Vulval cancer is skin cancer that develops around the opening of a woman’s vagina.
Vulval cancer is rare in women under the age of 40 years. You can lower your risk of developing this type of cancer by having the HPV vaccination. If you notice a persistent lump, ulcer or bleeding from your vulva, see your doctor straight away.
What causes vulval cancer?
The most common cause of vulval cancer is infection with the Human Papilloma Virus (HPV). HPV is a common sexually transmitted infection that causes most cases of cervical cancer and is responsible for about 50% of vulval cancers.
Practising safe sex by using condoms can help prevent the spread of HPV. However, the best way to prevent HPV infection is to be immunised against it before you become sexually active. A vaccination is available in New Zealand to boys and girls free of charge. Read more about HPV and the HPV vaccination.
Other causes of vulval cancer:
- Immune deficiency – our immune system is designed to prevent infection and stop cancer. People who have a weak or deficient immune system are more prone to vulval cancer. Some of the more common causes of immune deficiency are medical treatment with steroids, organ transplantation, treatment for another type of cancer and HIV.
- Smoking weakens the immune system and increases the risks of many different cancers.
- Lichen sclerosis is an autoimmune disorder that causes irritation, swelling and redness. It can occur in any area of skin but usually on the labia in women. The condition can usually be well controlled but it does increase the risk of vulval cancer, especially if it is not treated.
- Melanoma – although vulval skin cancer due to sun exposure is rare, melanoma can occur in the vulva.
What are the symptoms of vulval cancer?
The most common symptoms of vulval cancer are a lump, irritation or an ulcer. These can also be caused by other problems, such as lichen sclerosis, recurrent thrush (candida) or herpes infection, but you should still see your GP. Even if the problem is not cancer there are treatments for all of these conditions that can improve your quality of life.
How is vulval cancer diagnosed?
See your doctor if you notice a lump that won’t go away, or an ulcer or unusual bleeding (ie, not your period) from your vulva. Your doctor will talk to you about your symptoms and will examine the area to decide if further investigations or a referral to a specialist is required.
The main way of diagnosing vulval cancer is by taking a tiny skin biopsy of the affected area. This can be performed under local anaesthetic.
How is vulval cancer treated?
Treatment of vulval cancer will depend on what stage the cancer is at. All cancers usually start in one small localised area of the body and then spread. Usually, it spreads first to the lymph glands nearby and then to distant parts of the body. The aim of any cancer treatment is to remove the cancer before it has spread.
Local excision – most women with vulval cancer will require surgery. If the cancer is only on, only the affected skin will be removed and the chance of a cure is very good.
Simple vulvectomy and lymphadenectomy – if the cancer is more advanced, then the local lymph glands may also need to be removed to make sure the cancer hasn’t spread any further. This is called a lymphadenectomy.
Radical vulvectomy – this treatment involves the removal of most of the skin around the vagina plus the lymph nodes in the groin area. It is specialised surgery. In this procedur, the clitoris and vulva will be removed. This will have a significant effect upon a woman’s ability to have sex but usually bladder and bowel function will not be affected.
Radiation treatment is often used after surgery to improve the chance of long-term survival in early cases of cancer. This type of treatment is called adjuvent therapy, which means additional therapy. Occasionally combined radiotherapy and chemotherapy is given before surgery so that the surgery is more likely to remove all of the tumour.
Chemotherapy is also used as adjuvent therapy and is used more often in more advanced cases of cancer. Chemotherapy does often cause a number of side effects, such as hair loss, gastrointestinal problems and a lowering of the immune system.
The emotional impact of living with vulval cancer and life after surgery for vulval cancer can be challenging. There is no easy answer for how to best cope with vulval cancer, but the following may help:
- Ask lots of questions and learn as much as you can about vulval cancer and the treatment you require. This will help you to feel more involved in the decision-making process.
- Talk to someone about your feelings. When you are ready, find a trusted person to talk to about your hopes and fears. This may be a support worker, counsellor, a close friend or a spiritual advisor.
- Connect with other cancer survivors. Talking to other people who have been through the experience you are going through can be helpful. Ask your treatment team about support groups or online forums you can join.
- Don't be afraid of sexual intimacy. It's normal to feel anxious or self-conscious about having sex after treatment for vulval cancer. Try to talk to your partner about how you are feeling. You may also find it helpful to see a therapist. Remember there are many ways to be sexually intimate, such as touching, hugging, caressing and holding.
How can I reduce my risk of vulval cancer?
- Practice safe sex at all times and at all stages of your life
- Protect yourself or your children from HPV by being immunised
- If you smoke, then quit smoking
- See you GP if you have vulval itchiness, lumps or ulcers.
|Dr Jeremy Tuohy is an Obstetrician and Gynaecologist with a special interest in Maternal and Fetal Medicine. Jeremy has been a lecturer at the University of Otago, Clinical leader of Ultrasound and Maternal and Fetal Medicine at Capital and Coast DHB, and has practiced as a private obstetrician. He is currently completing his PhD in Obstetric Medicine at the Liggins Institute, University of Auckland.|