Cancer of the vulva

Saturday 1 October, 2016

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On this page: What is vulvar cancer? | What are the symptoms? | How common is it? | What are the risk factors? | Which health professionals will I see? | Diagnosis | Staging | Prognosis | Treatment | Key points


This section discusses symptoms, risk factors, diagnosis and treatment for vulvar cancer (also known as vulval cancer or cancer of the vulva). See information about side effects.

What is vulvar cancer?

Vulvar cancer can start in any part of the external female sex organs (genitals). It most commonly develops in the labia minora, the inner edges of the labia majora, and the perineum. Less often, it involves the clitoris or Bartholin glands.

Types of vulvar cancer
Squamous cell carcinoma (SCC)
  • starts in thin, flat (squamous) cells that line the vulva
  • makes up about 90% of vulvar cancers
  • includes verrucous carcinoma, a rare type of vulvar cancer that looks like a large wart and grows slowly
Vulvar melanoma
  • a type of skin cancer that develops from the cells that give the skin its colour (melanocytes)
  • makes up about 2–4% of vulvar cancers
Adenocarcinoma
  • develops from the mucus-producing (glandular) cells in the Bartholin glands or other vulvar glands
  • includes extramammary Paget’s disease, which looks like eczema
  • a rare type of vulvar cancer
Sarcoma
  • starts in muscle, fat and other tissue under the skin
  • tends to grow faster than other vulvar cancers
  • a rare type of vulvar cancer
Basal cell carcinoma (BCC)
  • starts in tall cells in the lower layer of the skin
  • the most common form of skin cancer, but a very rare type of vulvar cancer

What are the symptoms?

Women with early vulvar cancer may have few obvious symptoms, but most women are diagnosed after a long history of vulvar symptoms. These may include one or more of the following:

  • itching, burning and soreness or pain in the vulva
  • a lump, sore, swelling or wart-like growth on the vulva
  • thickened, raised skin patches (may be red, white or dark brown)
  • a mole on the vulva that changes shape or colour
  • blood, pus or other discharge coming from a lesion or sore spot, which may have an offensive or unusual odour or colour (not related to your menstrual period)
  • hard or swollen lymph nodes in the groin area.

Many women don’t examine their vulva, so they don’t know what is normal for them. The vulva can be difficult to see without a mirror, and some women feel uncomfortable examining their genitals. However, if you feel any pain in your genital area or notice any of the symptoms listed above, visit your general practitioner (GP).

How common is it?

Each year, about 300 Australian women are diagnosed with vulvar cancer. It most commonly affects women who have gone through menopause, and the average age at diagnosis is 67.2 However, vulvar cancer can occur in younger women.

"When you connect with another woman who has had vulvar cancer, you soon find out that there is no need for shame or embarrassment." – Jane

What are the risk factors?

The exact cause of vulvar cancer is unknown, but some factors increase the risk of developing it:

Vulvar intraepithelial neoplasia (VIN)

This is a precancerous condition that causes changes in the skin of the vulva. The vulva may itch, burn or feel sore. VIN may disappear on its own, but most women with VIN need some treatment. The condition sometimes becomes cancerous – about one in three women with vulvar cancer also has VIN.

Human papillomavirus (HPV)

Also known as the wart virus, HPV is a sexually transmitted infection that can cause women to develop VIN. It can be many years between the initial infection with HPV and the first signs of VIN or vulvar cancer. HPV is a very common virus and most women with HPV don’t develop vulvar or any other type of cancer.

HPV has been linked to a number of cancers, including vulvar, vaginal, cervical, anal and oral cancers. Studies have shown that HPV vaccination can reduce the risk of having abnormal cell changes that may lead to cancer, even in older women. Talk to your doctor about whether the HPV vaccination may be of benefit to you.

Abnormal Pap test

If a woman has had any abnormal cell changes detected on a Pap test, she has a slightly higher risk of developing vulvar cancer.

