Vulval cancer

Vulval cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Vulval cancer Vulval cancer About vulval cancer Causes of vulval cancer Diagnosing vulval cancer Treating vulval cancer About vulval cancer Cancer of the vulva is a rare type of cancer that affects women and anyone with a vulva. The vulva is a womans external genitals. It includesthe lips surrounding the vagina (labia minora and labia majora), the clitoris (sexual organthat helps reach sexual climax), and the Bartholins glands (2small glands each side of the vagina). Most of those affected by vulval cancer are older women and anyone with a vulva over the age of 65. The condition is rare in women and anyone with a vulva under 50 who have not yet gone through the menopause . Symptoms of vulval cancer Symptoms of vulval cancer can include: a persistent itch in the vulva pain, soreness or tendernessinthe vulva raised and thickened patches of skin that canbe red, white or dark a lump or wart-like growth on the vulva bleeding from the vulva orblood-stainedvaginal discharge between periods an open sore in the vulva a burning painwhen passing urine amole on the vulva that changes shape or colour Speak to your GP if you notice any changes in the usual appearance of your vulva. While its highly unlikely to be the result ofcancer, these changes should be investigated. Read more about diagnosing vulval cancer . What causes vulval cancer? The exact cause of vulval cancer is unclear, but your risk of developing the conditionis increased by the following factors: increasing age vulval intraepithelial neoplasia (VIN)  where the cellsin the vulva are abnormal and at risk of turning cancerous persistent infection with certain versionsof thehuman papilloma virus (HPV) skin conditions affecting the vulva,such aslichen sclerosus smoking You may be able to reduce your risk of vulval cancer by stopping smoking and taking steps to reduce the chances of picking up an HPV infection. Read more about the causes of vulval cancer . How vulval cancer is treated The main treatment for vulval cancer is surgery to remove the cancerous tissue from the vulva and any lymph nodes containing cancerous cells. Some people may also have radiotherapy (where radiation is used to destroy cancer cells) or chemotherapy (where medication is used to kill cancer cells), or both. Radiotherapy and chemotherapy may be used without surgery if youre not well enough to have an operation, or ifthe cancer has spread and it isnt possible to remove it all. Read more about treating vulval cancer . Canvulval cancer be prevented? Its not thought to be possible to prevent vulval cancer completely, but you may be able to reduce your risk by: practisingsafer sex using a condom during sex can offer some protection against HPV attending cervical screening appointmentscervical screening can detect HPV and pre-cancerous conditions such as VIN stopping smoking The HPV vaccination may also reduce your chances of developing vulval cancer. This is offered to all girlswho are 12 to 13 years old as part of their routine childhood immunisation programme. Causes of vulval cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. The exact reason why this happens in cases of vulval cancer is unknown, but certain things can increase your chances of developing the condition. These include: increasing age vulval intraepithelial neoplasia (VIN) human papilloma virus (HPV) infection skin conditions that can affect the vulva, such aslichen sclerosus smoking Increasing age The risk of developing vulval cancer increases as you get older. Most cases develop in women and anyone with a vulva aged 65 or over. Very occasionally women and anyone with a vulva under 50 can be affected. Vulval intraepithelial neoplasia (VIN) Vulval intraepithelial neoplasia (VIN) is a pre-cancerous condition. This meansthere are changes to certain cells in the vulva that arent cancerous, butcould potentially turn into cancer at a later date. This is a gradual process thatusually takes well over 10 years. In some cases, the abnormal cells may go away by themselves. However, because of the risk of cancer, treatment to remove the affected cells is often recommended. Symptoms ofVINare similar to those of vulval cancer, and include persistent itchinessof the vulva and raised discoloured patches. Speak to your GP if you have these symptoms. There are 2types ofVIN: usual or undifferentiated VIN  thisusually affectswomen and anyone with a vulva under 50 and is thought to be caused by an HPV infection differentiated VIN (dVIN)  this is a rarer type, usually affecting women and anyone with a vulva over 60, associated with skin conditions that affect the vulva Human papilloma virus (HPV) Human papilloma virus (HPV) is the name given to a group of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat.Its spread during sex, including anal and oral sex. There are many different types of HPV, and mostpeople are infected with the virus at some time during their lives. In most cases, the virus goes away without causing any harm and doesnt lead to further problems. However, HPV is present in at least 40% of people with vulval cancer, which suggests it may increase your risk of developing the condition. HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer . Its thought the virus could have a similar effect on the cells of the vulva, which isknown as VIN. Skin conditions Several skin conditions can affect the vulva. In a small number of cases these are associated with an increasedrisk of vulval cancer. Two of the main conditions associated with vulval cancer are lichen sclerosus and lichen planus . Both of these conditions