Vulvar cancers

There are several types of vulvar cancer, which most commonly develops in the labia minora, the inside edge of the labia majora, and the perineum. It can include the clitoris or Bartholin glands. Most women are past age 60 when they discover vulvar cancer, but it can occur in younger women.

     Types of vulvar cancer

  • Squamous cell carcinoma – thin, flat cells of the vulva, about 90 per cent of vulvar cancers, includes the rare verrucous carcinoma (looks like a slow-growing wart)
  • Vulvar melanoma – develops from melanocytes (pigment-producing cells), 2-4 per cent of vulvar cancers
  • Adenocarcinoma – develops from Bartholin glands or other mucous-producing vulvar glands, includes extramammary Paget’s disease (looks like eczema), rare
  • Sarcoma – starts in muscle, fat and other tissue in skin, faster growing than other cancers, rare
  • Basal cell carcinoma – starts in lower layers of skin, most common skin cancer, but rare type of vulvar cancer

     Symptoms of vulvar cancer

  • Itching
  • Burning
  • Soreness or pain
  • Lump or swelling, wart-like growth on the vulva
  • Thickened red, white or dark brown patches
  • Vulvar mole that changes
  • Vulvar lesions that may weep blood or pus
  • Lesions that smell unusual
  • Lesions that have an unusual colour
  • Swollen/hard lymph nodes in the groin

     Finding out what’s normal for your vulva – no surprises
Most women don’t examine their vulva so don’t know what looks normal. This means diagnosis is typically at a pelvic examination, which might be infrequent. Check yourself out regularly so you know what your vulva looks like, and then you’ll maybe catch vulvar cancer sooner.

     Risk factors for vulvar cancer

  • Vulvar intraepithelial neoplasia (VIN) – a precancerous skin change on vulvar tissue, can itch, burn or feel sore, can disappear on its own, one in three women with vulvar cancer also have VIN
  • HPV – sexually transmitted virus that can cause VIN, very common, can lead to gynaecological and anal cancers
  • Abnormal Pap test
  • Skin conditions – lichen planus or lichen sclerosus causing itching and soreness and scarring
  • Other gynaecological cancers
  • Smoking
  • Weak immune system

     Diagnosing vulvar cancer
Your doctor will diagnose you based firstly on your symptoms, then testing will be undertaken and a referral made to a specialist. A biopsy will be taken to see what changes may be occurring in your cells. Vulvar cancer can be associated with cervical cancer, so other tests will be done to confirm. Other testing may be done to check for cancer in other parts of your body.

     Vulvar cancer staging

  1. Cancer found only on the vulva or perineum
  2. Cancer is found on the vulva and/or perineum, spreading to lower urethra, lower vagina or anus
  3. Cancer is found on the vulva and/or perineum, in groin lymph nodes, regardless of spread to urethra, vagina or anus
  4. Cancer has spread to upper urethra, upper vagina or other parts of the body

     Prognosis of vulvar cancers
The outcomes of your cancer will depend heavily on the stage you are at when the cancer is discovered.

     Treatment of vulvar cancer
Treatments may include a combination of surgery, radiotherapy and chemotherapy, and in some cases topical treatments. Sometimes surgery can remove large parts of the labia, in what’s known as a radical local excision, which can result in a radical vulvectomy – the entire vulva is removed. Lymph nodes may also be removed. In serious cases, a pelvic exenteration may be recommended, which is where all affected organs in the pelvis are removed – that could mean the bowel, bladder, uterus and vagina, with stomas (openings) created for urine and faeces to be collected in bags.

Reconstructive surgery is a part of these types of surgery, to recreate the most normal appearance possible, and as much function as possible.

If a cure isn’t an option, palliative care will be offered.

     Emotional support
Losing part of your vulva or other pelvic organs comes with a period of grieving, so make sure you have emotional support. There are support forums online, where you can talk with other women who have been through a similar process. A therapist would also likely be useful for many people.