Vulval cancer: symptoms, tests and treatment in the UK

Cancer Research UK describes vulval cancer as abnormal cells in the vulva that start to divide and grow in an uncontrolled way. The vulva is the outer part of the female genitals and includes the inner and outer lips, the clitoris and the opening of the vagina. The NHS stresses that the symptoms are shared by many different conditions, so most changes people notice in this area have a different explanation.

It matters to know that vulval cancer sometimes develops from changes in skin cells that can be spotted and treated first. The NHS lists vulval intraepithelial neoplasia (VIN), lichen sclerosus and lichen planus as skin conditions of the vulva that can lead to vulval cancer. Cancer Research UK says VIN is not vulval cancer but could turn into cancer, and that many women with VIN will not go on to develop it.

The NHS lists the symptoms below. Cancer Research UK adds that not everyone diagnosed with vulval cancer has symptoms, and that its own list also includes pain or soreness and a lump or swelling in the groin.

• A lump.

• A sore, growth (which may look and feel like a wart) or ulcer.

• Bleeding from the vulva, or blood-stained vaginal discharge, that is not related to periods.

• Itching that does not get better.

• Skin changes such as red, white or dark patches (which may be harder to see on brown or black skin), or an area of thickened or raised skin.

• A mole that changes shape or colour.

• Burning pain when you pee.

The NHS advises seeing a GP if you have any symptoms of vulval cancer, and says not to be embarrassed because the GP will be used to talking about these symptoms. It stresses that the symptoms are very common and can be caused by many conditions, but that it is important to have them checked because early treatment is more likely to be successful.

Cancer Research UK points out that symptoms of vulval cancer can resemble those of VIN or vaginal thrush, and that if thrush keeps coming back it is worth seeing a GP or a sexual health clinic rather than repeatedly treating it yourself with over-the-counter creams.

At the appointment, the NHS says the GP may ask to examine you. You can ask for a female doctor, and you can have a friend, family member or other member of staff in the room. You will be asked to undress from the waist down behind a screen and given a sheet to cover yourself. The GP may look at the vulva, feel for lumps while wearing gloves, feel inside the vagina and use a speculum to see the cervix. It should not be painful but may be uncomfortable, and you can ask the doctor to stop at any time.

If the GP thinks your symptoms could be cancer, the NHS says you may get an urgent referral for more tests or to see a hospital specialist. It adds that this does not definitely mean you have cancer.

It is not always known what causes vulval cancer, according to the NHS. Many are caused by infection with certain types of human papillomavirus (HPV), which can pass on through skin-to-skin contact of the genital area, vaginal, anal or oral sex and sharing sex toys.

The NHS says you may be more likely to get vulval cancer if you smoke, have a weakened immune system (for example with HIV or because of treatments that affect the immune system) or have had cervical cancer. It also lists VIN, lichen sclerosus and lichen planus as skin conditions that can lead to vulval cancer.

You cannot always prevent it. The NHS suggests getting treatment for any skin conditions that affect the vulva, using condoms (which lower the chance of HPV but do not cover all the skin around the genitals), stopping smoking and eating a balanced diet. For younger people, HPV vaccination is described as the best protection, and all children aged 12 to 13 are offered it.

The NHS says people with symptoms are usually referred for a vulvoscopy, a test that uses a magnifier called a colposcope to look closely at the vulva from the outside. This helps the nurse or doctor find small changes that are hard to see. They may also look inside the vagina with a speculum. If anything unusual is seen they will usually take a small sample of cells (a biopsy) after giving a local anaesthetic injection, and the sample is sent to a laboratory. The NHS says it should not be painful but may be uncomfortable, and that there may be some bleeding or soreness afterwards.

Results can take several weeks, according to the NHS, and a long wait does not mean anything is wrong. If vulval cancer is confirmed, further tests will find out the type, size and how far it has spread (the stage). The NHS says these may include blood tests and scans such as a CT, MRI or PET scan, and that you may not have all of them.

A group of specialists will look after you, including a clinical nurse specialist who is your main point of contact during and after treatment, the NHS says.

The NHS says treatment depends on the size and type of cancer, where it is, whether it has spread and your general health. Surgery is usually the main treatment, and radiotherapy or chemotherapy may be used as well.

The NHS describes vulval cancer as often treatable. If it is advanced and cannot be cured, the aim of treatment becomes slowing the growth and spread of the cancer, helping with symptoms and helping you live longer, and a palliative care or symptom control team will support you and your family.

Being told you have cancer can feel overwhelming. The NHS suggests bringing someone with you to appointments, and says your clinical nurse specialist can answer questions between visits. Charities such as Macmillan Cancer Support and Cancer Research UK run information and support services for people affected by cancer.

Because the surgery and its recovery can affect appearance, intimacy and everyday comfort, it is reasonable to raise these concerns with your specialist team early. They can explain what to expect and what support is available.

On the NHS, the route runs from the GP to an urgent referral, vulvoscopy and biopsy, staging tests and a specialist team that agrees the treatment plan. Cancer treatment on the NHS is free at the point of use.

Some people also choose a private gynaecologist for a quicker first appointment or a second opinion. The tests themselves are the same, and the main differences tend to be waiting times and choice of clinician. It is sensible to ask any provider which team will be responsible for each stage of your care.