cause the vulva to become itchy, sore and discoloured. Its estimated that less than 5% of those who develop one of these conditions will go on to develop vulval cancer. Its not clear whether treating these conditions reduces this risk. Smoking Smoking increases your risk of developing VIN and vulval cancer. This may be becausesmoking makes the immune system less effective, and less able to clear the HPV virus from your body and more vulnerable to the effects of the virus. Diagnosing vulval cancer Speak to your GP if you notice any changes in the normal appearance of your vulva. Your GP will ask you about your symptoms, look at your medical history, andexamine your vulva to look for any lumps or unusual areas of skin. If you would prefer to be examined by afemale doctor or you would like a nurse present during the examination, it may help to let your GP practice know in advance of your appointment. Referral to a gynaecologist If your GP feels some further tests are necessary, they will refer you to a hospital specialist called a gynaecologist. A gynaecologist is a specialist in treating conditions of the female reproductive system. The National Institute for Health and Care Excellence ( NICE ) recommends that GPs consider referring a woman who has an unexplained vulval lump orulcer, or unexplained bleeding. The gynaecologistwillaskabout your symptoms and examine your vulva again, and they may recommendatest called a biopsy to determine whether you do have cancer. Biopsy A biopsy is wherea small sample oftissue is removed so it can be examined under a microscope to see if the cells are cancerous. This is often doneafter a local anaesthetic has been given to numb the area, whichmeans the procedure shouldnt be painful and you can go home the same day. Occasionally, it may be done under general anaesthetic (where youre asleep), which may require an overnight stay in hospital. Your doctor may put a few stitches in the area where the biopsy was taken from.You may have slight bleeding and soreness for a few days afterwards. Your doctor will usually see you 7to 10 days later to discuss the results with you. Further tests If the results of the biopsy show cancer, you may need further tests to assess how widespread it is. These may include: a colposcopya procedure where a microscope is used to check for abnormal cells in the vagina a cystoscopy an examination of the inside of the bladder using a thin, hollowtubeinserted into the bladder a proctoscopy  an examination of the inside of the rectum biopsies of the lymph nodes near your vulvatocheck whether cancer has spread through your lymphatic system a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan  scans to check for signs of cancer in your lymph nodes or other organs an X-ray to check that cancer has not spread to your lungs The results of these tests will allow your doctor to stage your cancer. This means using a number system to indicate how far the cancer has spread. Staging Vulval cancers are staged using a number from 1 to 4. The lower the stage, the less the cancer has spread and the greater the chance of treatment being successful. The staging system for vulval cancer is: stage 1  the cancer is confined to the vulva stage 2 the cancer has spread to other nearby parts of the body, such as the lower vagina, anus or lower urethra (the tube urine passes throughout of the body), but the lymph nodes are unaffected stage 3  the cancer has spread into nearby lymph nodes stage 4  the cancer has spreadto other parts of the body, including more distant lymph nodes Stage 1 and 2 vulval cancers are generally regarded as early-stage cancers with a relatively good chance of being treated successfully. Stage 3 and 4 cancers are usually regarded as advanced-stage cancers and a complete cure for these types of cancers may not always be possible. Treating vulval cancer Treatment for vulval cancer depends on factors such as how far the cancer has spread, your general health, and personal wishes. The mainoptions are surgery, radiotherapy and chemotherapy . Many women and anyone with a vulva with vulval cancer have a combination of these treatments. If your cancer is at an early stage, its often possible to get rid of it completely.However, this may not be possible if the cancer has spread. Even after successful treatment, there is up to a 1in 3chance of the cancer returning at some point later on, so youll need regular follow-up appointments to check for this. Your treatment plan Most hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Members of your MDT will probably include a specialist surgeon, a specialist in the non-surgical treatment of cancer (clinical oncologist) and a specialist cancer nurse. Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments. Surgery to remove vulval cancer In most cases, your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer. There are 3surgical options to treat vulval cancer: radical wide local excision the cancerous tissue from your vulva is removed, as a well as a margin of healthy tissue, usually at least1cm wide, as a precaution radical partial vulvectomy  a larger sectionofyour vulva is removed, such as 1 or both of the labia and the clitoris radical vulvectomy  thewhole vulva is removed, including the inner and outer labia, and possibly the clitoris The time it will take you to recover from surgery will depend on the type of surgery and how extensive it was. For extensive operations, such as a pelvic exenteration, it may be many weeks or monthsbefore you start tofeel better. Your surgeon will talk to you about the possible risks associated with the type of procedure youre having. Possible