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What is vulvar cancer?

Vulvar cancer (also known as vulval cancer, cancer of the vulva or vulva cancer) is a cancer that occurs in any part of the external female genitals.

Vulvar cancer most commonly develops in the labia minora (inner lips), the labia majora (outer lips), and the perineum (skin between the vagina and the anus).

About 380 Australian women are diagnosed with vulvar cancer each year. It most commonly affects women who have gone through menopause, however vulvar cancer can also occur in younger women.



Vulvar cancer symptoms

Symptoms of vulvar cancer may include:

  • itching, burning and soreness or pain in the vulva

  • a lump, sore, swelling or wart-like growth on the vulva

  • thickened, raised skin patches in the vulva (may be red, white or dark brown)

  • a mole on the vulva that changes shape or colour

  • blood, pus or other discharge coming from a lesion or sore spot in the vulva

  • hard or swollen lymph nodes in the groin area

The vulva is difficult to self-examine so if you feel any pain in your genital area or notice any of the symptoms listed above, visit your general practitioner (GP).



Causes of vulvar cancer

Some factors that may increase your risk of vulvar cancer can include:

  • a precancerous condition called vaginal intraepithelial neoplasia (VAIN) that often has no symptoms

  • human papillomavirus (HPV)

  • detection of abnormal cell changes on your cervical screening test 

  • skin conditions such as vulvar lichen sclerosus and vulvar lichen planus

  • having had cervical cancer or vaginal cancer

  • smoking

  • having had an organ transplant or are infected with the human immunodeficiency virus (HIV)



Diagnosis of vulvar cancer

The main tests used to diagnose vulvar cancer are a physical examination, a colposcopy, and a tissue biopsy. These tests are usually performed at the same time. Because vulvar cancer is sometimes associated with cervical cancer, the doctor may also check for abnormal cells in your vagina and cervix.

Physical examination

It is standard practice for your doctor to examine your groin and pelvic area, including the genitals. A nurse may be present during the examination, and you can ask for a family member to be in the room.

The doctor may also do an internal examination at the same time to check your vagina and cervix. This procedure involves your doctor inserting an instrument known as a speculum into your vagina to allow the doctor to examine your vagina and cervix.

Colposcopy

Your doctor may use a magnifying instrument called a colposcope to examine your vulva and vagina in detail. The colposcope does not go into your vagina; your doctor looks through it from the outside. The doctor applies a liquid to your vulva and vagina, which makes it easier to see abnormal cells through the colposcope. This may sting or burn, and you may have a brown discharge afterwards.

Biopsy

Your doctor will usually take a small tissue sample called a biopsy from your vulva during the colposcopy. This is the best way to diagnose vulvar cancer.

The tissue samples will be sent to a laboratory, and a pathologist will examine the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of vulvar cancer it is.

Cervical screening test

Your doctor may do a cervical screening test. This has replaced the Pap test and detects cancer-causing types of HPV in a sample of cells from the cervix or vagina.

Further tests

Further tests may be needed to determine the size and position of the cancer, and if the cancer has spread. These tests may include a blood test, chest x-ray, cystoscopy, proctoscopy and a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan.



Treatment for vulvar cancer

Staging

Based on the test results, your doctor will be able to tell you the stage of the cancer. This is a way to describe its size and if and how far it has spread.

Your doctor may also tell you the grade of the cancer cells. This tells you how quickly the cancer may develop.

Knowing the stage and grade of the cancer helps your doctor recommend the most appropriate treatment.

Treatment for vulvar cancer may involve surgery, radiotherapy and chemotherapy. You may have one of these treatments or a combination.

Surgery

Surgery is the main treatment for vulvar cancer. The type of operation will depend on the stage of the cancer. Your surgeon will try to remove all of the cancer along with some of the surrounding healthy tissue (called a margin). This helps reduce the risk of the cancer coming back. Some lymph nodes in your pelvis may also be removed.

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy) uses radiation, such as x-rays, to kill or damage cancer cells. Whether you have radiation therapy will depend on the stage of the cancer, its size, if it has spread to the lymph nodes and how many nodes are affected.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. For women with vulvar cancer, treatment may be given:

  • during radiation therapy, to make the radiation treatment more effective
  • to control cancer that has spread to other parts of the body
  • as palliative treatment, to relieve the symptoms of the cancer.

Chemotherapy may be given as tablets, in a cream applied to the vulva or, more commonly, by injection into a vein.

Palliative care

In some cases of vulvar cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of vulvar cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialiststo coordinate treatment.
  • Gynaecological oncologist- diagnoses and treats cancers of the female reproductive system
  • Gynaecologist- specialises in treating diseases of the female reproductive system.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Reconstructive (plastic) surgeon- performs any complex reconstructive surgery that restores or repairs the body's appearance and function.
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.


Screening for vulvar cancer

There is currently no screening for vulvar cancer available in Australia.



Preventing Vulvar cancer

There are no known lifestyle measures to prevent vulvar cancer, however not smoking may reduce your risk. Immunisation against HPV will also reduce your risk.



Prognosis of Vulvar cancer

Prognosis means the expected outcome of a disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.

You may wish to discuss your prognosis with your doctor. However, it is not possible for any doctor to predict the exact course of your disease. In most cases, the earlier that vulvar cancer is diagnosed, the better the chances of successful treatment.

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