The vulva is the name given to the visible sex organs that surround the opening of the vagina outside the body.
Cancer of the vulva is rare. About 1,300 women are diagnosed with it each year in the UK. It can affect anyone who has a vulva. This includes women, trans men and people assigned female at birth.
Vulval cancer is sometimes called vulvar cancer. It can affect any part of the vulva. The most common area for it to develop is the skin of the labia. It can also sometimes affect the tip of the clitoris or the Bartholin’s glands.
Types of vulval cancer
The most common type of vulval cancer is squamous cell carcinoma. 9 in 10 vulval cancers (90%) are this type. Squamous cell carcinoma can take many years to develop. It usually starts with pre-cancerous changes to the outer layer of the skin cells of the vulva.
There are other types of vulval cancer, but these are not as common.
Verrucous carcinomaThis is a very rare, slow-growing type of squamous cell carcinoma that looks like a large wart.
MelanomaThis is a type of skin cancer that develops from cells that produce the pigment that gives skin its colour. Rarely it can develop in the skin of the vulva.
Basal cell carcinomaThis is a cancer that develops from cells called basal cells. These are found in the deepest layer of the skin of the vulva.
SarcomaSarcomas develop from cells in tissue such as muscle, fat or blood vessels under the skin. They tend to grow more quickly than other types of vulval cancer.
AdenocarcinomaThis is a cancer that develops from cells that line the glands in the vulval skin.
Bartholin gland cancerThis is a cancer that develops in the Bartholin’s glands at the opening of the vagina.
The exact cause of vulval cancer is unknown. However, some risk factors can increase the chances of developing it.
We have more information about the causes of vulval cancer. This includes information about some skin conditions of the vulva that can increase your risk of developing vulval cancer:
If you have symptoms, you usually begin by seeing your GP. If they think that your symptoms could be caused by cancer, they will refer you to a specialist clinic or doctor. This is often a doctor who specialises in female reproductive system cancers (a gynaecological cancer specialist).
The main tests for vulval cancer are an examination of the vulva and a small sample (biopsy) of any abnormal looking areas. You can usually have these tests during an outpatient appointment. You may have them under a general anaesthetic if:
- there is a narrowing of the vagina due to lichen sclerosus (LS)
- the vulva is too sore for a full examination.
If your vulval examination and biopsy show cancer, your doctor will arrange further tests to check if the cancer has spread. This is called staging. The results will help you and your doctor decide on the best treatment for you. Some tests may be repeated during and after treatment to check your progress.
Your doctor or specialist nurse will explain which of the following tests you may need.
PET or PET-CT scan
CystoscopyYou may have a cystoscopy to check if the cancer has spread to the tube that you pass urine through (urethra) or to the bladder. You may have this test under a local anaesthetic or sometimes during an examination under a general anaesthetic.
ProctoscopyThis is an examination of the lower end of the large bowel (anus and rectum).
You will be asked to lie curled on your left side while the doctor gently passes a tube (proctoscope) into the back passage. The doctor can see any abnormal areas by using a tiny light and camera on the end of the proctoscope. If needed, they can take a small sample of cells (biopsy). A proctoscopy can be uncomfortable. Tell the doctor or nurse if you find it painful.
Exam under anaesthetic (EUA)
Lymph node tests
A common place for vulval cancer to spread to is the lymph nodes in the groin. Your doctor will check these nodes for swelling. Having swollen lymph nodes does not always mean that the cancer has spread. For example, an infection can also cause lymph nodes to swell.
Your doctor may suggest you have tests to check the groin lymph nodes. These may include:
Ultrasound and a fine needle aspirationYour doctor may suggest you have an ultrasound and a fine needle aspiration to check any of your lymph nodes that are swollen. If this test shows cancer cells, the groin lymph nodes will be removed during an operation or treated with radiotherapy.
Sentinel lymph node biopsyA sentinel lymph node biopsy is a small operation to remove the lymph nodes most likely to be affected by cancer. After surgery, the nodes are sent to a laboratory and examined under a microscope to see if they hold cancer cells. If they show cancer cells, the remaining groin lymph nodes will need to be removed with another operation or treated with radiotherapy.
The stage of a cancer explains its size and whether it has spread beyond the area it first started. Grading is how the cancer cells look under the microscope compared with normal cells.
Knowing the stage and grade will help you and your doctor decide on the best treatment for you.
We have more detailed information about the staging and grading of vulval cancer.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments. We have more detailed information about how vulval cancer is treated. You may have some treatments as part of a clinical trial.
Treatments may include:
Radiotherapy uses high-energy rays, such as x-rays, to treat cancer cells. This treatment may be used before or after surgery. Sometimes it is the main treatment if you cannot have surgery. Radiotherapy and chemotherapy can be given separately or together. When given together this is called chemoradiation.
Radiotherapy may also be used to manage any symptoms caused by the cancer and improve quality of life. This is called palliative treatment.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. This treatment may be used before or after surgery. Sometimes it is the main treatment if you cannot have surgery. Radiotherapy and chemotherapy can be given separately or together. When given together this is called chemoradiation.
Chemotherapy may also be used to manage any symptoms caused by the cancer and improve quality of life. This is called palliative treatment.
After your treatment has finished, you will have regular check-ups with your cancer doctor or nurse. Your appointments will usually be every few months at first. Later they may only be once a year.
If you had a vulval skin condition such as vulval lichen sclerosus (VLS) or vulval lichen planus (VLP) before vulval cancer, you should keep seeing your specialist for those conditions too. After cancer treatment, you may still need ongoing treatment for the skin. Your doctor will advise you about this.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan is also here to support you. If you would like to talk, you can:
- stop working normally because of radiotherapy
- are removed during surgery.
Fluid may collect and cause swelling in one or both legs, or the pubic area.
Not everyone gets lymphoedema after treatment for cancer of the vulva. But it can start months or years later.
There are treatments that help manage swelling. There are also things you can do to reduce your risk of getting lymphoedema. Your doctor or nurse may plan for you to see a specialist for advice.
Life after cancer treatment is often challenging. It can be especially difficult to cope with changes to something as personal as your sex life. Your treatment may have caused changes that affect how your body responds sexually or how sex feels. It may also affect how you feel about your body, sex and your relationships.
It is common to have questions about sex or need more help after treatment. These things are not always easy to talk about. There is support available. Do not be afraid or embarrassed to ask for advice. Your cancer doctor or nurse can help or arrange for you to see a specialist.
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.
Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.
Below is a sample of the sources used in our vulval cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Morrison J, Baldwin P, Buckley L, et al. Gynaecological Cancer Society (BGCS) vulval cancer guidelines: recommendations for practice. 2020. Available from https://www.bgcs.org.uk/wp-content/uploads/2021/07/BGCS-vulval-guidelines-v22.pdf [accessed November 2020].
Rogers LJ, and Cuello MA. Cancer of the vulva. Int J Gynaecol Obstet, 2018; 143, S2, 4-13. Available from https://doi.org/10.1002/ijgo.12609 [accessed November 2020].
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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