Vulvar cancer or the cancer of the vulva is a gynaecological cancer that is on the rise with around 1,000 new cases being diagnosed each year in the UK.
However, that said, vulvar cancer is rare and accounts for less than 1% of all cancer cases in the UK. North America has the highest incidence and Asia the lowest rates of vulvar cancer.
Anatomy of the vulva
The vulva comprises of the external sex organs of a woman. It is made up of the opening of the vagina, the external and internal lips covering the vagina called labia majora and minora respectively.
These shield the opening of the urethra, the clitoris (a small fleshy bit that is located over the urethral opening) and the vaginal opening. In 75% cases the cancer begins in the labia. (1-5)
Symptoms of vulvar cancer
Common symptoms of the condition are development of a small mass, lump or wart-like growth over the vulva. This may or may not be accompanied by persistent itchiness, pain on urination or passing blood or blood stained discharge.
Types of vulvar cancer
Vulvar cancer is divided into various types. The types are classified based on the cells that are primarily affected.
The commonest type of vulvar cancer is squamous cell carcinoma, which accounts for over 90% all cases of vulvar cancer. Here the cancer begins in the skin and outer layers.
The second common type of vulvar cancer is called vulval melanoma that comprises of 4% of all cases. These develop in the pigment and color producing cells of the skin.
Rarer types of vulvar cancer includes adenocarcinoma that affects the cells that line the glands in the vulva, verrucous carcinoma that is a slow growing cancer that begins as a wart and a sarcoma that develops in tissue such as muscle or fat under the skin.
Who is at risk of vulvar cancer?
Women who are most at risk of vulvar cancer are those over the age of 65. Women with lichen sclerosis – a skin condition that is not cancerous are also at a higher risk. In fact, of every 5 cases of vulvar cancer, advanced age and history of lichen sclerosis is present in at least 3 to 4.
The other cases are made up of women who have not yet reached menopause. Smoking poses another major risk factor. Women with a persistent infection with specific high-risk strains of the human papilloma virus (HPV) known as HPV 16 that may lead to cervical cancer are at risk of vulvar cancer as well.
Vulval intraepithelial neoplasia (VIN) is a condition where skin cells around the vulva show changes under the microscope that are deemed “pre-cancerous” or have a potential to turn into cancer. HPV infection and VIN are responsible for the majority of cases in younger women.
Treatment of vulvar cancer
Treatment mainly involves surgery. Surgery helps to remove the cancer as much as possible before starting therapy with other modalities such as radiotherapy and chemotherapy. Most women who undergo treatment for vulvar cancer recover fully.
It is seen that 70% of people with vulvar cancer survive at least five years after diagnosis with appropriate and timely therapy. Some live longer while others may even be cured.
Squamous cell carcinomas if diagnosed early have the best outcomes with 90% five year survival rate.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)