Introduction
What is vulvar cancer?
Chapter 01
What is vulvar cancer?
The vulva is a term used to describe a woman’s external genitals, including the labia majora (outer lips) and labia minora (inner lips) and clitoris. Vulvar cancer, also sometimes known as vulval cancer, begins with the development of abnormal cells in any part of the vulva.
Types of vulvar cancer
These are different types of vulvar cancer:
- Squamous cell carcinoma Cancer develops in the flat thin squamous cells that cover the vulva
- Adenocarcinoma Develops from the glandular cells (the Bartholin glands) of the vulva
- Sarcoma Develops in muscle and tissue of the vulva
- Basal cell carcinoma A common form of skin cancer that rarely originates in the vulva
- Melanoma This is a rare vulvar cancer and originates in the melanocytes (cells) of the skin
Make an enquiry
Contact us today to find out how GenesisCare can help you.
Symptoms of vulvar cancer
Symptoms may include:
- constant itching or pain in the genital area
- a lump or swelling on the vulva
- a mole on the vulva that changes shape or colour
- pus or discharge from an open sore or spot on the vulva
- raised patches of skin that are brown, red or white
- swollen lymph nodes around your groin
Having any of these symptoms doesn’t mean you have vulvar cancer, but you should see your doctor for a check-up.
What causes vulvar cancer?
It’s not known exactly what causes vulvar cancer, but some things are known to increase the risk. These include:
- smoking1
- weakened immune system2
- previous history of cervical or vaginal cancer3
- certain skin conditions of the vulva4
- a pre-cancerous condition called Vulvar Intraepithelial Neoplasia (VIN)5
- HPV (human papillomavirus)6, but this sexually transmitted infection does not necessarily lead to cancer
Can anything prevent vulvar cancer?
The HPV vaccine, Gardasil 9, gives almost 100% protection against 9 HPV types6. It’s currently given free in Australian secondary schools to children aged 12-13 as part of the National Immunisation Program. Talk to your GP for more information.
Diagnosis
Chapter 02
Diagnosing vulvar cancer
Your GP will probably conduct a physical exam and refer you to a specialist if they’re concerned about your symptoms and risk factors for vulvar cancer.
Tests may include:
- Colposcopy – Your doctor will use a magnifying device called a colposcope to examine your cervix, vagina and vulva. As with cervical screening, the doctor will insert a speculum (a small instrument) into your vagina to hold it open, but the colposcope does not enter your body.
- Biopsy - While the doctor performs a colposcopy, they may also do a biopsy. This procedure involves taking tissue samples from your vulva, usually with a local anaesthetic. It takes just a few minutes, and sometimes you may need stitches afterwards. The samples will be sent to a laboratory for analysis.
- Cervical Screening Test – If you haven’t had one recently, your doctor may want you to have a cervical screening test to look for any signs of types of HPV.
If you are diagnosed with vulvar cancer, your doctor will explain which of the four stages you have and how far your cancer has progressed. Stage 1 is the least advanced, and Stage 4 is the most advanced. Vulvar cancer can also be graded from 1 to 3 according to how quickly it is expected to grow.
Treatments
Chapter 03
Treatments for vulvar cancer
Treatments that may be offered include:
- Chemotherapy
- Immunotherapy
- Radiation therapy
- Surgery
Chemotherapy can involve a single drug or a combination of drugs. These drugs are often injected directly into a vein, although your doctor may prescribe oral medication. Chemotherapy may be given with radiation therapy, or if the cancer returns after surgery.
Immunotherapy helps your body’s own immune system kill cancer cells. Immunotherapy is used in advanced vulvar cancers or when the cancer recurs.
Radiation therapy uses X-rays to damage or kill cancer cells. It can be directed at specific areas of your body or is sometimes given everywhere. In vulvar cancer, radiotherapy is used when the cancer is not amenable to surgery, often used alongside chemotherapy. It is also used after surgery in high-risk cancers to reduce the chances of the cancer returning.
Surgery is the main treatment for vulvar cancer. There are several approaches, depending on how advanced the cancer is and how far it has spread.