Other skin conditions

Some skin conditions such as vulvar lichen planus and vulvar lichen sclerosus can cause itching and soreness. If not treated, these conditions can cause permanent scarring. In a small number of women, they may develop into cancer after many years.

Other cancers

Women who have had cervical cancer or vaginal cancer have an increased risk of developing vulvar cancer.

Smoking

Cigarette smoking increases the risk of developing VIN and vulvar cancer. This may be because smoking can make the immune system work less effectively.

Weakened immune system

Women who have had an organ transplant or who have human immunodeficiency virus (HIV) may be at higher risk of developing vulvar cancer because their immune system is not working normally.

Although HPV is sexually transmitted, vulvar cancer itself is not contagious and it can’t be passed on to other people through sexual contact. It is also not caused by an inherited faulty gene, so it can’t be passed on to children.

Which health professionals will I see?

Your GP will probably arrange the first tests to assess your symptoms. You will then be referred to a gynaecologist or gynaecological oncologist.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team or MDT. The table below lists some of the health professionals you may see.

MDT health professional Role
GP explains information provided by specialists; assists you with treatment decisions; helps you obtain practical and emotional support; and works in partnership with your specialists in providing your ongoing care
gynaecologist* specialises in treating diseases of the female reproductive system; may diagnose vulvar or vaginal cancer and then refer you to a gynaecological oncologist
gynaecological oncologist*
specialises in diagnosing and treating cancers of the female reproductive system (gynaecological cancers), such as vulvar and vaginal cancers
radiation oncologist* prescribes and coordinates the course of radiotherapy
medical oncologist* prescribes and coordinates the course of chemotherapy
reconstructive/plastic surgeon*
specialises in complex surgical techniques to restore the appearance of the genitals after the cancer is removed
nurses
administer treatment and provide care, information and support throughout treatment
cancer care coordinator, clinical nurse consultant (CNC) or cancer nurse specialist
coordinates your care; liaises with other members of the MDT; and supports you and your family throughout treatment
nurse practitioner
nurse who has had additional training and may be able to prescribe some medicines and refer you to other health professionals
consultant psychiatrist*, clinical psychologist, counsellor helps you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sexuality
social worker
links you to support services and helps you with emotional or practical issues
dietitian
recommends the best eating plan to follow while you are in treatment and recovery
physiotherapist
helps manage physical problems, such as weak pelvic floor muscles and pain
occupational therapist
assists in adapting your living and working environment to help you resume activities

*Specialist doctor

Diagnosis

If you have any of the symptoms listed above, your first step will be to visit your GP, who will conduct initial tests. If you need further tests, the GP will refer you to a specialist such as a gynaecologist or gynaecological oncologist.

Tests to diagnose vulvar cancer

The main tests used to diagnose vulvar cancer are a physical examination, a procedure called a colposcopy (see opposite), and the removal of a tissue sample (biopsy). Because vulvar cancer is sometimes associated with cervical cancer, the doctor may check for abnormal cells in the vagina and cervix as part of these initial tests.

Physical examination

Your doctor will examine your groin and pelvic area, including the genitals. You will remove your clothing from the waist down and lie on a table with your knees bent and legs apart. If you feel worried about this examination, let your doctor know. A nurse may be present during the examination, but you can also ask for a family member to be in the room.

Although the vulva is the outer part of your genitals, the doctor may also do an internal examination at the same time to check your vagina and cervix. This involves the doctor gently inserting an instrument with smooth, curved sides (speculum) into your vagina. A lubricant is used to make the speculum easier to insert. The sides of the speculum spread the vaginal walls apart so the doctor can see the vagina and cervix. This examination may be done under a general anaesthetic if you have a skin condition such as lichen planus or lichen sclerosus that has narrowed the vagina.

Viewing the vulva and vagina

The colposcope is an instrument used to view the cervix, vagina and vulva. It is not put into your body.

Colposcopy

Colposcope - an instrument used to view the cervix, vagina and vulva.To examine the vulva and vagina in detail, the doctor uses a magnifying instrument called a colposcope. The colposcope does not go into the vagina; the doctor looks through it from the outside. A colposcopy that examines the vulva is sometimes called a vulvoscopy, and one that examines the vagina may be called a vaginoscopy.

