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

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.

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

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.

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.

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.

• 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

General side effects include:

• nausea
• fatigue
• headaches
• bloating
• constipation or diarrhoea
• joint or muscle pain

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.

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

References

1. 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).
2. 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/
3. 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
4. Vulva Cancer. https://www.ncbi.nlm.nih.gov/books/NBK567798/
5. 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/
6. 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