What is Vulval Cancer?
The vulva is descriptive of the external genitalia of the labia majora and minora, clitoris and the Bartholin’s glands (two small glands each side of the vagina). Cancer can be defined as a malignant growth or tumour that has resulted from uncontrolled division of cells.
Cancer of the vulva is rare, with around 1,300 new cases diagnosed each year in the UK. It usually affects older women, and rarely occurs in women younger than 50.
The exact cause of vulval cancer is not known, however there are certain factors that can increase your risk:
- Increasing age, most cases of vulval cancer occur in women over 65 years of age.
- Vulval intraepithelial neoplasia (VIN) a condition which describes ‘pre-cancerous cells’ that have the potential to become cancerous over time. Symptoms of VIN are similar to those of vulval cancer (itching and skin changes). It is important to see your GP if you have either of these symptoms.
- Human Papilloma Virus (HPV) is the name of a group of viruses that spread through sexual contact. Most people have HPV at some point of their lives and in most cases the virus goes away without long term impact. HPV is thought to be linked to vulval cancer as it is present in at least 40% of women who present with vulval cancer.
- Some skin conditions that affect the vulva e.g. lichen sclerosus and lichen planus.
- Smoking increases the risk of developing vulval cancer and VIN.
Risk reduction can include:
- Stopping smoking
- HPV vaccination (this is now offered to all school children who are 12 to 13 as part of the routine childhood immunisation programme.
- Keeping up to date with cervical screening appointments will reduce the risk of vulval cancer as it can detect potential HPV infections and VIN.
- Using barrier methods such as condoms during sex can offer some protection against
What are the symptoms of Vulval Cancer?
- Persistent itch around the vulva
- Skin changes around the vulva
- Lump or swelling of the vulva
- Tenderness and pain in the vulva
- Blood stained discharge in-between periods
- Pain on passing urine
- A mole on the vulva that changes in shape or colour
- An open sore on the vulva
While there may be many non-cancerous causes for these symptoms it is important if you have any concerns that you could have vulval cancer that you see your GP for a full investigation as early diagnosis improves the chances of successful treatment.
Your GP will ask about the symptoms you have been experiencing and may ask to do an examination of the vulva and potentially the vagina.
Your GP may refer you to a specialist (gynaecologist) for further examinations and tests such as a biopsy for diagnosis. A biopsy is a small sample of tissue removed from the lesion in question. This sample can then be analysed under a microscope to visualise the cells and determine if they are cancerous.
Biopsies are often taken under local anaesthetic to ensure there is no pain. After the sample has been taken, you may have a few stitches in the area from where the sample is taken. The wound should heal over a few days.
If the results from your biopsy identify cancer, your doctor may suggest further tests to assess the extent of your cancer and to assess if it has spread to any other organs.
- A chest X-ray
- A colposcopy may be required to check for abnormal cells in the vagina
- A cystoscopy involves visualising the inside of the bladder
- A proctoscopy involves the examination of the rectum
- Further biopsies may be taken of lymph nosed that are in close relation to your vulva to see if there has been cancerous spread through the lymphatic system,
- CT and MRI scans can be used to assess for any cancer spread to lymph nodes or other organs.
The results of these further tests will allow for staging of your cancer. The staging system will be explained by your doctor, it indicates how far the cancer has spread.
What treatments are available?
Treatment of any form of cancer is complex and requires multidisciplinary input from a range of medical professionals. Treatment plans are personalised for each patient and take into account the stage of cancer, location and the general health and wishes of the patient.
All results will be discussed fully with a multidisciplinary team (MDT) of oncologists, surgeons, radiologists and specialist cancer nurses to create the most appropriate treatment plan for your cancer.
Your doctor or nurse will explain the treatment suggestions going forwards, it is important that you ask all the questions you have and explain if you need more information to make an informed decision regarding your treatment going forwards.
The main treatment for vulval cancer is surgical with the aim to remove the cancer from the vulva and any surrounding lymph nodes or tissue that contains cancer cells. The recovery from surgery will depend on how extensive the surgery is that is required.
All surgical procedures, follow up and risks will be discussed well before the operation with your surgeon. You will have the opportunity to ask all questions in regards to reconstruction, longer-term impacts of vulval surgery and whether any other treatment will be required.
Depending on the patient, some women will have radiotherapy or chemotherapy to destroy any remaining cancer cells, this may be in addition to surgery. Many women with vulval cancer will be treated with a combination of both radiotherapy and chemotherapy.
Living with cancer can have a huge impact on your emotions and mental wellbeing. Often the time from diagnosis to treatment if fast and there is a lot of information to process.
If you have received a diagnosis of cancer and feel that extra support would help in any way it may be useful to contact your GP or one of the helplines listed below.
This page was produced by Wellbeing of Women Contributor Dr Alice Bolton with information from the NHS website