Vulval cancer

Cancer of the vulva is a rare type of cancer with less than 1,200 new cases being diagnosed each year in the UK.

Symptoms of vulval cancer include:

• the development of a noticeable lump, mass or wart-like growth on a section of the vulva
• persistent itchiness in the vulva
• pain when passing urine
• bleeding from the vulva or passing a blood-stained discharge

Read more about the symptoms of vulval cancer.

Contact your GP if you experience any of these symptoms. They're unlikely to be the result of vulval cancer, but they will require further investigation.

Types of vulval cancer

The various types of vulval cancer are classified by the type of cells the cancer first develops in.

By far the most common is known as squamous cell carcinoma, which accounts for over 90% of all cases of vulval cancer. In this type the cancer develops in cells found on the outer layer of the body.

Vulval melanoma accounts for 4% of all cases. In this type the cancer develops in the cells that give skin its colour.

Other very rare types of vulval cancer include:

• adenocarcinoma, which develops from the cells that line the glands in the vulva
• verrucous carcinoma, which is a slow-growing type of vulval cancer that looks like a wart
• sarcoma, which develops in tissue such as muscle or fat under the skin

Who is affected

There are two main groups of women affected by vulval cancer.

The largest group are older women over the age of 65 who often have a history of non-cancerous skin conditions affecting their vulva, particularly a condition called lichen sclerosus. This group account for up to four out of five cases.

The second, smaller group are younger women who have not yet gone through the menopause.

The exact cause of vulval cancer is still unclear but significant risk factors include:

• age
• smoking
• persistent infection with specific high-risk strains of the human papilloma virus (HPV) - particularly a strain known as HPV 16, which is a strain of HPV virus responsible for almost all cases of cervical cancer
• vulval intraepithelial neoplasia (VIN) – where the skin cells around the vulva experience pre-cancerous changes but "full blown" cancer has not yet developed; a minority of cases will go on to develop vulval cancer

HPV infection and VIN are responsible for the majority of cases in younger women.

Read more about the causes of vulval cancer and preventing vulval cancer.

Treatment

The main treatment for vulval cancer is surgery to remove the cancerous tissue from the vulva and to assess the lymph nodes in the groin to check if the cancer has spread.

A combination of radiotherapy and chemotherapy is used if it looks as though surgery would lead to a loss of bladder control (urinary incontinence) or bowel control (bowel incontinence). This combination is also used to slow the spread of advanced cancer if a cure is not possible, which is known as palliative care.

Read more about the treatment of vulval cancer.

Emotional impact

Any type of cancer is likely to have a considerable negative emotional impact. But developing a cancer in one of the most intimate parts of the body can be profoundly distressing for some woman.

It can also take several months to adjust to the effects of surgery – both physical and psychological.

There are a range of services that provide both practical and emotional support for people affected by vulval cancer. Read more in recovering from the effects of vulval surgery.

Outlook

The outlook for the squamous cell carcinoma type of vulval cancer is good and many women recover fully. Around 70% of women survive for at least five years after diagnosis, many will live much longer and most of them will be cured.

Squamous cell carcinomas diagnosed in the initial stages have a much higher five-year survival rate (90%) than carcinomas diagnosed in their most advanced stage (20%).

The outlook for the melanoma type of vulval cancer isn't as good. But it is difficult to estimate reliable five-year survival rates as it is such a rare type of cancer.