You will lie on your back on an examination table with your knees up and apart. The doctor will apply a vinegar-like liquid or iodine to your vulva and vagina, which makes it easier to see abnormal cells through the colposcope. This may sting or burn, and you may have a brown discharge afterwards. During a colposcopy, the doctor will usually take a biopsy (see below) from the vulva and/or the vagina.

You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours before a colposcopy. Talk to your doctor about whether you should take over-the-counter pain relief about an hour before the procedure to ease discomfort.

"I felt uncomfortable for a few days after having the colposcopy and biopsy but a hot water bottle and mild painkillers helped." – Gina
Biopsy

During the colposcopy, your doctor will usually take a small tissue sample (biopsy) from the vulvar and possibly also the vaginal area. A biopsy is the best way to diagnose vulvar cancer.

The doctor may put a local anaesthetic into the affected area of your vulva to numb it before the biopsy. There should not be any pain when the sample is taken, but you may feel a little discomfort.

Afterwards, your vulva may bleed a little, and sometimes stitches are needed to close up the wound. Ask your doctor how much bleeding to expect after the biopsy, and how to care for the wound to keep it from becoming infected. You may have some soreness, which can be relieved by taking painkillers, and will be advised not to have sex or put anything in your vagina for 24 hours after the colposcopy.

The tissue sample will be sent to a laboratory, and a specialist called a pathologist will examine the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of vulvar cancer it is.

If large areas of the vulva look suspicious, you may have several biopsies taken under general anaesthetic. This is known as vulvar mapping and it helps the doctor plan the best treatment for you.

Pap test

If you haven’t had one recently, your doctor may do a Pap test (also called a Pap smear) to check the cells inside the vagina and cervix. This will be done during the internal examination while the speculum is in place. A small brush or swab is used to remove some cells from the surface of the cervix. This tissue sample is sent to a laboratory to check for abnormalities.

Further tests

Sometimes further tests are needed to determine your general health, the size and position of the cancer, and whether the cancer has spread. These tests may include:

Blood test

This checks the number of cells in your blood, and how well your kidneys and liver are working.

Chest x-ray

A painless scan that produces a detailed image of your lungs.

Cystoscopy

The doctor uses a slender tube with a camera and light (cystoscope) to look inside the urethra and bladder. This can be done under local or general anaesthetic.

Proctoscopy

The doctor uses a slender tube with a camera and light (proctoscope) to look inside the rectum and anus. This can be done under local or general anaesthetic.

CT scan

A computerised tomography scan. This scan uses x-rays and a computer to create detailed, cross-sectional pictures of the inside of your body. Before the scan, you may be given a drink or injection of a dye called contrast that makes the pictures clearer. If you have the injection, you may feel hot all over for a few minutes.

The CT scanner is large and round like a doughnut. You will lie on a flat table that moves in and out of the scanner. The scan is painless and takes 5–10 minutes.

MRI scan

A magnetic resonance imaging scan. This type of scan uses a powerful magnet and radio waves to create detailed, cross-sectional pictures of the inside of your body. Sometimes, dye will be injected before the scan to make the pictures clearer.

You will lie on a treatment table that slides into a metal cylinder that is open at both ends. The machine can be quite noisy, but you will usually be given earplugs or headphones. Some people feel anxious lying in the narrow cylinder. Tell your medical team beforehand if you feel concerned, as they may offer you some medicine to help you relax.

The dye used in a CT or MRI scan usually contains iodine. If you have had a reaction to the dye in a previous scan, tell your medical team beforehand. You should also let them know if you are diabetic, have kidney disease, are pregnant or have a pacemaker.

Staging vulvar cancer

Based on the test results, your doctor will be able to tell you the stage of the cancer. This is a way to describe its size and whether and how far it has spread. In Australia, vulvar cancer is usually staged using the staging system from the International Federation of Gynecology and Obstetrics (FIGO).

