Vulval Cancer

Symptoms and signs include:

• Persistent itching or pruritus which lasts for more than a few days
• A mole or pigmented patch in the vulva that changes shape, colour, or size
• Pain or soreness
• Thickened skin patch which looks different in texture
• Ulceration or bleeding
• Swelling or lump which is irregular
• Dark or red patches on the skin

If you have any of these symptoms, please see your doctor urgently and ask for a specialist referral. Some conditions can only be diagnosed by examination under a microscope (vulvoscopy) or biopsy. It is best to get things checked out for peace of mind.

As with all gynaecological cancers, treatment will depend on a variety of factors such as the stage of the cancer. Although there are a variety of options, the main treatments include surgery, radiotherapy, and chemotherapy.

Surgical treatment varies depending on the stage of the cancer:

Stage 1, when cancer is limited to the skin of the vulva, surgery involves wide local excision of the tumour with at least a 2cm clear margin with or without removal of the lymph nodes in the groins.

Stage 2 and beyond, surgery may involve radical excision of the vulval skin with removal of the groin lymph glands. You may need reconstruction of the perineum with plastic surgery. Surgery is followed by radiotherapy to the pelvic area.

Radiotherapy involves treatment to the vulval skin and other areas such as the groin lymph glands where the cancer has/may spread. Treatment usually is carried out every day from Monday to Friday for 5 weeks. The treatment itself usually takes about 10-15 minutes. Side effects of radiotherapy involve diarrhoea, blood is stools or urine, increased frequency of passing urine, soreness whilst passing urine. Many of these side effects may continue to be bothersome for years following the treatment.

Chemotherapy is needed when the cancer has spread to distant organs beyond the pelvis. It involves adminstration of intravenous medications that kill cancer cells. Treatment usually involves half a day in the hospital every 3-4 weeks for a total of 6 cycles.  Side effects include feeling tired, feeling sick, loss of weight and appetite, loss of hair

Treatment of vulval cancer often includes surgical removal of the cancer and lymph nodes in the groins and may be followed by radiotherapy or chemotherapy or both. This causes disfigurement of the external genitalia. Recent advances such as sentinel lymph node dissection may reduce the risk of unwanted effects such as lymphoedema (swelling of the leg).

When vulval cancer is diagnosed in an early stage (stage 1), this is completely curable. Overall 7 in 10 women diagnosed with vulval cancer survive up to 5 years.

Some cancers of the vulva are caused by Human Papilloma Virus (HPV) infection. HPV vaccination may prevent vulval cancer. Regular check-up of the skin of external genitalia may identify precancerous conditions, which when appropriately treated reduce the risk of vulval cancer.

Vulval cancer is often linked to persistent infection with high-risk strains of human papillomavirus (HPV). Other risk factors include vulval intraepithelial neoplasia (VIN), lichen sclerosus (a chronic skin condition), smoking, and a weakened immune system.

Diagnosis usually involves a physical examination, followed by a biopsy of any abnormal-looking areas. Imaging tests such as ultrasound, MRI, or CT scans may be used to determine the stage of the cancer and whether it has spread.

Surgery is often the main treatment, especially for early-stage disease. This may involve removing part of the vulva (partial vulvectomy) or, in some cases, more extensive surgery. Your team will explain the options and work to preserve as much healthy tissue as possible.