Gynaecological cancers
Vulval Cancer: Symptoms, Diagnosis and Treatment
Vulval cancer is a rare type of gynaecological cancer that develops in the vulva, the external female genital area. It can affect different parts of the vulva, including the labia, clitoris and the skin around the opening of the vagina.
Vulval cancer is more common in older women, although it can occur at any age. Around 1,500 people are diagnosed with vulval cancer in the UK each year.
Changes to the vulva, such as itching, irritation, skin changes or a lump, are common and are often caused by conditions other than cancer. However, persistent or unusual changes should always be assessed by a GP or specialist.
At Gynae Solution, we understand that symptoms affecting such a sensitive area can feel difficult or embarrassing to discuss. Our aim is to provide a comfortable, confidential and supportive environment where you can discuss your concerns and receive appropriate specialist assessment.
What Is Vulval Cancer?
The vulva refers to the external female genital area. It includes the inner and outer labia, clitoris and the skin and tissues surrounding the opening of the vagina and urethra.
Vulval cancer develops when abnormal cells within the vulval tissues begin to grow and divide in an uncontrolled way.
There are several different types of vulval cancer. The most common is squamous cell carcinoma, which develops from the cells covering the surface of the vulva. Less common types include melanoma and other rare forms of cancer.
Some vulval cancers are associated with persistent infection with high-risk types of human papillomavirus (HPV), while others develop through different pathways and may be associated with long-term vulval skin conditions.
Vulval cancer is different from vaginal cancer. Vaginal cancer develops inside the vagina, whereas vulval cancer affects the external genital area.
Symptoms of Vulval Cancer
Vulval cancer does not always cause obvious symptoms in its early stages. When symptoms do occur, they may initially look or feel like a common skin condition or irritation.
Symptoms can include:
- A lump, swelling or growth on the vulva
- A persistent sore, ulcer or area of broken skin
- Vulval itching that does not improve
- Persistent burning, irritation or pain
- Bleeding from the vulva that is not related to your period
- Blood-stained vaginal discharge
- Changes in the colour or appearance of the vulval skin
- Red, white, darkened, thickened or raised areas of skin
- A mole or other pigmented area that changes in size, shape or colour
- Pain or burning when passing urine
- A persistent change in the appearance or texture of the vulva
These symptoms are very common and do not necessarily mean that you have vulval cancer. Conditions such as infections, eczema, dermatitis, lichen sclerosus and other vulval skin conditions can cause similar symptoms.
However, if a change persists, does not respond to treatment or is unusual for you, it is important to have it checked. Early assessment can help identify the cause and, if cancer is present, allow treatment to begin promptly.
Causes and Risk Factors
There is not one single cause of vulval cancer, and some cases develop without an identifiable risk factor.
However, certain factors can increase the risk of developing the condition.
These include:
- Increasing age
- Persistent infection with certain high-risk types of HPV
- A weakened immune system
- Certain long-term vulval skin conditions, particularly lichen sclerosus
- Previous abnormal cervical cell changes or cervical cancer
- Vulval intraepithelial neoplasia (VIN)
- Smoking
HPV is a very common virus and most people will have an HPV infection at some point in their lives. In most cases, the immune system clears the infection naturally and it causes no lasting problems. However, persistent infection with certain high-risk types of HPV can increase the risk of several cancers, including vulval cancer.
Lichen sclerosus is a long-term inflammatory skin condition affecting the vulva. It is not cancer, but in some cases it can be associated with an increased risk of developing vulval cancer. Appropriate diagnosis, treatment and ongoing management of vulval skin conditions are therefore important.
Having a risk factor does not mean that you will develop vulval cancer. Equally, vulval cancer can occur in people who have no known risk factors.
How Is Vulval Cancer Diagnosed?
If you have persistent vulval symptoms or an area that looks unusual, your GP may refer you to a gynaecologist or specialist vulval clinic for further assessment.
Your assessment will begin with a discussion about your symptoms, medical history and any previous treatments. A careful examination of the vulva will then usually be performed.
Vulval Examination
A specialist will examine the vulva to look for changes such as lumps, ulcers, areas of thickened skin, changes in colour or other abnormalities.
The examination may also include an assessment of the vagina and cervix where appropriate.
Vulvoscopy
A vulvoscopy allows the vulva to be examined in greater detail using a magnifying instrument called a colposcope.
This can help identify small or subtle areas of abnormal tissue that may not be obvious during a standard examination.
Biopsy
If an area appears unusual or concerning, a small sample of tissue may be taken. This is called a biopsy.
The tissue is examined under a microscope by a specialist pathologist to determine whether abnormal or cancerous cells are present.
A biopsy is an important part of diagnosing vulval cancer because an examination alone cannot confirm whether an abnormal area is cancerous.
