Vulval Cancer

Vulval cancer is rare compared with other gynaecological cancers. Around 90% are squamous cell carcinomas. Less commonly, they can be malignant melanomas.

 

Risk Factors

  • Advanced age (particularly over 75 years)
  • Immunosuppression
  • Human papillomavirus (HPV) infection
  • Lichen sclerosus 

Around 5% of women with lichen sclerosus get vulval cancer.

 

Vulval Intraepithelial Neoplasia

Vulval intraepithelial neoplasia (VIN) is a premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer. VIN is similar to the premalignant condition that comes before cervical cancer (cervical intraepithelial neoplasia).

High grade squamous intraepithelial lesion is a type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.

Differentiated VIN is an alternative type of VIN associated with lichen sclerosus and typically occurs in older women (aged 50 – 60 years).

A biopsy is required to diagnose VIN. A specialist will coordinate management. Treatment options include:

  • Watch and wait with close followup
  • Wide local excision (surgery) to remove the lesion
  • Imiquimod cream
  • Laser ablation

 

Presentation

Vulval cancer may be an incidental finding in older women, for example, during catheterisation in a patient with dementia.

Vulval cancer may present with symptoms of:

  • Vulval lump
  • Ulceration
  • Bleeding
  • Pain
  • Itching
  • Lymphadenopathy in the groin

 

Vulval cancer most frequently affects the labia majora, giving an appearance of:

  • Irregular mass
  • Fungating lesion
  • Ulceration
  • Bleeding

 

Management

Suspected vulval cancer should be referred on a 2-week-wait urgent cancer referral.

 

Establishing the diagnosis and staging involves:

  • Biopsy of the lesion
  • Sentinel node biopsy to demonstrate lymph node spread
  • Further imaging for staging (e.g. CT abdomen and pelvis)

 

The International Federation of Gynaecology and Obstetrics (FIGO) system is used to stage vulval cancer.

 

Management depends on the stage, and may involve:

  • Wide local excision to remove the cancer
  • Groin lymph node dissection
  • Chemotherapy
  • Radiotherapy

 

Last updated July 2020
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