WHAT IS VULVAR CANCER?
Vulvar cancer (also known as vulval cancer, cancer of the vulva or vulva cancer) is a cancer that occurs in any part of the external female genitals.
Vulvar cancer most commonly develops in the labia minora (inner lips), the labia majora (outer lips), and the perineum (skin between the vagina and the anus).
About 300 Australian women are diagnosed with vulvar cancer each year. It most commonly affects women who have gone through menopause, however vulvar cancer can also occur in younger women..
VULVAR CANCER SYMPTOMS
Symptoms of vulvar cancer may include:
- itching, burning and soreness or pain in the vulvar
- a lump, sore, swelling or wart-like growth on the vulvar
- thickened, raised skin patches in the vulvar (may be red, white or dark brown)
- a mole on the vulvar that changes shape or colour
- blood, pus or other discharge coming from a lesion or sore spot in the vulvar
- hard or swollen lymph nodes in the groin area.
The vulvar is difficult to self-examine so if you feel any pain in your genital area or notice any of the symptoms listed above, visit your general practitioner (GP).
CAUSES OF VULVAR CANCER
Some factors that may increase your risk of vulvar cancer can include:
- A precancerous condition called vulvar intraepithelial neoplasia (VIN) that causes changes in the surface of the vulvar. The vulvar may itch, burn or feel sore.
- Infection with the human papillomavirus (HPV) can cause you to develop VIN. HPV is a common sexually transmitted infection and most women with HPV don’t develop vulvar or any other sort of cancer.
- If abnormal cell changes are detected on your Pap test you have a slightly higher risk of developing vulvar cancer.
- Some skin conditions such as vulvar lichen sclerosus and vulvar lichen planus may develop into cancer in a small number of women after many years.
- If you have had cervical cancer or vaginal cancer you have an increased risk of developing vulvar cancer.
- If you smoke you have an increased risk of developing VIN and vulvar cancer.
- If you have had an organ transplant or are infected with the human immunodeficiency virus (HIV) you may be at higher risk of developing vulvar cancer.
DIAGNOSIS FOR VULVAR CANCER
The main tests used to diagnose vulvar cancer are a physical examination, a colposcopy, and a tissue biopsy. These tests are usually performed at the same time. Because vulvar cancer is sometimes associated with cervical cancer, the doctor may also check for abnormal cells in your vagina and cervix.
It is standard practice for your doctor to examine your groin and pelvic area, including the genitals. A nurse may be present during the examination, and you can ask for a family member to be in the room.
The doctor may also do an internal examination at the same time to check your vagina and cervix. Your doctor may also perform a Pap test to check for abnormalities in the cells of your vagina and cervix.
Your doctor may use a magnifying instrument called a colposcope to examine your vulvar and vagina in detail. The colposcope does not go into your vagina; your doctor looks through it from the outside. The doctor applies a liquid to your vulvar and vagina, which makes it easier to see abnormal cells through the colposcope. This may sting or burn, and you may have a brown discharge afterwards.
Your doctor will usually take a small tissue sample called a biopsy from your vulvar during the colposcopy. This is the best way to diagnose vulvar cancer.
The tissue samples will be sent to a laboratory, and a pathologist will examine the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of vulvar cancer it is.
CERVICAL SCREENING TEST
Your doctor may do a cervical screening test. This has replaced the Pap test and detects cancer-causing types of HPV in a sample of cells from the cervix or vagina.
Further tests may be needed to determine the size and position of the cancer, and if the cancer has spread. These tests may include a blood test, chest X-ray, cystoscopy, proctoscopy and a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan.
TREATMENT FOR VULVAR CANCER
Based on the test results, your doctor will be able to tell you the stage of the cancer. This is a way to describe its size and if and how far it has spread.
Your doctor may also tell you the grade of the cancer cells. This tells you how quickly the cancer may develop.
Knowing the stage and grade of the cancer helps your doctor recommend the most appropriate treatment.
Treatment for vulvar cancer may involve surgery, radiotherapy and chemotherapy. You may have one of these treatments or a combination.
Surgery is the main treatment for vulvar cancer. The type of operation will depend on the stage of the cancer. Your surgeon will try to remove all of the cancer along with some of the surrounding healthy tissue (called a margin). This helps reduce the risk of the cancer coming back. Some lymph nodes in your pelvis may also be removed.
Radiotherapy uses radiation, such as X-rays, to kill or damage cancer cells. Whether you have radiotherapy will depend on the stage of the cancer, its size, if it has spread to the lymph nodes and how many nodes are affected.
Chemotherapy uses drugs to kill or slow the growth of cancer cells. For women with vulvar cancer, treatment may be given:
- during radiotherapy, to make the radiotherapy treatment more effective
- to control cancer that has spread to other parts of the body
- as palliative treatment, to relieve the symptoms of the cancer.
Chemotherapy may be given as tablets, in a cream applied to the vulvar or, more commonly, by injection into a vein.
The health professionals you see will depend on the treatment you have and may include:
- a GP who can assist you with treatment decisions and help manage your overall health
- a gynaecological oncologist who diagnoses and treats cancers of women’s reproductive system
- a gynaecologist who treats diseases of the female reproductive system
- a medical oncologist
- a radiation oncologist
- a plastic surgeon if any complex reconstructive surgery is needed
- cancer nurses
- other health professionals such as dietitian, psychologist, social worker, occupational therapist and physiotherapist.
In some cases of vulvar cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
As well as slowing the spread of vulvar cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
SCREENING FOR VULVAR CANCER
There is currently no screening for vulvar cancer available in Australia.
PROGNOSIS FOR VULVAR CANCER
Prognosis means the expected outcome of a disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.
You may wish to discuss your prognosis with your doctor. However, it is not possible for any doctor to predict the exact course of your disease. In most cases, the earlier that vulvar cancer is diagnosed, the better the chances of successful treatment.
PREVENTING VULVAR CANCER
There are no known lifestyle measures to prevent vulvar cancer, however not smoking may reduce your risk. Immunisation against HPV will also reduce your risk.