The vulva is the area of skin between a woman’s legs and is made up of all the visible sex organs. It consists of two outer lips (the labia majora), which are covered in pubic hair and surround two inner lips (the labia minora), which are thin and more delicate.

Vulvar cancer can occur on any part of the external female sex organs. The inner edges of the labia majora and the labia minora are the most common areas for it to develop. There are a number of different types of vulvar cancer

• Squamous cell carcinoma: Cancers of the vulva (90%) develop in the skin of the vulva from cells (squamous cells).
• Vulval melanoma: The second most common type of vulvar cancer, develops from pigment producing cells that give the skin its colour.
• Adenocarcinoma: Develops from cells that line glands in the vulvar skin, is very rare.
• Basal cell carcinoma: Develops from cells called basal cells that are found in the deepest layer of the skin of the vulva. Is very rare.
• Verrucous carcinoma: Looks like a large wart, again very rare.
• Sarcomas: Develop from cells in tissue such as muscle or fat under the skin. They tend to grow more quickly. Is very rare.

Cancer of the vulva is not infectious and can not be passed on to other people.

What causes it?

The causes of vulvar cancer are unknown. There are known factors that can increase your risk of getting Vulva cancer.

• Age: 80% of women who develop cancer of the vulva are over 60 years old.
• Non-cancerous skin conditions of the vulva: Women with vulvar lichen sclerosis and vulvar lichen planus, have a higher risk of developing cancer of the vulva.
• Human Papilloma Virus ( HPV ): Infection with this virus is a risk factor for vulvar cancer. HPV is a very common infection and is usually passed between people during sex. In most cases the natural immune system quickly gets rid of the virus.
• Vulvar intraepithelial neoplasia (VIN): This is a pre-cancerous condition that can occur in the skin of the vulva.
• Smoking
• Paget’s disease of the vulva: It's rare and usually only affects women who've been through the menopause

What are the symptoms?

The most common symptoms of cancer of the vulva are:

• itching, burning and soreness of the vulva
• a lump, swelling or wart-like growth
• thickened, raised, red, white or dark patches on the skin of the vulva
• bleeding, or a blood-stained vaginal discharge
• burning pain when passing urine
• pain in the area of the vulva
• a sore or ulcerated area on the vulva
• a mole on the vulva that changes shape or colour.

TIP: If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses other than vulvar cancer.

How is it diagnosed?

Usually you begin by seeing your GP, who will examine you. If there is any possibility of you having vulvar cancer, you should be referred to a specialist in women’s cancers (gynaecological cancer specialist).

• Blood test
• Biopsy

The vulva is an intimate and private part of the body, so some women and girls, understandably, find it embarrassing or upsetting to have a vulvar examination.

TIP: If you feel this way let your doctor or nurse know so that they can give you emotional support or some one to talk to about the procedure.

Examination of the vulva
For the examination, a nurse will help you to position yourself on a couch that has special leg supports (like stirrups on a riding saddle).

• The doctor will use a bright light and a magnifier to examine the vulva. They may then take small samples of tissue (biopsies).
• You will also have an internal examination to check your vagina and cervix for any abnormality. Using a speculum (a plastic or metal instrument) to hold the vaginal walls open, a liquid will be dabbed on to your cervix to help show up any abnormal areas.
• They may also take a cervical smear (a small sample of cells taken from the cervix). The doctor will also examine your back passage (anus).

Staging

The stage of a cancer is a term used to describe its size and whether it has spread beyond the area of the body where it first started.

A commonly used staging system is described here:

• Stage 1: Cancer is only in the vulva and/or perineum (the space between the opening of the rectum and the vagina).
• Stage 2: Cancer is only in the vulva and/or the perineum. The affected area is more than 2cm wide.
• Stage 3: Cancer is in the vulva and/or perineum and has spread to the lymph nodes and/or to nearby tissues such as the urethra (the tube from the bladder), vagina and anus (the opening of the rectum).
• Stage 4: Cancer has spread to the lymph nodes in the pelvis. Alternatively, it has spread into the lining of the bladder or bowel, or to other organs outside the pelvis.

Grading

Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how quickly the cancer may develop.

How is it treated?

Your team of doctors and other staff at the hospital will plan your treatment. It will depend on the size of the tumour and where it is. You may be treated by an oncologist (a doctor who specialises in treating cancer with chemotherapy) a gynaecological radiologist  (a surgeon who specialises in treating reproductive organs with radiation) and a radiologist (a doctor who specialises in treating cancer with radiation).

Treatment may involve

• Chemotherapy
• Radiotherapy
• Surgery

Most people have chemotherapy to shrink to size of the tumour and to get rid of any cancer cells around the body. More chemotherapy and radiotherapy usually follows surgery.

Chemotherapy for vulvar cancer

This treatment is often given to people with vulvar cancer to shrink the tumour prior to surgery. This means that the surgery will be less invasive. Often chemo starts again after surgery to kill any remaining cancer cells and stop them from spreading. This is called adjunct chemotherapy.

For more information about chemotherapy, go to our chemotherapy fact sheet

Surgery for vulvar cancer

The aim of surgery is to remove the tumour. There are different surgeries that can be used

• Checking the lymph nodes for cancer: Lymph nodes in the groin are the first place to which vulvar cancer can spread. Nodes are usually taken out during the operation to remove the cancer, done through a cut in the groin. Having been removed, are then checked for cancer.
• Sentinel node Biopsy: Sentinel node is the first node that fluid drains to from the vulva. If the sentinel nodes are free of cancer, no further nodes should have cancer and no more will be removed.
• Ultrasound scan of the groin and needle biopsy: Involves getting a sample of tissue from the lymph nodes. Usually painless but uncomfortable.
• Radical wide local excision: (also called a radical local excision or wide local excision) This operation takes away the cancer and a border (margin) of healthy tissue, usually 1cm, all around the cancer.
• Pelvic exenteration: Cancer has spread to organs close to the vulva such as the womb, bladder and/or bowel, it may still be possible to remove the cancer with surgery to take away any affected organs.

TIP: There is surgery to reconstruct the vulva is usually done at the same time as the operation to remove the cancer.
For more information about surgery, go to our surgery fact sheet 

Radiotherapy for vulvar cancer

For some, radiotherapy is considered the most suitable treatment, as it is the least intrusive of all therapies. Depending on age, a combination of chemotherapy and radiotherapy (chemo-radiotherapy) is considered best. Radiotherapy is the use of high energy X-rays to shrink and destroy the cancer cells. There are two main types of radiotherapy used against vulvar cancer.

• External radiotherapy: Beams of radiation being directed at the cancer from outside the body. Usual treatment regime, is five days a week, for 4–6 weeks. Chemotherapy may also be given once a week during the radiotherapy treatment (chemo-radiotherapy).
• Internal radiotherapy An applicator (similar to a tampon) containing a radioactive substance being inserted into your vagina, for a short period of time (several minutes to a few hours depending on the strength).

TIP: Make sure you ask as many questions as you need. Don’t be brave, be inquisitive!

For more information about radiotherapy, go to our radiotherapy fact sheet

Side effects of treatment

There are some side effects of the treatments for vulvar cancer which can be found in our side effects fact sheet

More information

You may want to check out the websites or fact sheets on the left hand side for more information other bone cancers, and related topics.

Check out our community pages to chat with other young people about vulvar cancer, or its treatment….or anything really.