  • Stage I: Cancer is found only in the vulva or perineum.
  • Stage II: Cancer is found in the vulva and/or perineum and has also spread to the lower urethra, the lower vagina or the anus.
  • Stage III: Cancer is found in the vulva and/or perineum and in lymph nodes of the groin (it can be stage III whether or not it has spread to the urethra, vagina or anus).
  • Stage IV: Cancer has spread to the upper urethra, upper vagina or more distant parts of the body.

Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may develop. Low- grade (grade 1) cancer cells are slow growing and are less likely to spread. High-grade (grade 3) cells look more abnormal, and are more likely to grow and spread quickly.

Knowing the stage and grade of the cancer helps your medical team recommend the most appropriate treatment.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Instead, your doctor can give you an idea about common issues that affect women with vulvar cancer.

Some women with vulvar cancer may want to know the statistics for women in similar situations, while others may not find the numbers helpful. Do what feels right for you.

In most cases, the earlier that vulvar cancer is diagnosed, the better the chances of successful treatment. To work out your prognosis, the doctor will consider:

  • your test results
  • the type of vulvar cancer you have
  • the stage and grade of the cancer
  • how well you respond to treatment
  • other factors such as age, general fitness and medical history.

In some cases, the doctor will not have enough information to assess prognosis until after the surgery to remove the cancer (see below).

Cancer Council produces information booklets on surgery, radiotherapy and chemotherapy. Call 13 11 20 for free copies.

"My partner’s support was invaluable during treatment and recovery. I know things were difficult – it’s not easy to see someone you love go through such a hard time. But we got through it together." – Nikki

Treatment

Vulvar cancer usually takes many years to develop but, like other types of cancer, it is easier to treat at an early stage. Treatment may involve surgery, radiotherapy and chemotherapy. You may have one of these treatments or a combination.

Surgery

Surgery is the main treatment for vulvar cancer. The type of operation you have depends on the stage of the cancer. One of the following types of surgery may be done:

Wide local excision

In this operation, the surgeon removes the cancerous part of your vulva and about a 1 cm border of healthy tissue around the cancer (called the margin).

Radical local excision

The surgeon cuts out the cancer and a larger area of normal tissue all around the cancer. The nearby lymph nodes in the groin may also be removed (see below).

Partial vulvectomy

The affected part of the vulva is removed. The surgeon may also take out some healthy tissue around the cancerous tissue (a wide local excision). This may mean that a significant portion of the vulva is removed.

Radical vulvectomy

The surgeon removes the entire vulva, sometimes including the clitoris. Usually, nearby lymph nodes are also removed (lymph node dissection).

Lymph node dissection

The lymph nodes (also called lymph glands) are part of the lymphatic system. Vulvar cancer typically spreads first to the lymph nodes in the groin, so these nodes are often removed from one or both sides of the groin. This is called an inguinal lymph node dissection.

Sometimes, the removal of lymph nodes in the groin can stop or slow the natural flow of lymphatic fluid. When this happens, it can cause one or both legs to swell. This is known as lymphoedema.

Sentinel lymph node biopsy

Before a lymph node dissection, the surgeon may perform a sentinel lymph node biopsy. You will have an anaesthetic and an injection of radioactive dye near the site of the cancer. This test helps to identify the lymph node most likely to be the first to have cancer spread to it. The dye will flow to this node, and the surgeon will remove it and determine whether it’s necessary to remove more lymph nodes.

A sentinel lymph node biopsy can help the doctor avoid removing more lymph nodes than necessary and thus minimise side effects such as lymphoedema (see above). Your doctor will talk to you about this type of biopsy and the associated risks.

Pelvic exenteration

This operation is no longer commonly done for vulvar cancer, but may sometimes be considered for advanced cancer that has spread beyond the vulva. A pelvic exenteration removes all the affected organs, such as the lower bowel, bladder, uterus and vagina. Because the bladder and bowel are removed, the surgeon will make two openings (stomas) in the abdomen so that urine and faeces can be collected in stoma bags. Your surgeon will only recommend this surgery if you are fit enough to make a good recovery.

