What is vulval cancer?

Vulval cancer is a cancer of the vulva, the skin and fatty tissue between the upper thighs that surrounds the opening of the vagina. It stretches from the area around the anus to just below the pubic hairline. Vulval cancer most often affects the two folds of skin around the vagina, known as the labia. In this post I explain the warning signs, how vulval cancer is diagnosed, and the treatments available.

Symptoms of vulval cancer

Early symptoms of vulval cancer can be easy to dismiss, or to put down to a minor skin problem. Look out for:

• itching of the vulva that lasts more than a few weeks
• a cut or sore on the vulva that will not heal
• a lump, swelling or thickened patch on the vulva (see vulval and vaginal lumps)
• pain or soreness of the vulva
• bleeding from the vulva that is different from your usual period
• burning in the genital area that continues even after treatment
• any change in the size, colour or texture of a mole or birthmark on the vulva

Most of these symptoms have a less serious cause, such as a skin condition or infection. However, if a symptom does not settle with treatment, it should be examined properly. Human papillomavirus (HPV) infection can also increase your risk of developing vulval cancer.

How is vulval cancer diagnosed?

The first step is a physical examination, including a pelvic examination. Your doctor will look closely at the vulva, then gently feel the womb, vagina, ovaries, bladder and rectum to check for anything unusual. If there is an abnormal area, a small piece of tissue (a biopsy) will be taken to examine under a microscope. A biopsy is the only way to confirm vulval cancer.

Depending on the findings, further tests may include:

• a colposcopy, to examine the vulva, vagina and cervix with a magnifying instrument
• a chest X-ray
• a CT, MRI or PET-CT scan, to check whether the cancer has spread
• an endoscopy, to look inside nearby organs

Cancer Research UK explains the symptoms of vulval cancer and when to see a doctor.

How is vulval cancer treated?

Vulval cancer is usually treated with surgery, radiotherapy, chemotherapy, or a combination. The type of surgery depends on the size and depth of the cancer and whether it has spread. Your doctor will go through each option with you, including its advantages and disadvantages. Even after surgery, some people need radiotherapy as well.

There are three main surgical options for vulval cancer:

• Radical wide local excision: the cancer is removed together with a margin of healthy tissue, usually at least 1cm wide, as a precaution.
• Radical partial vulvectomy: a larger part of the vulva is removed, such as one or both labia, and possibly the clitoris.
• Radical vulvectomy: the whole vulva is removed, including the inner and outer labia, and possibly the clitoris.

The lymph nodes in the groin are often checked too, because vulval cancer can spread there first. You can read more about these operations on our radical vulvectomy and groin node surgery page, and about lymph node surgery on our lymphadenectomy page.

Recovery after surgery

After surgery for vulval cancer, you will be supported through an enhanced recovery programme. This helps you get up and about, eat and drink, and return home as soon as it is safe. In some cases, your care team may combine surgery with chemotherapy and radiotherapy. That depends on where the cancer is, how aggressive it is and whether it has spread.

Cancer Research UK sets out the treatment options for vulval cancer, and our vulval cancer page has more detail. If you have any symptoms that worry you, you can book an appointment with Mr Jafaru Abu at The Park Hospital, Nottingham.