Vulval cancer

Symptoms of vulval cancer can include a lump, sore or wart-like growth on your vulva, itching, bleeding and changes to your skin.

Vulval cancer is diagnosed by looking closely at your vulva using a microscope (vulvoscopy), and a biopsy to remove and test a sample of cells.

Vulval cancer is sometimes caused by an infection with human papillomavirus (HPV), or skin conditions that affect your vulva.

The main treatment for vulval cancer is usually surgery. You may also have radiotherapy and chemotherapy.

Symptoms of vulval cancer can affect any part of your vulva, but they're most common on the inner and outer lips (labia) around the opening of your vagina.

Symptoms can include:

• a lump
• a sore, growth (this may look and feel like a wart) or ulcer
• bleeding from your vulva, or blood-stained vaginal discharge, that is not related to your periods
• itching that does not get better
• changes to your skin, such as red, white or dark patches (these may be harder to see on brown or black skin), or an area of thickened or raised skin
• a mole that changes shape or colour
• burning pain when you pee

• you have any symptoms of vulval cancer

Try not to be embarrassed – the GP will be used to talking about these symptoms.

It's not always known what causes vulval cancer.

But many vulval cancers are caused by an infection with certain types of human papillomavirus (HPV).

You can get HPV from:

• any skin-to-skin contact of the genital area
• vaginal, anal or oral sex
• sharing sex toys

Some skin conditions that affect your vulva can also lead to vulval cancer. These include:

• abnormal changes in the skin cells of your vulva, called vulval intraepithelial neoplasia (VIN)
• lichen sclerosus
• lichen planus

Who is more likely to get vulval cancer

Vulval cancer mostly affects women over 65 years old, but you can get it at any age. Anyone with a vulva can get vulval cancer.

You might also be more likely to get vulval cancer if you:

• smoke
• have a weakened immune system, for example if you have a health condition such as HIV or you're having treatments that affect your immune system
• have had cervical cancer

You cannot always prevent vulval cancer. But there are things you can do to lower your chances of getting it.

These include:

• getting treatment for any skin conditions that affect your vulva
• using condoms, which lower your chance of getting HPV – but they do not cover all the skin around your genitals so you're not fully protected
• quitting smoking – smoking can weaken your immune system and the chemicals in cigarettes can also cause cancer
• eating a balanced diet to help support your immune system

For younger people, HPV vaccination is the best way to protect yourself from vulval cancer.

All children aged 12 to 13 are offered the HPV vaccine. It helps protect against all cancers caused by HPV, as well as genital warts.

If you have symptoms of vulval cancer, you'll usually be referred for a test to have a closer look at the area around the opening of your vagina (your vulva). This is called a vulvoscopy.

You'll be asked to undress from the waist down, behind a screen. You'll be given a sheet to put over you.

You can have a friend, family member or other member of staff in the room with you during your vulvoscopy if you want.

During a vulvoscopy:

1. The specialist nurse or doctor will ask you to lie back on a bed, usually with your legs bent, knees up and legs apart. You may be asked to rest your legs on supports.
2. They'll use a magnifier called a colposcope (similar to a microscope) to look closely at your vulva from the outside. This will help them find any small changes that may be difficult to see.
3. They may also need to look inside your vagina and womb. If they do, they'll gently put a smooth, tube-shaped tool (a speculum) into your vagina so they can see your cervix with the colposcope.
4. If the nurse or doctor sees anything unusual, they'll usually collect a small sample of cells (biopsy) to send to a laboratory. They'll give you an injection of local anaesthetic first, to numb your vulva.

It should not be painful, but you may find it uncomfortable. Talk to the nurse or doctor if you're feeling uncomfortable.

If you had a biopsy, you may have a small amount of bleeding or soreness afterwards.

Vulval cancer is often treatable.

The treatment you have will depend on:

• the size and type of vulval cancer you have
• where the cancer is
• if it has spread
• your general health

The main treatment for vulval cancer is usually surgery. You may also have radiotherapy or chemotherapy.

The specialist care team looking after you will:

• explain the treatments, benefits and side effects
• work with you to create a treatment plan that's best for you
• help you to manage the side effects of treatment

If you have any questions or worries, you can talk to your specialist team. You do not have to wait for your next appointment.

You and your loved ones will be supported through your treatment by a group of specialists.

The clinical nurse specialist, or another member of your specialist team, will be able to give you information on local support services that you may find helpful.

There are also national cancer charities that offer support and information about vulval cancer.

Macmillan Cancer Support

Information and support for anyone affected by cancer.

• Website: macmillan.org.uk
• Helpline: 0808 808 0000
• Macmillan Cancer Support: support line service
• Macmillan Cancer Support: online community
• Macmillan Cancer Support: find local support services

Cancer Research UK

Information and support for anyone affected by cancer.

• Website: cancerresearchuk.org
• Nurse helpline: 0808 800 4040
• Cancer Research UK: ask a nurse service
• Cancer Research UK: online cancer chat forum
• Cancer Research UK: find a clinical trial service

Marie Curie

Care and support for anyone affected by a terminal illness.

• Website: mariecurie.org.uk
• Helpline: 0800 090 2309
• Marie Curie: information and support
• Marie Curie: online community
• Marie Curie: services

The Eve Appeal

Information and support for anyone affected by cervical, ovarian, vaginal, vulval and womb cancers.

• Website: eveappeal.org.uk
• Helpline: 0808 802 0019
• Ask Eve Nurse Information Service