risks include infection, bleeding, blood clots, altered sensation in your vulva, and problems having sex. Assessing and removing groin lymph nodes An additional operation may also be required to assess whether the cancerous cells have spread into one or more lymph nodes in your groin, and remove these if theyre found to contain cancer. Sentinel node biopsy If the cancer has spread to nearby lymph nodes, its sometimes possible to only remove certain lymph nodes, known assentinel nodes. Sentinelnodes are identified by injecting a dye at the site of the tumour and studyingits flowto locate the nodes closest to the tumour. These are then removed and checked for cancerous cells. Groin lymphadenectomy In some cases, some or all of the nodes in your groinmay need to be surgically removed. This is called a groin oringuinofemoral lymphadenectomy. Further treatment with radiotherapy may also berecommended. Removing cancerous lymph nodesreduces the risk of the cancer returning, but it can make you more vulnerable to infection and cause swelling in your legs from a build-up of lymphatic fluid (lymphoedema) . Pelvic exenteration In cases of advanced vulval cancer or where the cancer returns after previous treatment, an operation called a pelvic exenteration may be recommended. This involves removing your entire vulva as well as your bladder, womb and part of your bowel. This is a major operation and isnt carried out very often these days. If a section of your bowel is removed, it will be necessary for your surgeon to divert your bowel throughan opening made in your tummy (a stoma). Stools then pass along this piece of bowel and into a bag you wear over the stoma. This is known asa colostomy . If your bladder is removed, urine can be passed out of your body into a pouch via a stoma. This isknown as a urostomy. Alternatively,it may be possible to create a new bladder by removing a section of your bowel and using it to create a pouch to store urine in. Reconstructive surgery If only a small amount of tissue has been removed during surgery, the skin of the vulvacan often be neatly stitched together. Otherwise, it may be necessary to reconstruct the vulva using askin graft,where a piece of skin is taken from your thigh ortummy and moved tothe wound in yourvulva. Another option is to have askin flap, whereanarea of skin near the vulva is used to create a flap andcover the wound. These reconstructive procedures are usually carried out at the same time as the operation to remove the cancer. Radiotherapy Radiotherapy involves using high-energy radiation to destroy cancerous cells. There are several ways itcan be used to treat vulval cancer: before surgery totrytoshrink a large cancer this is tohelp make the operation possible without removing nearby organs after surgeryto destroy any cancerous cells that may be left for example, for cases where cancer cellshave spread to the lymph nodes in the groin as an alternative to surgery, if youre not well enough to have an operation to relieve symptoms in cases where a complete cure is not possible  this is known as palliative radiotherapy In most cases, youll have external radiotherapy, where a machine directs beams of radiationon to the section of the body that contains the cancer. Thisis normally given in daily sessions, 5days a week, with each session lasting a few minutes.The whole course of treatment will usually last a few weeks. Side effects While radiation is effective in killing cancerous cells, it can also damage healthy tissues. This canlead to a number of side effects, such as: sore skin around the vulva area diarrhoea feeling tired all the time loss of pubic hair, which may be permanent swelling of the vulva narrowing of your vagina, which can make sex difficult inflammation of your bladder (cystitis) In younger people, external radiotherapy can sometimes trigger an early menopause .This means theywill no longer be able to have any children. Read more about the side effects of radiotherapy . Chemotherapy Chemotherapy is where medication is used to kill cancer cells. Its usually given by injection. Its usually used if vulval cancer comes back or to control symptoms when a cure is not possible. Sometimes it may be combined with radiotherapy. Side effects The medicines used in chemotherapy can sometimes damage healthy tissue, as well as the cancerous tissue. Side effects are common and include: tiredness feeling and beingsick hair thinning orhairloss sore mouth and mouth ulcers an increased risk of infections  tell your care team if you develop any symptoms of an infection, and try to avoid close contact with people known to have an infection These side effects should pass once treatment has finished. Read more about the side effects of chemotherapy . Emotional support The emotional impact of living with vulval cancer can be significant. Many people report experiencing a kind of rollercoaster effect. You may feel down at receiving a diagnosis, feel up when the cancer has been removed from your body, and then feel down again as you try to come to terms with the after-effects of surgery. Some people experience feelings of depression . If you think you may be depressed, contact your GP or care team for advice. There are a range of treatments that can help. You may also find it useful to contact one of the main cancer charities, such as: Macmillan Cancer Support  the helplineis availableon 0808 808 00 00, Monday to Friday, 9am to 8pm Cancer Research UK  a cancer nurse helpline is availableon 0808 800 4040, Monday to Friday, 9am to 5pm Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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