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Vulvar cancer

Summary

The external female genitals are called the vulva. Vulval cancer is a type of cancer that affects the vulval region. It accounts for about three per cent of all gynaecological cancers.

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Vulval cancer is a type of cancer that affects the vulval region. It accounts for about three per cent of all gynaecological cancers and is most commonly diagnosed in older women aged around 70 years or over. However, an increasing number of women aged 35 to 45 are being diagnosed with this form of cancer.

The most common site for vulval cancer is the labia majora, while just one in 10 cases originates in the clitoris. The vulva has lots of blood and lymphatic vessels, which means that vulval cancer cells can easily spread to nearby body parts such as the bladder, vagina and anus. Without treatment, it can cause severe infection and pain.

Vulva is a general term that describes the external female genitals. The vulva is made of three main parts: the labia majora (outer lips), the labia minora (smaller inner lips) and the clitoris.

Symptoms of vulval cancer


In its early stages, vulval cancer often has no symptoms. This is because the cancer is so tiny. The progression of symptoms can include:
  • An unusual lump or bump can be felt somewhere on the vulva.
  • The lump becomes itchy and painful.
  • The lump progresses to an ulcerated sore that refuses to heal.
  • The raw-looking sore can be white, red or pink. The sore gets bigger with time.
  • There could be unusual bleeding or discharge from the vagina.
  • The lymph glands in the groin may swell.
  • Problems with bowel motions and passing urine may indicate the cancer has spread into the bowel or bladder.
  • Secondary cancers may cause a range of symptoms, such as aching bones.

Risk factors for vulval cancer


Some of the risk factors for vulval cancer include:
  • Age – vulval cancer usually occurs in postmenopausal women, but there appears to be an increasing number of young women being diagnosed
  • Sexually transmitted infections
  • Multiple sex partners
  • Never having children (nulliparity)
  • Chronic vulval itching (pruritis)
  • Genital warts (human papilloma virus infection)
  • Vulval intraepithelial neoplasia (a pre-cancerous condition)
  • Prior incidence of squamous cell cancer of the cervix
  • Prior incidence of squamous cell cancer of the vagina
  • Smoking
  • Lichen sclerosus (a rare skin condition that usually occurs around the vulva and anus).

VIN and vulval cancer


Vulval intraepithelial neoplasia (VIN) is a pre-cancerous condition of the vulva. It is uncommon, but appears to have a high risk of becoming cancerous if untreated. Of those women who are treated, 5 to 10 per cent may still develop vulval cancer. If cancer cells reach the pelvic lymph nodes, secondary cancers can spread to almost anywhere in the body.

Types of vulval cancer


Vulval cancer is classified according to its cell of origin. This can include:
  • Squamous cell carcinoma – originating in the skin cells. This type accounts for about 90 per cent of cases
  • Melanoma – originating in the pigment cells deeper in the skin. This type accounts for about five per cent of cases (in the vulva it is not related to sun exposure)
  • Adenocarcinoma – originating from the Bartholin’s glands, the structures that supply lubricant to the genitals. This type accounts for less than one per cent of cases
  • Sarcoma – originating from fat cells. This type is quite rare
  • Lymphoma – originating from the immune cells. This type is quite rare
  • Basal carcinoma – a form of skin cancer. This type is quite rare.

Diagnosis of vulval cancer


Some of the methods for diagnosing vulval cancer include:
  • Taking a medical history
  • A physical examination
  • Examination of the vulva with a colposcope, which makes it easier to see the lesions of certain diseases (including VIN and vulval cancer)
  • Taking a biopsy of the sore or lump using a scalpel (with local anaesthesia), or performing a punch biopsy (this instrument extracts a little core sample)
  • Excising (removing) some tissue under general anaesthetic.

Treatment for vulval cancer


Treatment for vulval cancer can include:
  • Vulvectomy – the first line of treatment is to surgically remove the tumour. Depending on factors including the location, type, stage and severity of the cancer, surgery may include radical vulvectomy (removal of the vulva), with or without removal of the groin lymph nodes from one or both sides. The clitoris may or may not need to be removed
  • Radiation therapy – the use of precisely targeted x-rays to kill cancer cells. This may be used as the primary treatment to avoid removal of the clitoris
  • Chemotherapy – the use of cancer-killing drugs, often in combination. Chemotherapy can be helpful in controlling secondary cancers because it treats the whole body. It may also be used with radiation to increase the effectiveness of radiotherapy.

When a cure for vulvar cancer isn't possible


If vulvar cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms. This is called palliative treatment.

Reducing the risk of vulval cancer


It is possible to reduce your risk by avoiding known risk factors. The most significant risk reduction strategy is to protect yourself from sexually transmissible infections (STIs). This is because women with previous dysplasia or cervical intraepithelial neoplasia (CIN) of the cervix, genital warts and herpes are at increased risk of developing VIN, which is the precursor of (comes before) vulval cancer.

Other risk reduction strategies include:
  • Don’t smoke
  • Don’t dismiss chronic vulval itching as a persistent thrush infection
  • Don’t treat a vaginal itch with over-the-counter preparations – see your doctor for tests
  • Have regular gynaecological check-ups
  • If you think you may be at increased risk of vulval cancer, ask your doctor to show you how to perform a self-examination.

Where to get help

  • Your doctor
  • A women’s health clinic
  • Family Planning Victoria Tel. (03) 9257 0100 or 1800 013 952
  • Cancer Council Victoria Tel. 13 11 20

Things to remember

  • Vulval cancer is a type of cancer that affects the vulval region.
  • It is most commonly diagnosed in older women aged around 70 years or over.
  • Symptoms include an ulcerous sore that refuses to heal and unusual bleeding or discharge from the vagina.

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This page has been produced in consultation with and approved by:

Royal Women's Hospital

(Logo links to further information)


Royal Women's Hospital

Fact sheet currently being reviewed.
Last reviewed: October 2011

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The external female genitals are called the vulva. Vulval cancer is a type of cancer that affects the vulval region. It accounts for about three per cent of all gynaecological cancers.



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