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Cancer of the vulva is a rare type of cancer that affects women.

The vulva is a woman’s external genitals. It includes:

  • the lips surrounding the vagina (labia minora and labia majora)
  • the clitoris, the sexual organ that helps women reach sexual climax
  • the Bartholin’s glands, 2 small glands each side of the vagina

Most of those affected by vulval cancer are older women over the age of 65.

The condition is rare in women under 50 who have not yet gone through the menopause.

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Symptoms of vulval cancer can include:

  • a persistent itch in the vulva
  • pain, soreness or tenderness in the vulva
  • raised and thickened patches of skin that can be red, white or dark
  • a lump or wart-like growth on the vulva
  • bleeding from the vulva or blood-stained vaginal discharge between periods
  • an open sore in the vulva
  • a burning pain when peeing
  • a mole on the vulva that changes shape or colour

See a GP if you notice any changes in the usual appearance of your vulva.

While it’s highly unlikely to be the result of cancer, these changes should be investigated.

The exact cause of vulval cancer is unclear, but your risk of developing the condition is increased by the following factors:

  • increasing age
  • vulval intraepithelial neoplasia (VIN) – where the cells in the vulva are abnormal and at risk of turning cancerous
  • persistent infection with certain versions of the human papillomavirus (HPV)
  • skin conditions affecting the vulva, such as lichen 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.

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 medicine is used to kill cancer cells, or both.

Radiotherapy and chemotherapy may be used without surgery if you’re not well enough to have an operation, or if the cancer has spread and it’s not possible to remove it all.

The outlook for vulval cancer depends on things such as how far the cancer has spread, your age, and your general health.

Generally, the earlier the cancer is detected and the younger you are, the better the chances of treatment being successful.

Overall, around 7 in every 10 women diagnosed with vulval cancer will survive at least 5 years.

But even after successful treatment, the cancer can come back.

You’ll need regular follow-up appointments so your doctor can check if this is happening.

It’s not thought to be possible to prevent vulval cancer completely, but you may be able to reduce your risk by:

  • practising safer sex – using a condom during sex can offer some protection against HPV
  • attending cervical screening appointments – cervical screening can detect HPV and precancerous conditions such as vulval intraepithelial neoplasia (VIN)
  • stopping smoking

The HPV vaccination may also reduce your chances of developing vulval cancer.

This is now offered to all girls and boys who are 12 to 13 years old as part of the routine childhood immunisation programme.

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: These factors are described in more detail below.
INCREASING AGE
The risk of developing vulval cancer increases as you get older. Most cases develop in women aged 65 or over, although very occasionally women under 50 can be affected.
VULVAL INTRAEPITHELIAL NEOPLASIA (VIN)
Vulval intraepithelial neoplasia (VIN) is a pre-cancerous condition. This means there are changes to certain cells in the vulva that aren’t cancerous, but could potentially turn into cancer at a later date. This is a gradual process that usually 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 of VIN are similar to those of vulval cancer, and include persistent itchiness of the vulva and raised discoloured patches. See your GP if you have these symptoms. There are two types of VIN:
  • usual or undifferentiated VIN – this usually affects women under 50 and is thought to be caused by an HPV infection
  • differentiated VIN (dVIN) – this is a rarer type, usually affecting women over 60, associated with skin conditions that affect the vulva
You can read more about HPV and the skin conditions associated with vulval cancer below.
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. It’s spread during sex, including anal and oral sex. There are many different types of HPV, and most people are infected with the virus at some time during their lives. In most cases, the virus goes away without causing any harm and doesn’t lead to further problems. However, HPV is present in at least 40% of women 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. It’s thought the virus could have a similar effect on the cells of the vulva, which is known as VIN.
SKIN CONDITIONS
Several skin conditions can affect the vulva. In a small number of cases these are associated with an increased risk 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. It’s estimated that less than 5% of women who develop one of these conditions will go on to develop vulval cancer. It’s not clear whether treating these conditions reduces this risk.
SMOKING
Smoking increases your risk of developing VIN and vulval cancer. This may be because smoking 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.
See 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, and examine your vulva to look for any lumps or unusual areas of skin. If you would prefer to be examined by a female doctor or you would like a nurse present during the examination, it may help to let your GP surgery 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 or ulcer, or unexplained bleeding. The gynaecologist will ask about your symptoms and examine your vulva again, and they may recommend a test called a biopsy to determine whether you do have cancer.

Biopsy

A biopsy is where a small sample of tissue is removed so it can be examined under a microscope to see if the cells are cancerous. This is often done after a local anaesthetic has been given to numb the area, which means the procedure shouldn’t be painful and you can go home the same day. Occasionally, it may be done under general anaesthetic (where you’re 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 7 to 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 colposcopy – a 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, hollow tube inserted into the bladder
  • a proctoscopy – an examination of the inside of the rectum
  • biopsies of the lymph nodes near your vulva to check 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 through out of the body), but the lymph nodes are unaffected
  • Stage 3 – the cancer has spread into nearby lymph nodes
  • Stage 4 – the cancer has spread to 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.

See 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, and examine your vulva to look for any lumps or unusual areas of skin.

If you would prefer to be examined by a female doctor or you would like a nurse present during the examination, it may help to let your GP surgery 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 or ulcer, or unexplained bleeding.

The gynaecologist will ask about your symptoms and examine your vulva again, and they may recommend a test called a biopsy to determine whether you do have cancer.

Biopsy

A biopsy is where a small sample of tissue is removed so it can be examined under a microscope to see if the cells are cancerous.

This is often done after a local anaesthetic has been given to numb the area, which means the procedure shouldn’t be painful and you can go home the same day. Occasionally, it may be done under general anaesthetic (where you’re 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 7 to 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 colposcopy – a 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, hollow tube inserted into the bladder
  • a proctoscopy – an examination of the inside of the rectum
  • biopsies of the lymph nodes near your vulva to check 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 through out of the body), but the lymph nodes are unaffected
  • Stage 3 – the cancer has spread into nearby lymph nodes
  • Stage 4 – the cancer has spread to 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.

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