Cancer of the vulva


This section discusses symptoms, risk factors, diagnosis and treatment of vulvar cancer (also known as vulval cancer or cancer of the vulva). See information about managing treatment 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 majora, labia minora and the perineum. Less often, it involves the clitoris, mons pubis or Bartholin glands.

What are the types of vulvar cancer?

The types of vulvar cancer are named after the cells they start in:

Squamous cell carcinoma (SCC)

The most common type, accounting for about 9 out of 10 (90%) cases. It starts in the thin, flat (squamous) cells lining the vulva. The two main subtypes are keratinising vulvar carcinomas (not linked to HPV) and warty/ basaloid (linked to HPV). Also includes verrucous carcinoma, a rare subtype, that looks like a large wart and grows slowly.

Vulvar (mucosal) melanoma

Makes up about 2-4% of vulvar cancers. It starts in the cells that give the skin its colour (melanocytes), also found in the moist lining of the vulva. Mucosal melanomas are not related to overexposure to UV radiation.

Sarcoma

A rare type that starts in cells in muscle, fat and other tissue under the skin. It tends to grow faster than other types.

Adenocarcinoma

A rare type that develops from the mucusproducing (glandular) cells in the Bartholin glands or other vulvar glands. It includes extramammary Paget's disease, which looks like eczema.

Basal cell carcinoma (BCC)

Although the most common form of skin cancer, BCC is a very rare type of vulvar cancer that starts in tall (basal) cells in the skin's lower layer.

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:

  • 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 an area of skin or a sore spot in the vulva, which may have an offensive or unusual smell or colour (not related to your menstrual period)
  • hard or swollen lymph nodes in the groin area.

Many women don't look at 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 these symptoms, visit your general practitioner (GP) for a check-up.

How common is it?

Vulvar cancer is not common - each year in Australia, about 340 women are diagnosed with vulvar cancer. 3 Although it most commonly affects women who have gone through menopause, diagnoses of vulvar cancer in women under 60 have increased in recent years. This is likely to be due to rising rates of infection with HPV (see below). 4

What are the risk factors?

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

Vulvar intraepithelial neoplasia (VIN)

This precancerous condition 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 diagnosed 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 common virus and most women with HPV don't develop vulvar or any other type of cancer. Although HPV is sexually transmitted, vulvar cancer itself is not contagious and it can't be passed on to other people through sexual contact.

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 developing 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 cervical screening test

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

Other skin conditions

Vulvar lichen planus and vulvar lichen sclerosus are skin conditions that can cause itching and soreness. If not treated, these conditions can cause permanent scarring and narrow the vaginal opening. In a small number of women, they may develop into vulvar 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've had an organ transplant or have human immunodeficiency virus (HIV) may be at higher risk of developing vulvar cancer because their immune system is not working normally.

Diagnosis

The main tests used to diagnose vulvar cancer are a physical examination, a procedure called a colposcopy, 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 ask to do a physical examination of your groin and pelvic area, including the genitals. You will remove your clothing from the waist down, then lie on a table with your knees bent and legs apart. If you feel embarrassed or scared about this examination, let your doctor know. A nurse may be present during the examination, but you can also ask for a family member or friend 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.

Colposcopy

To examine the vulva, vagina and cervix in detail, the doctor looks through a magnifying instrument called a colposcope. The colposcope is placed near your vulva but does not enter your body. 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 use a speculum to spread the walls of the vagina apart, and then apply a vinegar-like liquid or iodine to your vulva and vagina. This makes it easier to see abnormal cells through the colposcope. The liquid 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.

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.

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

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.

After the biopsy your vulva may bleed a little, and sometimes stitches are needed to close up the wound. Ask your doctor how much bleeding to expect afterwards, 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 you will be advised not to have sex or put anything in your vagina for 24 hours after the biopsy.

The tissue sample will be sent to a laboratory, and a specialist doctor 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.

Cervical screening test

If you haven't had one recently, your doctor may do a cervical screening test. This test has replaced the Pap test.

The cervical screening test detects cancer-causing types of HPV in a sample of cells taken from the cervix or vagina. While the speculum is in place for the internal examination, the doctor will use a small brush or swab to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two.

The sample is sent to a laboratory to check for the presence of HPV. If HPV is found, the pathologist will do an additional test on the sample to check for cell abnormalities.

Further tests

Sometimes further tests are needed to assess your general health, determine the size and position of the cancer, and find out whether the cancer has spread. You will probably not need to have all of these tests:

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 an image of your lungs.

Cystoscopy

The doctor uses a slender, flexible 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 CT (computerised tomography) scan uses x-ray beams 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

An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed, cross-sectional pictures of the inside of your body.

Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you are diabetic, have kidney disease or are pregnant.

During the MRI scan, you will lie on a treatment table that slides into a metal cylinder that is open at both ends. Sometimes, dye will be injected before the scan to make the pictures clearer. 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.

