Vulval cancer

How common is vulval cancer?

Vulval cancer is an uncommon disease, accounting for less than 1% of all new cancer cases in the UK. It is the 20th most common form of cancer affecting women in the UK, with about 1300 new cases being diagnosed in 2014. More than 6 out of every 10 cases (55%) in the UK each year occur in women aged 70 and over, with the highest rates being seen in women aged 90 and over. Overall, it is estimated that 1 in 275 women in the UK will be diagnosed with vulval cancer during their lifetime.

What are the risk factors?

The risk factors for vulval cancers are not well understood, largely because it is a relatively rare form of cancer, but it is estimated that about 40% of cases in the UK each year are linked to major lifestyle or other risk factors. The strongest risk factor appears to be infection with human papillomavirus (HPV), which is present in more than a third (35%) of cases in Europe. HPV infection is more likely to contribute to vulval cancer risk in younger women than in older women. Because HPV is also a major risk factor for cervical cancer, vulvar cancer rates are markedly higher among cervical cancer survivors than among women who have never had cervical cancer.

Other factors that appear to increase the risk of vulval cancer include smoking and conditions that lower the body’s ability to clear HPV infection, such as organ transplantation, autoimmune diseases such as systemic lupus erythematosus, and infection with human immunodeficiency virus (HIV).

How is vulval cancer diagnosed?

Symptoms of vulval cancer include:

• persistent itching
• pain or soreness
• thickened or discoloured patches, or open sores, on the skin of the vulva
• burning pain on passing urine
• vaginal bleeding or discharge
• a lump or swelling in the vulva or groin.

The diagnosis of vulval cancer usually involves an examination of the vulva and taking a sample of tissue (a biopsy) from the affected area.

A vulval examination should be carried out as part of a cervical smear test, as this could help to identify any abnormal cells. You can also perform a vulval examination yourself, looking for any lumps, warts or sores, or any changes in skin colour around the vulva. If you find any of these, you should have them checked at a well woman clinic or sexual health clinic as soon as possible.

If symptoms of vulval cancer are present, it may be necessary to take a biopsy to look for abnormal or cancerous cells. This can be done under local anaesthetic at an outpatient clinic, or under a general anaesthetic. A biopsy can reveal the presence of cancer or a condition called vulval intraepithelial neoplasia (VIN), in which there are abnormal cells on the surface of the vagina that could develop into cancer.

How is vulval cancer treated?

The treatment of vulvar cancer may include surgery, chemotherapy and radiotherapy. Your doctors will discuss the different options with you, to help you make the right choice for you.

VIN is usually treated by an operation called a wide local excision, in which the affected skin is removed together with an area of healthy skin around it. A drug called imiquimod may be used if VIN is present at a number of sites, rather than just a single site.

The surgical treatment of vulval cancer depends on the size of the cancer and on how much of the vulva is involved. This may involve a wide local excision, or for larger cancers it may be necessary to remove a larger part of the vulva in an operation called a partial vulvectomy. More rarely, it may be necessary to remove the whole vulva: this is called a radical vulvectomy. It may also be necessary to remove the lymph nodes around the vulva if they contain cancer cells.

Radiotherapy may be given in some circumstances before surgery to reduce the amount of cancer tissue that needs to be removed. This is called neoadjuvant radiotherapy. Alternatively, radiotherapy may be given after surgery to reduce the chance of the cancer coming back in the lymph nodes: this is called adjuvant radiotherapy. Radiotherapy may also be used instead of surgery in women who are not fit enough for an operation.

Chemotherapy may be given, alone or in combination with radiotherapy, to shrink the cancer before surgery (neoadjuvant chemotherapy) or to control advanced cancer that has spread to other organs. The most widely used drug is called cisplatin.

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