Introduction
Cancer of the vulva is a rare type of cancer with around 1,000 new cases being diagnosed each year in the UK.
The vulva
The vulva is a collective term to refer to the external sex organs of a woman and the skin that surrounds them. The vulva is made up of:
- the opening of the vagina
- two sets of a pair of lips that surround the vagina the two inner lips are known as the labia minora and the outer lips are known as the labia majora
- the opening of the urethra the urethra is a tube that runs from the bladder through which a woman passes urine out of her body; the opening of the urethra is located above the opening of the vagina
- the clitoris which is a sexual organ, around the size of a button, that is located above the urethra; the clitoris helps woman reach sexual climax
In three out of four cases the cancer first develops in one of the patient's labia.
Symptoms
Symptoms of vulval cancer include:
- the development of a noticeable lump, mass or wart-like growth on a section of the vulva
- persistent itchiness in the vulva
- pain when passing urine
- bleeding from the vulva or passing a blood-stained discharge
Read more about the symptoms of vulval cancer.
Types of vulval cancer
The various different types of vulval cancer are classified by the type of cells that the cancer first develops in.
By far the most common is known as squamous cell carcinoma, which accounts for over 90% of all cases of vulval cancer. In this type the cancer develops in cells found on the outer layer of the body.
The second most common type is known as vulval melanoma, which accounts for 4% of all cases. In this type the cancer develops in the cells that give skin its colour.
Other, very rare, types of vulval cancer include:
- adenocarcinoma, which develops from the cells that line the glands in the vulva
- verrucous carcinoma, which is a slow-growing type of vulval cancer that looks like a wart
- sarcoma, which develops in tissue such as muscle or fat under the skin
Who is affected
There are two main groups of women who are affected by vulval cancer.
The largest group are older women over the age of 65 who often have a history of non-cancerous inflammatory skin conditions affecting their vulva, particularly a condition called lichen sclerosus. This group account for around three to four out of five cases.
The second smaller group are younger women who have not yet gone through the menopause, who account for the remaining one to two out of five cases.
The exact cause of vulval cancer is still unclear but significant risk factors include:
- age
- smoking
- persistent infection with specific high-risk strains of the human papilloma virus (HPV), particularly a strain known as HPV 16, which is a strain of HPV virus responsible for a large number of cases of cervical cancer
- vulval intraepithelial neoplasia (VIN) VIN is a condition where the skin cells around the vulva experienced pre-cancerous changes but "full blown" cancer has not yet developed; a minority of women with VIN will go on to develop vulval cancer
HPV infection and VIN are responsible for the majority of cases in younger women.
Read more about the possible risk factors and causes of vulval cancer.
Treatment
The mainstay of treatment for vulval cancer is surgery. The surgery will remove cancerous tissue from the vulva while trying to minimise the impact of surgery on the vulva. However, in some cases this may not be possible.
A combination of radiotherapy and chemotherapy can also be used as the main treatment if surgery would lead to a loss of bladder control (urinary incontinence) or bowel control (bowel incontinence). This combination can also be used to slow the spread of advanced cancer if a cure is not possible, which is known as palliative care.
Read more about the treatment of vulval cancer.
Emotional impact
Any type of cancer is likely to have a considerable negative emotional impact. But developing a cancer in one of the most intimate parts of the body can be profoundly distressing for some woman.
It can also take several months to adjust to the effects of surgery both physical and psychological.
There are a range of services that can provide both practical and emotional support for people affected by vulval cancer.
You can read more about recovering from the effects of vulval surgery.
Outlook
The outlook for the squamous cell carcinoma type of vulval cancer is good and many people will recover fully.
Around 70% of people with that type of vulval cancer will survive for at least five years after diagnosis, many will live much longer and most of them will be cured.
As you would expect, squamous cell carcinomas diagnosed in the initial stage have a much higher five-year survival rate (90%) than carcinomas diagnosed in their most advanced stage (13%).
The outlook for the melanoma type of vulval cancer is less favourable. But it is hard to estimate a reliable five-year survival rate as it is such a rare type of cancer.
However, there are other independent factors that could improve (or worsen) your own outlook, so the above figures should only be taken as a general estimate.