Reconstructive surgery

The surgeon will aim to remove all of the vulvar cancer while preserving as much normal tissue as possible. However, it is essential to remove a margin of healthy tissue around the cancer to reduce the risk of the cancer coming back (recurring) in the same area.

It is usually possible to stitch the remaining skin together, but if a large area of skin is removed, you may need a skin graft or skin flap. To do this, the surgeon may take a thin piece of skin from another part of your body (usually your thigh or abdomen) and stitch it onto the operation site. It may be possible to move flaps of skin in the vulvar area to cover the wound. The graft or flap will be done as part of the initial operation, sometimes with the involvement of a reconstructive (plastic) surgeon.

"I asked my husband to take pictures of my vulva so we could see it and talk about what happened. This helped him understand what I’d been through." – Trudy
What to expect after surgery

Your recovery time after the operation will depend on the type of surgery you have. If a small amount of skin is removed, the wound will probably heal quickly. If your lymph nodes are removed or the surgery is more extensive, recovery will take longer.

Pain
  • You will be given medicine to reduce any pain.
  • For the first day or two, pain medicine may be given by injection into a muscle; by a drip into a vein (intravenous or IV drip); by a drip into a space around the spinal cord (epidural), which numbs the body from the waist down; or by injection into specific nerves during or after the surgery (nerve block).
  • When you are ready, you will switch to pain-relieving pills or tablets. After you go home, you can continue taking these for as long as needed.
  • Strong pain medicines and long periods in bed can make bowel motions difficult to pass (constipation). Talk to your treatment team about this, as medication can help.
Tubes and stitches
  • You may have a tube called a catheter to drain urine from your bladder. This helps keep your wound clean and dry. It will be removed before you leave hospital.
  • There may be a surgical drain placed in the wound to draw fluid away from the incision. The drain needs to stay in until it is not draining too much fluid, so you may go home with the drain still in place. If this is the case, community nurses can help you manage the care of the drain at home until it is removed.
  • Your doctor will tell you how soon you can sit following surgery and how to walk to avoid the stitches coming apart. Stitches usually dissolve and disappear as the wound heals. Otherwise, they will be removed within a couple of weeks.
  • Some surgeons use surgical glue instead of stitches. The glue falls off when the wound is healed.
Wound care
  • Infection rates after vulvar surgery are very high, so it is vital to keep the area clean and dry.
  • While you are in hospital, the nurses will wash and dry the vulva for you a few times a day. They may also apply an ointment to help prevent infection.
  • The nurses will show you how to look after the wound at home. You will need to wash it two to three times a day using a handheld shower or a shallow basin (sitz bath).
  • Dry the vulva well. If the area is numb, be careful patting it dry. Some women use a hair dryer (on a low heat setting and at a safe distance).
  • To ventilate the wound, wear loose fitting clothing and try not to wear underwear.
  • Report any redness, pain, swelling, wound discharge or unusual odour to your surgeon or nurse.

Do not put anything into the vagina after the surgery until your doctor says the area is healed (usually 6–8 weeks). This includes using tampons and having sexual intercourse.

Recovering from surgery at home

When you return home from hospital after surgery for vulvar cancer, there will be a period of recovery and adjustment.

Rest

Get plenty of rest in the first week after you return home. Take it easy and only do what is comfortable. However, avoid sitting for long periods of time as this can put pressure on the wound.

Emotions

If you have lost part of your genital area, you may feel a sense of loss and grief. You can call Cancer Council 13 11 20 for support.

Exercise

Check with your surgeon or nurse about when you can start doing your regular activities. You may not be able to lift anything heavy or drive for 6–8 weeks, but gentle exercise such as walking can speed up recovery.

Using the toilet

If the opening to your urethra is affected, you may find that going to the toilet is different. The urine stream might spray in different directions or go to one side.

