Medical Advice

Vulval Cancer

What is vulval cancer?

The vulva is part of the skin and vulval cancer is therefore a type of skin cancer. Skin cancers that occur on other parts of the skin also can happen on the vulva.

Cancer can be dangerous because it can spread from its original location to other places like your lungs and your liver. This is something called metastasis. When this happens cancer can kill.

Metastasis is rare with most skin cancers. This is partly because they are easily noticed and treated early before they become advanced. The only skin cancer that often results in metastasis is melanoma and melanoma is exceptionally rare on the vulva.

Many skin cancers have an early phase which is called "precancerous". If they are treated at this stage the outlook for cure is very good.Ordinary skin cancer, which is caused by sun exposure, is very common.While vulval skin cancer is increasing in our community, it is still quite rare.

What is precancer?

Many cancers have an early phase where changes happen before true cancer develops.This is called "precancer". Precancers may be found on the vulva and the treatment of them is much simpler than that for cancer. Such treatment will often prevents cancer developing.

Precancers can also occur on the cervix (opening to the womb). A precancer of the cervix can be picked up by a Pap test, but a Pap test will not find vulval precancers.On the vulva precancers are usually found just by looking. They look like an abnormal area of vulval skin which feels rough and appears discoloured.

What does precancer look like?

Precancer is frequently a slightly elevated and roughened area of skin, arising anywhere on the vulva.It may occasionally be pigmented, red or white.In a small proportion of patients there may be no visible lesion initially.

What does cancer look like?

Cancer usually looks like a raised lump with an rough surface or a hard and non-healing ulcer.There may be bleeding and pain.

What symptoms are associated with these diseases?

Apart from feeling an abnormal area of skin, most women with vulval cancer have persistent irritation which doesn't get better at all with creams or other treatment. Less commonly there may be pain or bleeding.

What causes vulval cancer?

The two most frequent causes of vulval cancer are lichen sclerosus and human papilloma virus infection.

Lichen sclerosus must be be treated and monitored because of the risk of vulval cancer.

Human papilloma virus (HPV), the same virus that causes cancer of the cervix, can also cause vulval cancer cancer. Not all types of HPV cause cancer, but we know there are some that are capable of causing cancerous change in the skin of the vulva.

Women who get vulval cancer are often also smokers. Over 95% of women with vulval precancer are or have been smokers.If you have had a precancer and continue to smoke the disease almost always recurs and frequently progresses to cancer.

What is the treatment of vulval cancer?

You will be referred to a gynaecologist or a gynaecological oncologist (cancer specialist) for examination.The area will be examined closely, sometimes with a microscope, and a biopsy will frequently be performed to confirm the diagnosis.

Precancer can be treated by surgically removing the lesion or treated with the laser depending on the examination and biopsy results and where the cancer is and how big or small it is.

Cancer requires more extensive excision and surgery to ensure there has been no spread of the cancer.Occasionally some patients may have chemotherapy and radiotherapy in addition to or instead of surgery.

What about survival after vulval cancer?

Survival after precancer is 100% when it has been properly treated and cancer has been excluded. Survival after vulval cancer is very high as most patients will be diagnosed at an early stage as a result of having found a change in the skin of the vulva.We recommend that all cancers be treated by a gynaecological oncologist properly trained in cancer management.

Do I need follow up after vulval cancer?

Follow up is important with precancer because there is always a chance that it may come back. This may be a long term risk.Follow up after cancer is routine as for every patient. Your doctor will guide you regarding the type of follow up you need.