommends that GPs consider referring a woman who has an unexplained vulval lump or ulcer, or unexplained bleeding.

The gynaecologist will ask about your symptoms and examine your vulva again, and they may recommend a test called a biopsy to determine whether you do have cancer.

Biopsy
A biopsy is where a small sample of tissue is removed so it can be examined under a microscope to see if the cells are cancerous.

Your doctor will usually see you 7 to 10 days later to discuss the results with you.

Treatment

Treatment for vulval cancer depends on factors such as how far the cancer has spread, your general health, and personal wishes.

The main options available to those who have been diagnosed with vulval cancer are: surgery, radiotherapy and chemotherapy.

Surgery to remove vulval cancer
In most cases, your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer.

There are three surgical options to treat vulval cancer:

  • Radical wide local excision – the cancerous tissue from your vulva is removed, as a well as a margin of healthy tissue, usually at least 1cm wide, as a precaution
  • Radical partial vulvectomy – a larger section of your vulva is removed, such as one or both of the labia and the clitoris
  • Radical vulvectomy – the whole vulva is removed, including the inner and outer labia, and possibly the clitoris and removal of the important lymph nodes