Health A to Z
Cancer of the vulva is a rare type of cancer that affects women. Around 1,200 new cases are diagnosed each year in the UK.
The vulva is a woman's external genitals. It includes the lips surrounding the vagina (labia minora and labia majora), the clitoris (sexual organ that helps women reach sexual climax), and the Bartholin's glands (two 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.
Symptoms of vulval cancer can include:
See your 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.
Read more about diagnosing vulval cancer.
The exact cause of vulval cancer is unclear, but your risk of developing the condition is increased by the following factors:
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.
Read more about the causes of vulval cancer.
The main treatment for vulval cancer is surgery to remove the cancerous tissue from the vulva and any lymph nodes containing cancerous cells.
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 isn't possible to remove it all.
Read more about treating vulval cancer.
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 6 in every 10 women diagnosed with vulval cancer will survive at least five years. However, even after successful treatment, the cancer comes back in up to one in every three cases. 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:
The HPV vaccination may also reduce your chances of developing vulval cancer. This is now offered to all girls who are 12 to 13 years old as part of their 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 factors are described in more detail below.
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) 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:
You can read more about HPV and the skin conditions associated with vulval cancer below.
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.
Several skin conditions can affect the vulva. In a small number of cases these are associated with an increased risk of vulval cancer.
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 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.
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.
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.
If the results of the biopsy show cancer, you may need further tests to assess how widespread it is.
These may include:
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.
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 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.
Treatment for vulval cancer depends on factors such as how far the cancer has spread, your general health, and personal wishes.
If your cancer is at an early stage, it's often possible to get rid of it completely. However, this may not be possible if the cancer has spread.
Even after successful treatment, there is up to a one in three chance of the cancer returning at some point later on, so you'll need regular follow-up appointments to check for this.
Most hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Members of your MDT will probably include a specialist surgeon, a specialist in the non-surgical treatment of cancer (clinical oncologist) and a specialist cancer nurse.
Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.
In most cases, your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer.
There are three surgical options to treat vulval cancer:
The time it will take you to recover from surgery will depend on the type of surgery and how extensive it was. For extensive operations, such as a pelvic exenteration, it may be many weeks or months before you start to feel better.
You surgeon will talk to you about the possible risks associated with the type of procedure you're having. Possible risks include infection, bleeding, blood clots, altered sensation in your vulva, and problems having sex.
An additional operation may also be required to assess whether the cancerous cells have spread into one or more lymph nodes in your groin, and remove these if they're found to contain cancer. This may involve one or more of the procedures outlined below.
If the cancer has spread to nearby lymph nodes, it's sometimes possible to only remove certain lymph nodes, known as sentinel nodes.
Sentinel nodes are identified by injecting a dye at the site of the tumour and studying its flow to locate the nodes closest to the tumour. These are then removed and checked for cancerous cells.
In some cases, some or all of the nodes in your groin may need to be surgically removed. This is called a groin or inguinofemoral lymphadenectomy. Further treatment with radiotherapy may also be recommended.
Removing cancerous lymph nodes reduces the risk of the cancer returning, but it can make you more vulnerable to infection and cause swelling in your legs from a build-up of lymphatic fluid (lymphoedema).
In cases of advanced vulval cancer or where the cancer returns after previous treatment, an operation called a pelvic exenteration may be recommended. This involves removing your entire vulva as well as your bladder, womb and part of your bowel. This is a major operation and isn't carried out very often these days.
If a section of your bowel is removed, it will be necessary for your surgeon to divert your bowel through an opening made in your tummy (a stoma). Stools then pass along this piece of bowel and into a bag you wear over the stoma. This is known as a colostomy.
If your bladder is removed, urine can be passed out of your body into a pouch via a stoma. This is known as a urostomy. Alternatively, it may be possible to create a new bladder by removing a section of your bowel and using it to create a pouch to store urine in.
If only a small amount of tissue has been removed during surgery, the skin of the vulva can often be neatly stitched together.
Otherwise, it may be necessary to reconstruct the vulva using a skin graft, where a piece of skin is taken from your thigh or tummy and moved to the wound in your vulva. Another option is to have a skin flap, where an area of skin near the vulva is used to create a flap and cover the wound.
These reconstructive procedures are usually carried out at the same time as the operation to remove the cancer.
Radiotherapy involves using high-energy radiation to destroy cancerous cells. There are several ways it can be used to treat vulval cancer:
In most cases, you'll have external radiotherapy, where a machine directs beams of radiation on to the section of the body that contains the cancer.
This is normally given in daily sessions, five days a week, with each session lasting a few minutes. The whole course of treatment will usually last a few weeks.
While radiation is effective in killing cancerous cells, it can also damage healthy tissues. This can lead to a number of side effects, such as:
In younger women, external radiotherapy can sometimes trigger an early menopause. This means they will no longer be able to have any children.
Read more about the side effects of radiotherapy.
Chemotherapy is where medication is used to kill cancer cells. It's usually given by injection.
It's usually used if vulval cancer comes back or to control symptoms when a cure is not possible. Sometimes it may be combined with radiotherapy.
The medicines used in chemotherapy can sometimes damage healthy tissue, as well as the cancerous tissue. Side effects are common and include:
These side effects should pass once treatment has finished.
Read more about the side effects of chemotherapy.
The emotional impact of living with vulval cancer can be significant. Many people report experiencing a kind of rollercoaster effect. You may feel down at receiving a diagnosis, feel up when the cancer has been removed from your body, and then feel down again as you try to come to terms with the after-effects of surgery.
Some people experience feelings of depression. If you think you may be depressed, contact your GP or care team for advice. There are a range of treatments that can help.
You may also find it useful to contact one of the main cancer charities, such as:
Read more about living with cancer.