- If the cells are pre-cancerous, the surgeon may perform a local excision to cut out only the pre-cancerous cells. However, if a small amount of cancer is present, a radical wide local excision is performed. This is where the cancerous tissue is removed together with a margin of about 1cm as a precaution
- A partial radical vulvectomy is used if the cancer has grown but is still confined to only one part of the vulva. It may involve the removal of a large part of the vulva
- A radical vulvectomy is performed if the cancer covers a large part of the vulva. This removes the entire vulva. Reconstructive surgery is often performed at the same time
Your treatment with GenesisCare
Chapter 04
Your treatment with GenesisCare
We understand that a cancer diagnosis can be emotional and life-changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.
Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re with GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.
Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.
Side effects
Chapter 05
Side effects
Side effects of chemotherapy for cervical cancer
Whether you experience side effects and how severe they are, depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:
- fatigue
- nausea or vomiting
- constipation or diarrhoea
- hair loss
- easily bruising or bleeding
- weight changes
- skin changes
- dryness during sex
- permanent or temporary menopause
- potential infertility
- vaginal sores
- changes in your menstrual cycle
- mood changes
These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.
What can I do to help my chemotherapy treatment go smoothly?
- Get as much rest as possible
- Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
- Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
- Drink lots of water
- Reach out to support groups and others who have had chemotherapy
- Ask your team about topical treatments for your skin if you have irritation or pain
- Stay out of the sun as much as possible throughout your treatment
- Record your side effects in a diary or journal
- Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
- It is important to acknowledge when you are fatigued and rest when you need to
- Ask for and accept help from family, friends and neighbours
- Be open with employers about your treatment and discuss flexible working options if you need them
Side effects of immunotherapy for vulvar cancer
General side effects include:
- nausea
- fatigue
- headaches
- bloating
- constipation or diarrhoea
- joint or muscle pain
Side effects of radiation therapy for vulvar cancer
General side effects include:
- soreness and swelling around the treatment area
- tiredness and lethargy for a few weeks after you finish
Specific side effects (depending on the area being treated):
- bladder or bowel changes
- cystitis
- vaginal dryness
- lymphoedema
- incontinence
- menopause
Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you, depending on the tumour type.
Side effects of surgery for vulvar cancer
General side effects include:
- impact on your sex life
- bowel and bladder issues
- pain and swelling
- numbness or tingling due to nerve damage
- swelling in your legs or groin
Helpful services
Chapter 06
Helpful services
Other information, resources and support services are available to assist you during your cancer journey. These include:
Cancer Council Australia
13 11 20
Australian Cancer Research Foundation
02 9223 7833
References
- Cervical and Vulvar Cancer Risk in Relation to Joint Effects of Cigarette Smoking and Genetic Variation in Interleukin 2. Cancer Epidemiol Biomarkers Prev. 2008 Jul; 17(7): 1790–1799.doi: 10.1158/1055-9965.EPI-07-2753. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2497438/#:~:text=Current%20smokers%20are%20at%20approximately,risk%20(5%2C%206).
- Is the incidence of invasive vulvar cancer increasing in the United States? Cancer Causes Control. 2009 Nov; 20(9): 1779–1782. Published online 2009 Aug 13. doi: 10.1007/s10552-009-9418-8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868506/
- Familial Clustering, Second Primary Cancers and Causes of Death in Penile, Vulvar and Vaginal Cancers. Scientific Reports volume 9, Article number: 11804 (2019). https://www.nature.com/articles/s41598-019-48399-4
- Vulva Cancer. https://www.ncbi.nlm.nih.gov/books/NBK567798/
- Vulvar intraepithelial neoplasia: Incidence and long‐term risk of vulvar squamous cell carcinoma. Int J Cancer. 2021 Jan 1; 148(1): 90–98. Published online 2020 Jul 22. doi: 10.1002/ijc.33198. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689827/
- Women exposed to DES in the womb face increased cancer risk. https://www.nih.gov/news-events/news-releases/women-exposed-des-womb-face-increased-cancer-risk
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