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Vulval Cancer

Vulval cancer starts in the vulva, the outer part of the genitals. It is uncommon and mostly affects people over 65, but it can happen at any age. Around 4 in 10 cases are linked to HPV.

~40%of vulval cancers in the UK are attributable to HPV

Attributable to HPV. Source: (Parkin, 2011)

What it is

The vulva includes the inner and outer lips (labia), the clitoris and the opening of the vagina. Most vulval cancers are squamous cell carcinomas, which start in the skin cells covering the vulva.

There are two main routes to vulval cancer. One is caused by HPV and tends to affect younger people. The other is not caused by HPV and is linked to long-term skin conditions such as lichen sclerosus. It is more common in older people.

Symptoms

  • An itch on the vulva that doesn’t go away
  • Pain, soreness or tenderness
  • Raised, thickened patches of skin that may be red, white or dark
  • A lump or wart-like growth
  • Bleeding from the vulva, or bloodstained discharge between periods
  • An open sore
  • A burning pain when peeing
  • A mole on the vulva that changes shape or colour

Many of these symptoms are caused by more common conditions such as thrush or skin irritation. But if they last, see your GP. It can help to check your vulva regularly with a mirror so you know what’s normal for you.

Causes

Vulval cancer can be caused by high-risk HPV, passed on through skin-to-skin genital contact, vaginal, anal or oral sex, and sharing sex toys. It can also develop from skin conditions affecting the vulva, including vulval intraepithelial neoplasia (VIN), lichen sclerosus and lichen planus.

Statistics

1,500people diagnosed in the UK each year
520deaths from vulval cancer in the UK each year
58%survive for 10 years or more
69%of cases are considered preventable

Source: Cancer Research UK.

Risk factors

  • Age. It mostly affects people over 65
  • HPV infection
  • Lichen sclerosus or lichen planus, long-term skin conditions that cause itching and changes to the skin of the vulva
  • VIN, a pre-cancerous skin condition
  • Smoking
  • A weakened immune system, for example from HIV or immune-suppressing treatment
  • Having had cervical cancer

How it develops

In HPV-related vulval cancer, the virus’s E6 and E7 proteins drive abnormal cell growth, causing a pre-cancerous stage called HPV-associated VIN (also called vulval HSIL). This is usually found in younger people and can be treated.

Cancers not caused by HPV usually develop from differentiated VIN, which grows in skin damaged by years of inflammation from lichen sclerosus. These cells often carry changes in the TP53 gene, which makes the p53 protein. This route is less common but more likely to progress to cancer, so people with lichen sclerosus are advised to have regular checks.

Diagnosis and treatment

Your GP will examine you and may refer you to a gynaecologist, who can take a small sample of skin (biopsy) under local anaesthetic. Treatment depends on the size and stage of the cancer and may include surgery, radiotherapy and chemotherapy.

Prevention

  • Get to know your vulva. Checking regularly with a mirror helps you spot changes early.
  • Get lichen sclerosus and VIN treated and monitored. Finding and treating these conditions early lowers the risk of cancer.
  • Get the HPV vaccine if eligible, and stop smoking.

Common misconceptions

"Vulval itching is always thrush."

Often it is, but itching that doesn’t go away with treatment should be checked by your GP.

"Cervical screening checks my vulva."

Screening only tests cells from the cervix. Changes to the vulva need to be checked separately by your GP.

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NHS guidance

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