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Vulval Cancer

cancer vulva


Vulval cancer (cancer of the vulva) is an uncommon cancer. It usually affects women aged over 55, although it can also affect younger women. The most common symptoms are a persistent itch or pain in the vulval area. Some vulval cancers start as a sore or lump in the vulva.

What is the vulva?

The vulva is the external sex organs of a woman. It is made up of two pairs of 'lips'. The outer pair, called the labia majora, is covered in pubic hair. The inner pair is called the labia minora, which are thinner and more delicate.There are two openings between these lips. One is the vagina which leads to the womb (uterus). The other is the urethra, which is the short tube that carries urine from the bladder.

What is vulval cancer?

Vulval cancer can occur on any part of the vulva. It can also occasionally start on the perineum (the skin between the vulva and the anus).
Most vulval cancers are squamous cell cancers.

What causes vulval cancer?

A cancerous tumour starts from one abnormal cell.In many cases, the reason why a vulval cancer develops is not known. However, there are factors which are known to alter the risk of vulval cancer developing. These include:

Age. Most cases develop in people over the age of 55.
A condition called vulval intra-epithelial neoplasia (VIN) can occur in the skin of the vulva. The most common symptom of VIN is a persistent itch. Areas of skin affected by VIN can look thickened and swollen, with red, white or dark coloured patches. Around one third of vulval cancers develop in women who have VIN.
Human papillomavirus (HPV). This is an infection which is passed between people during sex. Some types of HPV, including types 16, 18 and 31 can lead to VIN developing. However, more than half of all vulval cancers are not related to HPV infection.
Lichen sclerosus and lichen planus. These are two conditions that cause long-term inflammation of the skin in the vaginal area. Although almost two thirds of vulval cancers occur in women who have lichen sclerosus, only between 1 and 2 in 100 women who have lichen sclerosus will develop vulval cancer.
Genital herpes. Infection with the genital herpes virus type 2 increases the risk of vulval cancer. However, most women who have genital herpes do not develop vulval cancer.
Smoking. Smoking increases the risk of developing both VIN and vulval cancer.
Note: vulval cancer is not an inherited condition and does not usually run in families.

What are the symptoms of vulval cancer?

The symptoms of vulval cancer can vary between women. They may include:

A persistent itch.
Pain or soreness in the vulval area.
Thickened, raised, red, white or dark patches on the skin of the vulva.
An open sore or growth that does not improve.
Burning pain when you pass urine.
Vaginal discharge or bleeding.
A lump or swelling in the vulva.
A mole on the vulva that changes shape or colour.
Note: all these symptoms can be caused by other conditions which are not cancer. If you have any of these symptoms then you should see your doctor.

How is vulval cancer diagnosed and assessed?

Anyone who has an abnormal growth or sore on their vulva will have a thorough examination by their doctor. It is likely that further tests are required. These may include:
A biopsy. This is where a small sample of tissue is removed from the affected area of your vulva. The tissue is then looked at under a microscope and can help to show whether you have VIN or vulval cancer.

Other tests. These may include one or more of: a CT scan or MRI scan of the abdomen and chest, a chest X-ray, blood tests, and sometimes other tests.

This assessment is called 'staging' of the cancer. The aim of staging is to find out:

Whether the cancer has spread to local lymph glands (nodes).
Whether the cancer has spread to other areas of the body (metastasised).
Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for vulval cancer?

Treatment options which may be considered include surgery, radiotherapy and chemotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), the exact subtype or 'grade' of the cancer, and your general health.

Surgery

Surgery is the main treatment for vulval cancer. The operation performed depends on the size and position of the cancer.If the cancer is small, then the cancer and a small amount of surrounding normal tissue can be removed. For larger cancers, an operation called a vulvectomy (removal of the vulva) may be is done .It  may be a partial vulvectomy or a radical vulvectomy in which the entire vulva including the inner and outer labia and the clitoris are removed, usually with the surrounding lymph nodes. If a large amount of skin is removed in the operation then you may need to have a skin graft or skin flaps.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation tokill cancer cells, or stops cancer cells from multiplying. Radiotherapy may be advised in addition to surgery which aims to kill any cancerous cells which may have been left behind following an operation. Radiotherapy is sometimes given before an operation, to shrink the cancer so a smaller operation can then be performed.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying. It can be before or after an operation.

What is the prognosis (outlook)?

The outlook is best in those who are diagnosed when the vulval cancer is at an early stage. Surgical removal of a small vulval cancer gives a good chance of cure.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment


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