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What is vulval cancer?

Vulval (or vulvar) cancer happens when tumour cells start developing in the vulva. The vulva is a woman's external genitals. It includes the lips surrounding the vagina (labia minora and labia majora), the clitoris, the vaginal orifice and the urinary meatus. Vulval cancer can spread to the vagina, the ovaries, the uterus and the Fallopian tubes.

Vulval cancer is relatively rare, with around 1,300 cases diagnosed in the UK each year. It is more common in older women over the age of 65.

There are several kinds of vulval cancer:

• Squamous cell carcinoma: this type of cancer represents 90% of the cases of vulval cancer
• Verrucous carcinoma: it is more common in younger women
• Adenocarcinoma
• Melanoma
• Sarcoma
• Basal cell carcinoma
•  

What are the symptoms of vulval cancer?

The most common symptoms are:

• A persistent itch in the vulva, which may be followed by a burning sensation
• A lump, nodule or wart-like growth on the vulva which you can feel by touching it
• In the most advanced stages, foul-smelling vaginal discharge; blood-stained vaginal discharge between periods and abdominal pain

If you have started a targeted therapy to treat these symptoms and they haven’t gone away, you will need to see a gynaecologist.

How is it diagnosed?

To diagnose vulval cancer, the gynaecologist will examine your vulva. In case there’s any anomalies, the doctor will have you do some specific tests. These may include:

• Colposcopy and vulvoscopy: while a colposcopy analyses the epidermis of the vulva and the cervix, a vulvoscopy analyses the external genitalia.
• Fine-needle aspiration or biopsy: a tissue sample is taken and analysed under a microscope to determine whether or not there are tumour cells.
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• PET scan
• Cystoscopy or bladder endoscopy
• Proctoscopy or endoscopy of the rectum and anal canal

What causes it?

The exact cause of vulval cancer is unknown, but certain things can increase your chances of developing the condition:

• Human papilloma virus (HPV) infection
• Being infected with HIV
• Vulval intraepithelial neoplasia (VIN)
• Syphilis
• Lichen sclerosus
• Diabetes
• High blood pressure
• Obesity
• Increasing age
• Smoking
• A previous history of cervical or vaginal cancer

How can it be prevented?

You can prevent HPV infection (which can lead to vulval cancer) by getting a vaccine.

You should also avoid secondary risk factors such as smoking and obesity, and remember to go for a gynaecological check-up at least once a year.

How is it treated?

Treatment varies according to which stage the tumour has reached and to your general state of health. This is essential, as a lot of the women who get this type of cancer are over the age of 65.

The most common treatments include:

• Surgery: depending on the extent of the cancer, the surgeon may need to remove only a small section of the vulva or the whole vulva, including the inner and outer labia and possibly even the clitoris. In other cases, the doctor may decide to remove the lymph nodes of the inguinal and pelvic area, where some tumour cells may be.
• Radiotherapy: it is usually done before or after surgery. If you can’t have surgery, radiotherapy can be done to relieve the symptoms of the tumour.
• Chemotherapy: the drug is administered via injection or orally. Its purpose is to destroy the tumour cells in your body. Chemotherapy is often done together with radiotherapy in order to fight a cancer which has reached an advanced stage.

Which doctor should I talk to?

The first examination will be done by a gynaecologist, who could refer you to an oncologist specialised in the gynaecological field. Should it be necessary, the oncologist will have you see an oncological surgeon or a radiotherapist, based on which treatment you need.