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 it has spread from the vulva to other parts of the body. In Australia, vulvar cancer is usually staged using the staging system from the International Federation of Gynecology and Obstetrics (FIGO).

Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may grow. Low-grade (grade 1) cancer cells are slow-growing and 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 health care team recommend the most appropriate treatment for you.

Stages of vulvar cancer

  • 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.

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 anyone to predict the exact course of the disease in an individual woman. Instead your doctor can give you an idea about the general prognosis for women with the same type and stage of vulvar cancer.

In most cases, the earlier vulvar cancer is diagnosed, the better the chances of successful treatment. To work out your prognosis, your doctor will consider your test results; the type of vulvar cancer you have; the stage and grade of the cancer; whether the cancer has spread to the lymph nodes; and other factors such as your age, fitness and overall health. In some cases, the doctor will not have enough information to assess prognosis until after the surgery to remove the cancer (see below).

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, radiation therapy and chemotherapy. You may have one of these treatments or a combination.

The treatment recommended by your doctor will depend on the results of your tests, the type of cancer, where the cancer is, whether it has spread, your age and your general health. You'll have regular check-ups to see whether the cancer has responded to treatment.

Surgery

Surgery is the main treatment for vulvar cancer. Your gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and any possible complications.

The type of operation recommended depends on the stage of the cancer. The information below provides more information about the main types of surgery.

All tissue removed during surgery is examined for cancer cells by a pathologist. The results will help confirm the type of vulvar cancer you have and its stage.

Cancer Council produces information on surgery, radiation therapy and chemotherapy.

Types of vulvar surgery

Depending on how far the cancer has spread, you may have one of the following types of surgery.

Local excision

Wide local excision

The surgeon cuts out the cancer, as well as a small border of healthy tissue (called the margin).

Radical local excision

The surgeon cuts out the cancer with a deeper margin. May be done together with a lymph node dissection (see below).

Partial vulvectomy

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

Complete vulvectomy

The surgeon removes the entire vulva, sometimes including the clitoris. A complete radical vulvectomy also removes deep tissue around the vulva. Usually, nearby lymph nodes are also removed - this is called a lymph node dissection (see below).

Other surgical procedures

Lymph node dissection

The lymph nodes (also called lymph glands) are part of the lymphatic system. Cancer cells can spread from the vulva to the lymph nodes in the groin, so your doctor may suggest removing these nodes from one or both sides. This is called an inguinal lymph node dissection or lymphadenectomy.

Sentinel lymph node biopsy

Before a lymph node dissection, the surgeon may perform a sentinel lymph node biopsy. This test helps to identify which lymph node the cancer is most likely to spread to first (the sentinel lymph node).

You will usually have an anaesthetic, then a small amount of radioactive dye will be injected near the site of the cancer. The dye will flow to the sentinel lymph node, and the surgeon will remove it. If a pathologist finds cancer cells in the sentinel lymph node, the remaining nodes in the area may need to be removed.

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

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 - see more information and some tips on managing this side effect.

"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

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.

Most women will be able to have the remaining skin drawn together with stitches, 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 abdomen or thigh) and stitch it onto the operation site. It may also 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 assistance of a reconstructive (plastic) surgeon.

Pelvic exenteration

This operation is very rarely 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.

What to expect after surgery

Recovery time

  • Your recovery time after the operation will depend on your age, the type of surgery you had and your general health.
  • If only a small amount of skin is removed, the wound will probably heal quickly. You will spend several days in hospital.
  • If your lymph nodes are removed or the surgery is more extensive, recovery will take longer. You will spend about 6-8 days in hospital.
  • While you are in bed, you may need to wear compression stockings and have blood-thinning injections. These measures help the blood in your legs circulate and prevent blood clots in the deep veins of your legs (deep vein thrombosis).
  • 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.

Pain

  • You will be given medicine to reduce any pain.
  • For the first day or two, pain medicine may be given in various ways: 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). It is important to avoid straining when passing a bowel motion, so you may need to take laxatives. Talk to your treatment team about suitable drugs.

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 there is not too much fluid coming out, 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 up after 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 has healed.

Wound care

  • Infection is a risk after vulvar surgery, so it is important 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). You will also need to rinse the vulva with water after urinating or having a bowel movement.
  • 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 air the wound, avoid wearing underwear and wear loose-fitting clothing.
  • Report any redness, pain, swelling, wound discharge or unusual smell to your surgeon or nurse.

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.

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.

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.

Sexuality

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

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. See bladder and bowel problems.

Emotions

If you have lost part of your genital area, you may feel a sense of loss and grief. See more information.

Driving

You will need to avoid driving after the surgery until your wounds have healed and you are no longer in pain. Discuss this issue with your doctor before the surgery.

