Vulval and vaginal cancers

Vulval and vaginal cancers are rare. Professor Isaac Manyonda (MRCOG, Consultant Gynaecologist) and Dr Vikram Talaulikar (MRCOG, Specialist in Reproductive Health), talk about symptoms and how they are treated.

Vulval cancer

Vulval cancer is a rare cancer that most commonly starts on the inner edges of the two pairs of lips of the vulva, the inner and outer labia. It can also occur on the skin between the lips, including the clitoris, and the skin between the vulva and the anus.

Most vulval cancers do not form quickly. Usually, there is a gradual change in the cells. The medical name for these abnormal cells is vulval epithelial neoplasia (VIN). There are different types of vulval cancer depending on the type of cells it starts in. The most common type of vulval cancer is squamous cell carcinoma (SCC).

Vulval cancer is a rare cancer which is more common in older women. Around 1300 people are diagnosed in the UK each year.

Around half (50%) of vulval cancers are caused by the Human Papilloma Virus (HPV). HPV can pass from one person to another by skin to skin contact and during sexual contact. Around 80% in the UK will have the HPV virus at some time during their lifetime. So, it is a very common infection.

Some long-term vulval skin conditions are associated with vulval cancer such as lichen sclerosus and lichen planus. The most common of these is lichen sclerosus. This causes itching and sometimes pain in the vulva area. This usually affects women over the age of 60. Women with lichen sclerosus may develop a condition called differentiated vulval intraepithelial neoplasia (dVIN). Weakened immune system, radiotherapy for other genital cancers and smoking are other risk factors for vulval cancer.

Symptoms around the vulval area can include:

• a lasting itch;
• pain or soreness;
• thickened, raised, red, white or dark patches on the skin;
• an open sore or growth visible on the skin;
• a mole that changes shape or colour;
• a lump.

You must see your GP if you notice any of these symptoms. Your GP can examine you and can refer you for tests or to see a specialist if needed. Some Doctors recommend that you examine your vulva regularly to look for any changes.

Your GP will ask about your symptoms and may ask to examine your vagina (a pelvic examination). They may refer you to a specialist for further tests, such as another pelvic examination (if required under anaesthesia), colposcopy and a biopsy.

Depending on the results on the tests, you may need further tests such as ultrasound / CT or MRI scans. The main treatment for vulval cancer is surgery to remove the cancerous tissue from the vulva and any lymph nodes containing cancerous cells.

There are three surgical options to treat cancer of the vulva:

• Radical wide local excision - the cancerous tissue from the vulva is removed, as a well as a margin of healthy tissue, at least 1cm wide, to prevent spread to healthy tissue.


• Radical partial vulvectomy - a larger section of the vulva is removed, this may include the labia and the clitoris.


• Radical vulvectomy - the whole vulva is removed, including the inner and outer labia, and possibly the clitoris and removal of some lymph nodes.


• In some centres they will use sentinel node surgery, where a safe radioactive dye is injected into the affected area. During surgery this dye will highlight any potential spread into lymph nodes that will guide the surgeon to selectively remove to be tested, increasing accuracy of diagnosis and reducing the long-term side effect of lymph node surgery, lymphoedema.


• Other treatments are radiotherapy and chemotherapy. Radiotherapy and chemotherapy may be used without surgery if the cancer has spread and it's not possible to remove it all.

The outlook for vulval cancer depends on things such as how far the cancer has spread, age and general health.

Overall, around 7 in every 10 women diagnosed with vulval cancer will survive at least 5 years.

It's not thought to be possible to prevent vulval cancer completely, but risk can be reduced by practising safer sex, regular cervical screening and not smoking.

HPV vaccination can reduce chances of developing vulval cancer. This is now offered to all girls who are 12 to 13 years old as part of the routine childhood immunisation programme.

Being diagnosed with cancer, and the treatment that follows, can be a very difficult thing to cope with. The support of family, friends, healthcare professionals and other people with similar experiences can be invaluable at this time.

Vaginal cancer

Vaginal cancer is also a rare cancer. It starts inside the vagina and is most commonly diagnosed in women above the age of 60.

Symptoms of vaginal cancer include:

• vaginal bleeding after the menopause;
• bleeding after sex or pain during sex;
• smelly or bloodstained vaginal discharge;
• unexpected persistent bleeding between periods;
• a lump or itch in the vagina that won't go away;
• urgency or pain when passing urine.

You should see your GP if you think you might have symptoms of vaginal cancer. It's unlikely you have it, but it's best to get checked so that any serious problems can be ruled out. Your GP will ask about your symptoms and may ask to examine your vagina (a pelvic examination). They may refer you to a specialist for further tests, such as another pelvic examination (if required under anaesthesia), colposcopy - where a microscope is used to look inside the vagina and a biopsy (a small piece of vaginal tissue) may be removed for testing. Depending on the results on these tests, you may have to have further tests such as ultrasound / CT or MRI scans.

Treatment of vaginal cancer depends on how far the cancer has spread. The main treatments for vaginal cancer are radiotherapy, surgery and chemotherapy. Vaginal cancer can sometimes be cured if it's caught early on.

Vaginal cancer is usually caused by infection with some types of the Human Papilloma Virus (HPV). The HPV vaccination which is now routinely offered to 11- to 13-year-old girls, helps prevent infection with the main types of HPV linked to cervical and vaginal cancers.

For more information, you can contact Professor Manyonda and Mr Talaulikar at the Menopause Clinic, London