Cancer of the Vulva - Fact Sheet

Contents

The Vulva

The term vulva refers to the external sexual organs in a woman. It is made up of two pairs of lips called labia, between which are two openings. The largest of these is the entry to the vagina (introitus) which is the passage between the uterus (womb) and the outside world. The smaller opening is the urethra, which is the outlet from the bladder through which urine is passed.

What Is Cancer of the Vulva? 

Cancers of the vulva are cancers in the skin covering the vulva. It is an uncommon cancer, with less than 100 cases reported each year in Queensland. Most of these cases are in women over 50 years of age, with the most common occurrence in the 70-79 year age group. It does, however, appear that vulval cancer is becoming more common in younger women between 30 and 50 years of age.

Symptoms

Some common symptoms of cancer of the vulva are:

Cancer of the vulva can take many years to develop as it is usually a slow-growing tumour. Although you may be uncomfortable discussing concerns you have about this part of your body, it is important to see your doctor if you do notice any of the above symptoms, as early cancer is easier to treat and cure. Most women with these symptoms will not have cancer.

What Causes Cancer of the Vulva?

Little is known about the causes of these cancers, but age is thought to be a significant factor in its development. Cancers of the vulva are also thought to share some of the risk factors as cancer of the cervix, as certain types of a virus known as the human papilloma virus (HPV) have been associated with cancer of the vulva. There is some evidence that cigarette smoking may be linked with cancer of the vulva.

Sometimes abnormal cells are found in the skin of the vulva. This condition is called VIN. These cells may sometimes be precancerous and may develop into cancer of the vulva if left untreated.

Diagnosis

There are certain tests your doctor may perform. The first of these is a careful examination of the vulva, to check for any lumps. Sometimes the diagnosis will be visible to the naked eye. If not, the doctor may undertake a colposcopic examination. A colposcope is a binocular instrument which has a light source in it and allows for a magnified view of the vulva. 

If cancer of the vulva is suspected following these examinations, you will usually be referred to a specially trained gynaecological oncologist, who may then go on to cut a small piece of skin from the vulva (called a biopsy) to be examined under a microscope by a pathologist. You will either be given some local anaesthetic to numb the area prior to the biopsy or, if necessary, admission to hospital may be arranged to conduct the biopsy under general anaesthetic.

If the diagnosis of cancer of the vulva is confirmed, further tests will need to be performed prior to undertaking treatment. These will give your doctor a better picture of your health and the stage of your cancer. Some of these tests are blood tests, X-Rays and possibly and electrocardiograph.

Treatment

All stages of cancer of the vulva can be treated, however all are not curable. Treatment for cancer of the vulva depends on the stage of your disease, the type of disease and your age and overall medical condition. Although the main treatments are surgery and radiation therapy, chemotherapy is also sometimes used.

If cancer of the vulva is detected while is it still in a pre-cancerous phase, is small, and has not yet begun to invade the deeper tissues of the vulva, treatment is by local excision of the lesion. This excision can be up to a few centimetres in dimension. 

However, in this early stage, if the lesions are multifocal or wide spread, it may be better to treat them with a skinning vulvectomy. This involves the removal of the skin that covers part or all of the vulva. It does not involve removing any of the deep tissue - only the skin. If the skinning vulvectomy is performed on only a small area, then the wound may just be stitched. If it is a large area, then it will require a skin graft.

Once the cancer has begun to invade the deeper tissues of the vulva and/or the skin between your vagina and anus (perineum), and if it is less than two centimetres in size, treatment is usually by a wide local excision of the lesion. If the cancer is only on one side of your vulva, this operation is called a hemivulvectomy. This is the removal of not just the skin, but also the deep tissue from one side of your vulva. 

If the cancer comes close to the midline of your vulva, then a radical vulvectomy is usually recommended. This is the removal of the entire vulva, including the skin and the deep tissues, right down to the fascia over the muscle and bone. Both of these procedures will be performed in hospital under a general anaesthetic. 

It is important in both a radical vulvectomy and a hemivulvectomy that the doctor removes at least one centimetre of normal tissue from around the cancer, to ensure that none remains. 

If the cancer invades to a depth of more than 1 millimetre, the lymph nodes will be removed from your groin. If cancer is found in these lymph nodes, then further treatment may be by radiation therapy. 

If the cancer is not found until it has begun to spread to the urethra, vagina, anus or lymph nodes, treatment will be by radical vulvectomy with the removal of the lymph nodes from both groins. At times, and in order to minimise the surgery, initial treatment may be by radiation therapy and chemotherapy to reduce the size of the tumour, followed by surgery.

If you have any questions about your own treatment, don't be afraid to ask your doctor. It often helps to make a list of questions for your doctor and to take a close friend or relative with you. Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel this will be helpful

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