Vulval Cancer

vulval cancer

Vulval cancer or cancer of the vulva is an uncommon cancer, affecting mainly women over the age of 55, although younger women are also affected. Most vulval cancers can be cured. The outlook is good in women who have small cancers that have not spread.

What part in the body is called as vulva?

The external sex organs of a woman are called as vulva and is made up of two pairs of 'lips' the outer pair, called the labia majora, is covered in pubic hair and the inner pair called as labia minora, which are thinner and more delicate. These surround two openings, 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. At the front of the vulva is the small organ called the clitoris.

What do you understand by cancer?

Cancer is a disease of the cells in the body where the abnormal cells multiply out of control. A malignant tumour is a lump or growth of tissue made up from cancer cells, which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage. Also by invading blood vessels these cancerous cells can be deposited to other parts of the body, leading to secondary tumors (metastasis) in different areas of the body. Some cancers are more serious than others; some are more easily treated than others; some have a better outlook (prognosis) than others. Therefore, one has to know exactly what type of cancer one is treating before recommending any treatment.

What is vulval cancer?

Cancer that occurs in any part of the vulva is called as vulval cancer. Most commonly it develops on the inner edges of the labia majora and the labia minora. It can also sometimes affect the clitoris or Bartholin's glands (small glands on each side of the vagina). It can also occasionally start on the perineum (the skin between the vulva and the anus). They are generally squamous cell cancers, which means that they have developed from the skin cells in the outer layer of the vulva. Around 4 in 100 cases of vulval cancers are due to a melanoma, which develops from cells in the skin that cause pigmentation.

What are the causes of vulval cancer?

The exact cause of normal cells becoming abnormal is not known may be It is thought that something damages or alters certain genes in the cell, thus making the cell abnormal and multiply 'out of control'.

Vulval cancer is an uncommon cancer, which usually affects women over the age of 55, but is most common in those who are 85 or over, it has seen of late that the number of younger women with vulval cancer have increased, but are still small. Generally, the reason of developing vulval cancer is not known , however, factors  known to alter the risk of vulval cancer developing 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) which is an infection which is passed between people during sex. However, more than half of all vulval cancers are not related to HPV infection.
  • Lichen sclerosus and lichen planus 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 increases the risk of vulval cancer. However, most women who have genital herpes do not develop vulval cancer.
  • 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 is the presentation 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 do you diagnose vulval cancer?

Women having abnormal growth and pain at the vulval area should get themselves thoroughly examinedfrom a doctor. This may include feeling for any enlarged lymph glands in the groin and you will then be referred to see a specialist in the hospital.

Further tests would be required in the hospital these include:

  • A biopsy or a small sample of tissue removed from the affected area of your vulvawhich  is then looked at under a microscope and can help to show whether you have VIN or vulval cancer. If you do have vulval cancer, the biopsy will show which type of vulval cancer you have. Results of a biopsy can take two weeks.
  • Other tests 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).

How do you treat vulval cancer?

Treatment options that 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.

There should be a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side effects, and other details about the various possible treatment options for your type of cancer.


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 performed. This may be a partial vulvectomy in which only part of the vulva is removed.

Alternatively, this may be 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. Your surgeon will be able to talk to you about this in more detail. Generally surgeons will try to perform surgery that will give the best possible result for the least scarring procedure.


Radiotherapy uses high-energy beams of radiation, which are focused on cancerous tissue killing 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.It might be given before an operation, to shrink the cancer so a smaller operation can then be performed.


Chemotherapy is a treatment of cancer by using anti-cancer drugs, which kill cancer cells or stop them from multiplying. Chemotherapy may be used in three different ways: before an operation, to shrink a large tumour, to give a better chance of the operation being successful; after the operation to give a better chance of cure; if a cancer recurs.
There are many different types of chemotherapy. Which type depends on many factors, including your age, general health and your particular stage of cancer? Your specialist can discuss this with you, if you wish.

How do people fare?

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.


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