Sexuality

You may feel concerned about the impact on your sex life.

Radiotherapy

Radiotherapy uses radiation, such as x-rays, to kill or damage cancer cells. It is also known as radiation therapy. Whether you have radiotherapy will depend on the stage of the cancer, its size, whether it has spread to the lymph nodes and, if so, how many nodes are affected. You can have radiotherapy:

  • before surgery to shrink the cancer and make it easier to remove (neo-adjuvant treatment)
  • after surgery to get rid of any remaining cancer cells and reduce the risk of the cancer coming back (adjuvant treatment)
  • instead of surgery
  • to control symptoms of advanced cancer (palliative treatment).
External radiotherapy

Also called external beam radiotherapy (EBRT), this is the most common radiotherapy for vulvar cancer. You will lie on a treatment table while a machine, called a linear accelerator, directs radiation towards the areas of the vulva that are affected or at risk. Treatment is usually given daily, Monday to Friday, over 5–6 weeks. The number of sessions will depend on the type and size of the cancer. Each session takes about 20 minutes.

Radiotherapy to the vulva and groin is painless, but it can cause side effects (see below). External radiotherapy will not make you radioactive. It is safe for you to be with other people, including children, after your treatment.

Internal radiotherapy

Also called brachytherapy, this delivers radiotherapy to the tumour from inside your body. It is not used often for vulvar cancer.

Side effects of radiotherapy

The side effects you experience will vary depending on the radiotherapy dose and areas treated. Many will be short-term side effects that occur during treatment or within a few weeks of finishing.

Side effects often get worse 1–2 weeks after the end of treatment, before starting to get better. Some side effects may continue for longer or they may be late effects, not appearing until some time after treatment.

Short-term side effects
  • Fatigue
    Your body uses a lot of energy to heal itself after the treatment, and travelling to treatment can also be tiring. The fatigue may last for weeks after treatment ends.
  • Bowel and bladder problems
    Radiotherapy can irritate the bowel and bladder. Bowel motions may be more frequent or urgent or may become loose (diarrhoea), or you may pass more wind than normal. Less commonly, women may have some blood in the stools (faeces), but always tell your doctor about any bleeding. You may also pass urine more often or have a burning sensation when you pass urine.
  • Nausea and vomiting
    Because the radiotherapy is directed near your abdomen, you may feel sick (nauseous), with or without vomiting, for several hours after each treatment. Your doctor may prescribe anti-nausea medicine to help prevent this.
  • Vaginal discharge
    Radiotherapy may cause or increase a vaginal discharge. Let your treatment team know if it is foul smelling or bloody. Do not wash inside the vagina with douches as this may cause infection.
  • Skin redness, soreness and swelling
    The vulva may become sore and swollen. It may start by being pink or red and feeling itchy, and progress to peeling, blistering or weeping. Your treatment team will recommend creams and pain relief to use until the skin heals. Wash the area with lukewarm water or weak salt baths, and avoid perfumed products and talcum powder.
Long-term or late effects
  • Hair loss
    You may lose your pubic hair. For some women, this can be permanent. It will not affect the hair on your head or other parts of your body.
  • Bowel and bladder changes
    Bowel changes, such as diarrhoea or wind, and bladder changes, such as frequent or painful urination, can also be late effects, appearing some weeks after radiotherapy finishes. In rare cases, blockage of the bowel can occur, so it is important to let your doctor know if you have pain in the abdomen and cannot open your bowels.
  • Lymphoedema
    Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly from the legs, making the legs swollen. This can occur months or years after radiotherapy, and it is easier to treat if recognised early.
  • Narrowing of the vagina
    The vagina can become dryer, shorter and narrower (vaginal stenosis), which may make sex and follow-up pelvic examinations uncomfortable or difficult. Your treatment team will suggest strategies to prevent this, such as the use of vaginal dilators.
  • Menopause
    In premenopausal women, radiotherapy to the pelvis can stop the ovaries producing hormones, and this causes early menopause. Your periods will stop, you will no longer be able to become pregnant and you may have menopausal symptoms. Talk to your radiation oncologist about any menopause or fertility issues before treatment.
Chemotherapy

Chemotherapy uses drugs known as cytotoxics to kill or slow the growth of cancer cells. For women with vulvar cancer, treatment may be given:

  • during a course of radiotherapy, to make the radiotherapy treatment more effective
  • to control cancer that has spread to other parts of the body
  • as palliative treatment, to relieve the symptoms of the cancer.

