What is Vulval Cancer?
Vulval cancer is a cancer of the skin of the vulva, the external female genitalia. It is overall a rare cancer.
There are two main types of vulval cancer, one caused by HPV or human papilloma virus (“HPV dependent type”). The second is not caused by HPV, but by high grade genetic mutations within cells with a relationship to chronic inflammation and the immune system, that is currently not fully understood (“HPV independent type”). Both types of vulval cancer are preceded by precancerous skin changes. This means that if skin changes are detected early, many cases of vulval cancer can be prevented.
There are rarer subtypes of vulval cancer – such as melanoma or sarcoma, that are not discussed here.
What are the symptoms of Vulval Cancer?
Vulval cancer has a precancerous stage. It can also be related to inflammatory conditions such as lichen sclerosis.
Symptoms may include:
- vulval itch or burning sensation
- vulval pain or discomfort
- vulval skin thickening or a lump
- new skin discolouration, pigmentation or a white plaque
- bleeding or discharge from the skin
- difficulty or pain passing urine
- vulval skin ulcer
- some changes may not cause noticeable symptoms but only be noticed on self examination or examination by a health care professional
Is there a test for Vulval Cancer?
Diagnosis is made after examination and a skin biopsy.
Frequently Asked Questions
Most cases of early stage vulval cancer are treated with surgery to remove the affected area of skin with a peripheral and deep margin. There is a risk of lymph node spread in cancers that invade the skin greater than 1mm, and if this has occurred, lymph node surgery in the groins is performed.
If there has been spread to cancer cells in the lymph nodes of the groin, then a combination of surgery, radiation and chemotherapy may be needed for treatment.
If a vulval cancer is not able to be removed with surgery, the radiation and chemotherapy may be an option.
You will be followed closely to detect any recurrence and supported to live well following cancer treatment. Associated chronic inflammatory skin conditions such as lichen sclerosis will need lifelong treatment with steroid ointments.
All types of cancer have an associated risk of recurrence following successful treatment. You will be monitored closely following treatment in a schedule tailored to your risk category. If your cancer recurs, treatment options will depend on where the cancer has recurred, what treatment you initially received.
Vulval cancer and its treatment typically does not affect the ability to have a pregnancy, except in some cases if radiation or chemotherapy have been used.
Early treatment of chronic inflammatory skin conditions of the vulva (lichen sclerosis) and precancerous skin changes (vulval intra-epithelial neoplasia, VIN, differentiated vulval intra-epithelial neoplasia, dVIN) can prevent vulval cancer.
There is no screening system for vulval cancer.
Knowing what is normal for your body, both in sensation, experience and visually and by palpation on self examination is important. New symptoms or a change in appearance should be reported to your health care provider (GP) and a clinical examination performed. A biopsy is recommended in most cases for diagnosis of vulval skin disorders. This may be performed by your GP, or after referral to a gynaecologist, gynaeoncologist, or dermatologist.
If you have not been offered a skin examination, or have commenced a course of treatment and your symptoms persist, or there is uncertainty in your diagnosis, it is ok and recommended to review the issue with your treating doctor, or request a referral to a specialist or seek a second opinion.
If you are facing a new diagnosis of vulval cancer or suspected vulval cancer, write down any questions you can think of, bring a family member or friend to your specialist appointment, and reach out to those around you and the resources below for support.