Radiation therapy

Also known as radiotherapy, this treatment uses a controlled dose of radiation, such as x-rays, to kill or damage cancer cells. Whether you have radiation therapy 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 radiation therapy:

  • before surgery to shrink the cancer and make it easier to remove (neoadjuvant 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 beam radiation therapy (EBRT)

This is the most common type of radiation therapy 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. EBRT is usually given daily, Monday to Friday, over 5-6 weeks. The exact number of sessions you have will depend on the type and size of the cancer. Each session takes about 20 minutes.

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

Internal radiation therapy

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

Side effects of radiation therapy

The side effects you experience will vary depending on the dose of radiation and the areas treated. Many will be short-term side effects. These often get worse during treatment and just after the course of treatment has ended.

Side effects can take several weeks to get better, though some may continue longer. Some side effects from radiation therapy may not show up until many months or years after treatment. These are called late effects.

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.

Bladder and bowel problems

Radiation therapy can irritate the bladder and bowel. You may pass urine more often or have a burning sensation when you pass urine. Bowel motions may be more frequent, urgent or loose (diarrhoea), or you may pass more wind than normal. Less commonly, women may have some blood in the stools (faeces). Always tell your doctor about any bleeding.

Nausea and vomiting

Because the radiation therapy 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

Radiation therapy may cause or increase vaginal discharge. Let your treatment team know if it smells bad or has blood in it. 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.

Bladder and bowel changes

Bladder changes, such as frequent or painful urination, and bowel changes, such as diarrhoea or wind, can also be late effects, appearing months or years after radiation therapy finishes. In rare cases, blockage of the bowel can occur. 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 radiation therapy, and it is easier to treat if diagnosed early.

Narrowing of the vagina

The vagina can become drier, 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.

Menopause

In premenopausal women, radiation therapy 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 menopause or any fertility issues before treatment.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells. For women with vulvar cancer, treatment may be given:

  • during a course of radiation therapy, to make the radiation therapy 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.

The chemotherapy drugs are commonly given by injection into a vein (intravenously), but may also be given as tablets or in a cream applied to the vulva. Most women have several treatment sessions, with rest periods in between. Together, the session and rest period are called a cycle. 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 medicine.

"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

Most side effects are temporary. Common side effects experienced after chemotherapy for vulvar cancer include feeling sick (nausea), tiredness (fatigue), and a reduced resistance to infections.

Chemotherapy for vulvar cancer may also increase any skin soreness caused by radiation therapy. 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. See Understanding Chemotherapy.

Palliative treatment

Palliative treatment helps to improve people's quality of life by managing the symptoms of cancer without trying to cure the disease. It is best thought of as supportive care. Many people think that palliative treatment is for people at the end of their life, but it may be beneficial at any stage of advanced vulvar cancer. It is about living for as long as possible in the most satisfying way you can.

Sometimes treatments such as radiation therapy, chemotherapy or other drug therapies are given palliatively. The aim is to relieve symptoms such as pain or bleeding by shrinking or slowing the growth of the cancer.

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. See Understanding Palliative Care and Living with Advanced Cancer.

Key points about vulvar cancer

What it is

Vulvar cancer is cancer that starts in any part of the external female genitals. The main type of vulvar cancer is squamous cell carcinoma.

Tests

The main tests are a physical examination, a colposcopy and the removal of a tissue sample (biopsy). You may also have a cervical screening test to check for abnormal cells in the vagina and cervix. Other tests are not always needed but may include blood tests, imaging tests, a cystoscopy or a proctoscopy.

Main treatment

Surgery is the main treatment for vulvar cancer. The type of operation you have depends on how far the cancer has spread. Small cancers may be removed with a wide local excision or radical local excision. A partial or complete vulvectomy may be used to remove more advanced vulvar cancer.

Other treatments

  • Radiation therapy uses radiation to kill or damage cancer cells. External beam radiation therapy is the most common type used for vulvar cancer. Side effects may be short-term or long-term, or may appear later.
  • Chemotherapy uses 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.

Expert content reviewers:

Prof Jonathan Carter, Director, Gynaecological Oncology, Chris O'Brien Lifehouse, and Professor of Gynaecological Oncology, The University of Sydney, NSW; Ellen Barlow, Clinical Nurse Consultant, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Dr Dani Bullen, Clinical Psychologist, Peter MacCallum Cancer Centre, VIC; Wendy Cram, Consumer; Dr Tiffany Daly, Senior Radiation Oncologist, Radiation Oncology Princess Alexandra Raymond Terrace (ROPART), South Brisbane, QLD; Kim Hobbs, Clinical Specialist Social Worker, Westmead Centre for Gynaecological Cancer, Westmead Hospital, NSW; Anya Traill, Head of Occupational Therapy and Physiotherapy, Peter MacCallum Cancer Centre, VIC.

3. Australian Institute of Health and Welfare (AIHW), Cancer in Australia 2017, AIHW, Canberra, 2017.

4. YJ Kang et al., “Vulvar cancer in high-income countries: Increasing burden of disease”, International Journal of Cancer, vol. 141, iss.11, 2017, pp. 2174–86.

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