Chemotherapy may be given as tablets, in a cream applied to the vulva or, more commonly, by injection into a vein (intravenously).

Most women have several treatment sessions (a cycle), followed by a break. Treatment can often be given to you during day visits to a hospital or clinic as an outpatient, but sometimes you may need to stay in hospital for a few nights.

Side effects of chemotherapy

There are many different types of chemotherapy drugs. The side effects will vary depending on the drugs you are given, the dosage and your individual response. Your medical oncologist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medication.

Common side effects experienced after chemotherapy for vulvar cancer include:

  • feeling sick (nausea)
  • tiredness (fatigue)
  • a reduced resistance to infections.

Chemotherapy for vulvar cancer may also increase any skin soreness caused by radiotherapy. Some women find that they are able to continue with their usual activities during treatment, while others find they need to take things more slowly.

For more information, see Understanding Chemotherapy or call Cancer Council 13 11 20.

Palliative treatment

In some cases of advanced vulvar cancer, the medical team may talk to you about palliative treatment. Palliative treatment helps to improve quality of life by alleviating symptoms of cancer. It can be used at any stage of advanced cancer.

As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs.

For more information see palliative care or advanced cancer or call Cancer Council 13 11 20.

Key points

  • Vulvar cancer is also known as vulval cancer or cancer of the vulva. There are several types of vulvar cancer.
  • Symptoms may include burning, itching, pain, a lump, coloured skin patches, or a mole that changes in colour.
  • A condition known as vulvar intraepithelial neoplasia (VIN) can increase the risk of developing vulvar cancer.
  • Tests for vulvar cancer include a physical examination of the groin and pelvic area, a biopsy and scans.
  • The cancer’s stage describes its size and whether and how far it has spread. The grade tells how quickly it is growing.
  • The prognosis is the expected outcome of the disease. In general, the earlier vulvar cancer is diagnosed, the better the outcome.
  • You may see a range of health professionals, including a gynaecologist or gynaecological oncologist.
  • Surgery is the main treatment for vulvar cancer. The type of operation you have depends on the stage of the cancer. The lymph nodes in the groin may also be removed.
  • Radiotherapy uses radiation to kill cancer cells. The most common type of radiotherapy for vulvar cancer is external radiotherapy. Side effects may be short-term or long-term or may appear later.
  • Chemotherapy uses cytotoxic drugs to kill or damage cancer cells. Side effects can include nausea and fatigue.
  • For advanced vulvar cancer, palliative treatment can help with symptoms and improve quality of life. It is an important part of palliative care.

Reviewed by: Professor Selvan Pather, Senior Staff Specialist, Chris O’Brien Lifehouse, NSW; Dr Tiffany Daly, Radiation Oncologist, Mater Cancer Care Centre, South Brisbane, QLD; Anne Mellon, Gynaecological Clinical Nurse Consultant, Gynaecological Oncology, Hunter New England Centre for Gynaecological Cancer, and Chair, Gynaecological Oncology Specialist Practice Network, Cancer Nurses Society of Australia, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, SA; Juliane Samara, Gynaecological and Brain/Central Nervous System Tumour Cancer Specialist Nurse, Canberra Region Cancer Centre, ACT; Robyn Teuma, Consumer; Dr Charlotte Tottman, Clinical Psychologist, Allied Consultant Psychologists and Flinders University, SA; Dr Paige Tucker, Research Registrar and Gynaecological Oncology Clinical and Surgical Assistant, St John of God Subiaco Hospital, WA.