Imaging
If vulval cancer is confirmed, further investigations may be recommended to establish the size and location of the cancer and whether it has spread to nearby lymph nodes or other areas of the body.
Depending on your circumstances, this may include an MRI scan, CT scan or PET scan. Blood tests may also be performed as part of your assessment.
Staging and Grading
If cancer is confirmed, your specialist team will determine its type, grade and stage.
The stage describes the size of the cancer and whether it has spread beyond the vulva. The grade describes how abnormal the cancer cells appear and provides information about how they may behave.
This information is important when deciding on the most appropriate treatment.
Treatment Options
Treatment for vulval cancer depends on a number of factors, including the type and size of the cancer, where it is located, whether it has spread and your general health.
The main treatments are surgery, radiotherapy and, in selected circumstances, chemotherapy. Your treatment will be planned around your individual diagnosis and circumstances.
Surgery
Surgery is usually the main treatment for vulval cancer, particularly when it has been diagnosed at an early stage.
Depending on the size and position of the cancer, surgery may involve removing the cancer together with a margin of surrounding healthy tissue. In some circumstances, part of the vulva may need to be removed, while more extensive surgery may be required for larger or more advanced cancers.
The lymph nodes in the groin may also need to be assessed or removed to determine whether cancer cells have spread.
Where a larger area of tissue needs to be removed, reconstructive surgery may sometimes be considered to restore the appearance and function of the vulva.
Radiotherapy
Radiotherapy uses high-energy radiation to destroy cancer cells.
It may be recommended before surgery to shrink a tumour, after surgery to reduce the risk of the cancer returning, or as the main treatment where surgery is not appropriate.
Radiotherapy may also be used to treat cancer that has spread or to help control symptoms.
Chemotherapy
Chemotherapy uses medicines to destroy cancer cells or prevent them from growing.
For vulval cancer, chemotherapy may sometimes be used alongside radiotherapy, before or after surgery, or to help control symptoms when cancer has spread.
Whether chemotherapy is appropriate will depend on your individual diagnosis.
Clinical Trials
For some patients, taking part in a clinical trial may be an option. Clinical trials investigate new or developing approaches to cancer diagnosis and treatment.
If a suitable clinical trial is available, your specialist team can discuss this with you.
Recovery and Aftercare
Recovery from vulval cancer treatment varies considerably depending on the type and extent of treatment you have received.
Following surgery, you will be given detailed advice about caring for the treated area, managing discomfort and gradually returning to your normal activities.
If lymph nodes have been removed or affected by treatment, there may also be a risk of swelling in the legs, known as lymphoedema. Your specialist team can advise you about reducing and managing this risk.
Radiotherapy and chemotherapy can cause their own side effects, and some effects may continue after treatment has finished. Your healthcare team will explain what to expect and how symptoms can be managed.
Follow-up appointments are an important part of your aftercare. These appointments allow your specialist team to monitor your recovery, assess the treated area and look for any signs of recurrence.
Vulval cancer treatment can also affect intimate relationships, sexual health, body confidence and emotional wellbeing. These are important aspects of your recovery, and you should feel comfortable discussing any concerns with your healthcare team.
Risks and Benefits of Treatment
Every treatment has potential benefits and risks. These will depend on the treatment recommended, the stage of your cancer and your individual health.
The potential benefits of treatment may include removing or controlling the cancer, reducing symptoms, preventing further spread and improving long-term outcomes.
Surgery carries general risks such as bleeding, infection, blood clots and complications associated with anaesthesia. Depending on the extent of surgery, there may also be specific risks affecting the vulva, nerves, lymphatic system, bladder or bowel.
More extensive surgery can affect the appearance and function of the vulva and may have an impact on sexual health and body image. Where appropriate, reconstructive techniques may be discussed.
Radiotherapy can cause changes to the skin and tissues in the treated area, while chemotherapy can cause side effects such as tiredness, nausea and an increased risk of infection.
Before recommending treatment, Mr Jafaru Abu and your specialist team will discuss the potential benefits, risks and alternatives with you. You will have the opportunity to ask questions and understand what your treatment involves before making an informed decision about your care.
Specialist Vulval Cancer Care
Changes to the vulva can feel difficult or embarrassing to discuss, but you should never feel uncomfortable about seeking medical advice. GPs and specialists regularly assess these symptoms, and many are caused by conditions other than cancer.
There is no national screening programme specifically for vulval cancer in the UK, which makes awareness of persistent vulval changes particularly important.
At Gynae Solution, we provide a confidential and supportive environment where you can discuss your symptoms openly and receive appropriate specialist assessment.
If you have noticed a persistent lump, sore, change in skin appearance, itching, bleeding or another unusual change affecting your vulva, speak to your GP or contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
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