Vulvar cancer

The vulva is the name of the genitals on the outside of a woman’s body. It includes the clitoris, the labia majora (the larger, outer lips around the vagina) and labia minora (the smaller, inner lips around the vagina). Vulvar cancer grows in the clitoris or labia.

Each year, about 280 women in Australia find out they have vulvar cancer. Around one in 100 Australian women with cancer have vulvar cancer. It usually occurs between the ages of 55 and 75.

Cancer of the vulva is a skin cancer, so the cell types that occur are similar to those of skin cancers that appear elsewhere in the body. The most common is squamous cell cancer, followed by melanoma, adenocarcinomas and, less often, verrucous cancers and sarcomas.

Because the vulva has a lot of blood and lymphatic vessels cancer that starts here can easily move to other nearby parts of the body, like the vagina and bladder.

If the cancer is detected early most women will be cured. Even if the disease is not discovered until after it has advanced, treatment is still possible but the likelihood of a long-term cure is lower.

Causes

It is not usually possible to say what causes cancer in a particular woman but known risk factors include:

• being older, vulvar cancer is most common in women aged over 60
• having had the human papillomavirus (HPV) or genital warts
• being childless
• smoking
• if you have the skin conditions vulvar intraepithelial neoplasia or lichen sclerosus or if your vulva is often itchy
• previously having vaginal or cervical cancer
• radiotherapy to your pelvis in the past.

Symptoms

If you are concerned about symptoms it is important that you see a nurse, doctor or gynaecologist (specialist doctor in women’s health). It is more likely that your symptoms are not related to cancer but it is important to have any symptoms checked.

Sometimes there are no signs when the cancer first begins to grow. You should see a nurse, doctor or gynaecologist if your vulva is often itchy because it may be cancer and not a thrush infection that won’t go away.

Symptoms of vulvar cancer can include:

• an unusual lump or bump on your vulva or the area around it
• itching, burning, soreness or pain in your vulva
• unusual (and sometimes smelly) bleeding, pus or fluids coming from your vagina
• a mole on your vulva that changes shape or colour
• raised, red, white or dark brown patches of skin on your vulva.

See a doctor if you have any of these symptoms and they don’t go away and/or are unusual for you.

Diagnosis

If you think you might have vulvar cancer see a nurse, doctor or gynaecologist. Tell them about any changes to your body that you have noticed. Let them know if you have ever had a sexually transmitted infection or any other conditions that may mean you are more likely to have vulvar cancer.

They will most likely:

• ask you questions about the history of the health of you and your family
• examine you
• do a blood test
• look at your vulva using a magnifying machine called a colposcopy that sits close to your body
• give you an injection of medicine (local anaesthetic) to numb your vulva or put you to sleep (general anaesthetic) so they can take a sample of any sores or lumps you have and send them away to be tested. 

Treatment

The kind of treatment you have will depend upon:

• the size of the cancer and where it is in your body (this is known as the stage of cancer)
• how quickly it is growing (the grade of cancer)
• where in the vulva it started (the type of cancer)
• your age, health and medical history.

Your doctors will discuss these things with you and help choose the best possible treatment for your particular cancer, lifestyle and wishes.

Treatment options

• Surgery to remove the cancer. Your surgeon will remove some of the healthy tissue that surrounds the cancer (known as a margin) to try to stop the cancer from coming back. This may mean removing parts or all of your vulva (known as a vulvectomy).  Lymph nodes may also be removed from your groin (lymphadenectomy). If the cancer has spread to other parts of your body, you may also have surgery to remove these other cancers.
• Radiotherapy to control or kill the cancer. If you have external radiation you will lie or sit near a machine that directs radiation beams at your cancer. Your doctor may recommend that you try radiotherapy first because it may mean that you do not have your clitoris or labia removed.
• Chemotherapy drugs to control or kill the cancer. Usually this involves being connected to an IV or drip for a few hours so the drugs can be released slowly into your body.

Questions to ask

• How big is my cancer and where exactly is it?
• Is my daughter more likely to have vulvar cancer if I have it?
• What if I want to become pregnant?
• Is there a risk that any children I have after being treated will get cancer?
• Will I still be able to have sex?
• What will my vulva look like after treatment?
• Will I have problems going to the toilet?
• What are the side effects of the treatment you are recommending?
• Why is the treatment you are recommending best for me?
• Will I have all my treatments at this hospital?
• How often will I need to have checkups?
• Will treatment stop my periods and start menopause?
• Can you write down what you have told me so that I can read it again later?

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