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Vulval Cancer

Vulval cancer is otherwise known as vulvar cancer.

Many women with a very early stage of Vulval Cancer don't experience any symptoms at all but early detection can save lives.

Education and awareness is critical for early diagnosis.

What is vulval cancer?

What are the types of vulval cancer?

There are two different types of vulval cancer. 

HPV dependent -related to Human Papilloma Virus (HPV) infection (similar to cervical cancer) and this type is more common in younger women.  HPV is a common sexually transmitted infection that causes most cases of cervical cancer and is responsible for about 60% of vulval cancers.  Practicing 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, especially  before you become sexually active.  

 

HPV independent -Related to chronic inflammatory or autoimmune processes (e.g. lichen sclerosis), mainly in older women.  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 if not treated.

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Awareness saves lives. Help us to educate and inform women across Aotearoa about the signs of gynae cancer.

Vulval cancer is a relatively rare type of cancer and occurs on the outer surface area of the genitalia. 

The vulva includes the opening of the vagina, the labia minora (inner lips), the labia majora (outer lips), the clitoris and the Bartholi's glands (two small glands on either side of the vagina just inside the opening of the vagina).  These glands produce a mucus-like fluid that acts as a lubricant during sex.   

Vulval cancer commonly presents itself as a lump or sore on the vulva that often causes itching.  
 

What are the symptoms of vulval cancer?

Know the signs.

Signs and symptoms may include:

  • A recurring/persistent itch in the vulva

  • Pain or soreness in the vulva

  • Thickened, raised, red, white or dark patches on the skin of the vulva

  • Bleeding from the vulva or blood stained vaginal discharge between periods

  • Open sore or growth visible on the skin

  • A mole on the vulva that changes shape or colour

  • Lump or swelling in the vulva

If you have any of the symptoms listed above, particularly if:

  • They are not normal for you

  • They are persistent

  • There are repeated episodes

  • The do not go away

.
..be sure to visit your doctor for a check up.

Remember, early detection can save lives. Most women with symptoms like these do not have cancer.  Your awareness of your symptoms is the first and most important step.

 

Reduce your risk
 

  • 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, quit!

  • See your GP if you have vulval itchiness, lumps or ulcers
     

 

What is the treatment?

What to expect from diagnosis to treatment.

Diagnosis:

  • Examining your vulva 
    Using a special device called a colposcope to examine the vulva 
    and removing a sample of tissue to test and see if it is cancer. Usually this can be done with a local anaesthetic in the clinic.

  • Determining the spread 
    Sometimes the doctor might need to do a more thorough examination to determine the spread. Imaging like a CT scan can be used to determine the spread.

Vulval Cancer Treatment:

Surgery
Surgery is the most common treatment for vulval cancer.  The removal of the tumor and some surrounding healthy tissue.  Due to the location and sensitivity of the vulval tissue, the type of surgery performed is carefully considered.  

Surgical options for invasive vulval cancer include:
 

  • Radical local excision
    Removing the cancer with a margin of healthy tissue but preserving the rest of the vulva.

  • Vulvectomy
    The removal of part or all of the vulva, depending on the size and spread of the primary tumour.  

  • Removing a few lymph nodes ( sentinel lymph node biopsy)
    This procedure identifies the lymph nodes most likely to contain cancer, removed and analysed. If cancer isn’t found in these lymph nodes it is unlikely to be in other lymph nodes

  • Lymphadenectomy( removing many lymph nodes)
    If there is suspicion that the cancer has spread to the lymph nodes, these will be removed to reduce the risk of it spreading to other areas.

Coping with vulvar surgery
It is common to experience a range of emotions after vulvar surgery, such as loss, sadness or anxiety.  Some women may feel that they have lost a part of their identity as a woman.  Others have questions about whether sexual intercourse can continue after surgery.  Women may also worry about how the surgery will affect their relationships with their husbands or partners.

Radiation Therapy
Radiation therapy uses radiation beams to destroy cancer cells . Whether you have radiation therapy will depend on the stage of the cancer, its size, if it has spread to the lymph nodes and how any nodes are affected. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells. The radiation treatment is carefully planned to affect only the part of the body at which the beams are aimed.

Chemotherapy
Treatments using medication are used to destroy cancer cells while doing the least possible damage to normal cells.  

For women with vulval cancer, treatment may be given during radiation therapy, to make the radiation treatment more effective, to control cancer that has spread to other parts of the body or as palliative treatment, to relieve the symptoms of the cancer.

Follow-up
After treatment you will be seen initially every six months for two years, then yearly for at least five years. Follow up includes a groin examination and vulvoscopy.