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).
There are several different types of vulvar cancer:
- Squamous cell carcinoma (SCC) is the most common type, accounting for about 90% of all vulvar cancers in Australia. It begins in the thin, flat (squamous) cells covering the vulvar.
- Vuvlar (mucosal) melanoma makes up between 2% and 4% of vulvar cancers. It begins in the cells that give skin its colour (melanocytes) which are also found in the lining of the vulva. They are not related to overexposure to UV radiation from the sun.
- Sarcoma is a rare type of vulvar cancer that begins in cells in muscle fat and other tissue under the skin.
- Adenocarcinoma is another rare form of vulvar cancer the develops from the glandular (mucus-producing) cells in the vulvar glands.
- Basel cell carcinoma (BCC) is a very rare type and stars in the tall (basal) cells in the skin’s lower layer.
Vulvar cancer is not common. It most commonly affects women who have gone through menopause, however vulvar cancer can also occur in younger women.
It is estimated that 447 women in Australia will be diagnosed with vulvar cancer in 2020.
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 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.
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.
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.
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 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.
After a diagnosis of vulvar cancer
After a diagnosis of vulvar cancer you may feel disbelief, sadness, shock and anxiety. It may help to talk to family and friends about how you feel.
The days and weeks after a diagnosis of vulvar cancer can be very stressful and you may feel like things are moving either too fast or too slowly. Ask your specialist to explain the treatment options available to you, timelines and potential side effects. You may wish to have a family member or friend go with you to your appointment. Take as much time as you can so you can make well-informed decisions.
Treatment for vulvar cancer
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 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. You may have radiation therapy before, after or instead of surgery.
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.
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 radiation therapy, chemotherapy or other drug therapies.
Treatment TeamDepending 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 specialists to 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 national screening program for vulvar cancer available in Australia.
Preventing vulvar cancer
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.
Understanding Vulvar and Vaginal Cancers, Cancer Council Australia © 2020. Last medical review of this booklet: October 2020.
Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: Vulval cancer. Canberra: AIHW.
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