What is cancer of the vulva?
The vulva describes the external genitals. It includes the soft tissue (lips) surrounding the vagina (labia minora and labia majora), the clitoris, and the Bartholin’s glands, two small glands each side of the vagina that secrete fluid to enhance lubrication.
Around 80% of vulval cancers are diagnosed in women over 60; however anyone with a vulva can be diagnosed with vulval cancer, and we are increasingly seeing more and more women being diagnosed at a younger age.
How does it develop?
Skin conditions that cause inflammation may develop into an early vulval cancer. The two most common of these being vulval intraepithelial neoplasia (VIN) and Lichen Sclerosus.
There are a number of rare sub-types of vulval cancer, including mucosal melanoma, which can predict how the cancer might behave. You may find that you are cared for by gynaecologists and melanoma specialists to give you the best all-round support.
VIN does not mean you have cancer of the vulva – it is the stage before a potential cancer may develop. 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.
Vulval cancer symptoms
- A lasting vulval itch
- Pain or soreness
- Thickened, raised, red, lighter or darker 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 on the vulva
All these symptoms can be caused by other more common conditions, such as infection, but if you have any of these, 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… remember non- cancerous conditions can be uncomfortable and so much better when treated!
Vulval intraepithelial neoplasia (VIN)
VIN is potentially a pre-cancerous condition. This means there are changes to certain cells in the vulva that aren’t cancerous, but could become a cancer at a later date. This is a gradual process that usually takes well over 10 years.
Symptoms of vulva cancer are similar to those of VIN, and can 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 typically 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, and is more likely to be associated with cancer.
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 skin to skin sexual contact ).
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 is cleared by the body 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.
Several skin conditions can affect the vulva. In a small number of cases these are associated with an increased risk of vulval cancer.
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.
How is it diagnosed?
Your doctor will examine your skin to determine whether to refer you to a gynaecologist or a dermatologist (skin specialist).
Referral 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.
A biopsy is where a small sample of tissue is removed so it can be examined under a microscope to determine what the skin cell changes are due to.
Your doctor will usually see you 7 to 10 days later to discuss the results with you.
Treatment for vulval cancer depends on factors such as how far the cancer has spread from the area it started. Vulval cancer can be treated by surgery, radiotherapy and chemotherapy or a combination of all three.
Surgery to remove vulval cancer
In most cases, the treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer. The principle of surgery being to remove all diseased skin with a margin of healthy skin all around it and also to check for potential spread.
There are three surgical options to treat cancer of the vulva:
- Radical wide local excision – the cancerous tissue from the vulva is removed, as a well as a margin of healthy tissue, at least 1cm wide, to prevent spread to healthy tissue.
- Radical partial vulvectomy – a larger section of the vulva is removed, this may include 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 some lymph nodes
- In some centres they will use sentinel node surgery, where a safe radio – active dye is injected into the affected area. During surgery this dye will highlight any potential spread into lymph nodes that will guide the surgeon to selectively remove to be tested, increasing accuracy of diagnosis and reducing the long term side effect of lymph node surgery, lymphoedema.