Vulval cancer

Understanding vulval cancer

What are the types of vulval cancer ?

The most common type of vulvar cancer is squamous cell carcinoma. This type of vulvar cancer starts in the thin cells that line the vulva’s surface and often looks like a wart.  Adenocarcinoma is a rarer type of vulvar cancer. It starts in the Bartholin glands or sweat glands on the sides of the vaginal opening.  Other rare types of vulvar cancer include melanoma, sarcoma and basal cell carcinoma. 

What causes vulval cancer ?

The most common risk factors of vulval cancer include:

• Older age

• HPV (human papillomavirus) infection

• Tobacco use

• Weakened immune system

• A precancerous condition called vulvar intraepithelial neoplasia (VIN) or vulval dysplasia

• A disorder called lichen sclerosus

• You had melanoma in the past

• You had other genital cancers in the past

What are the symptoms of vulval cancer ?

You can have vulvar cancer with no symptoms. Some women do have symptoms. Common symptoms of vulval cancer may include:

• Vulvar itching that does not get better

• An area of skin on your vulva that is red, or lighter or darker in colour

• A patch of skin on your vulva that feels thick, scaly, rough, or bumpy

• Wart-like bump or bumps, cauliflower-like growths, or ulcers or sores on the vulva that last for more than a month

• Pain when you urinate

• Burning or bleeding and discharge not related to your menstrual cycle

Diagnosing vulval cancer

A biopsy is the only way to confirm cancer. Small pieces of tissue are taken and checked for cancer cells.

What should I do if I am diagnosed with cervical cancer?

If the biopsy shows vulval cancer, the next step for the patient is to visit a Certified Gynaecological Oncologist. Seeking specialist care is crucial, as Gynaecological Oncologists have the knowledge, training, and experience to provide the best vulval cancer care. 

Will I need other tests ?

After a diagnosis of vulval cancer, you’ll likely need other tests in order to determine the stage of the cancer. The stage is how much and how far the cancer has spread in your body. It’s one of the most important things to know when deciding how to treat the cancer. The following exams may be used to ascerain the satge of the diasease:

• Examination under anaesthesia
• Magnetic Resonance Imaging (MRI) of the lower abdomen with intravenous contrast agent
• PET/CT or alternatively chest CT and upper abdomen CT or MRI with intravenous contrast agent
• Rarely, cystoscopy and/ or orthoscopy

Treating vulval cancer

Your treatment choices depend upon the type of vulvar cancer you have, test results, and the stage of the cancer. Treatment for vulvar cancer usually involves surgery and/or radiation. You might also have chemotherapy and/or radiation therapy either before surgery (neoadjuvant) to shrink the cancer for the best surgical outcome or after (adjuvant) surgery to kill cancer cells beyond the vulva. 

Surgical management

Surgery for vulvar cancers may include: 

• Radical excision of the vulval tumour (wide local excision or radical vulvectomy) 
• Excision of groin (inguino-femoral) lymph nodes
• Sentinel lymph node biopsy for women who fulfill specific criteria
• Exenterative procedure
• Plastic reconstruction of vulva and pelvic floor

Excellence in surgical care

Dr. Tranoulis is highly experienced in the treatment of gynecological cancers and a recognised leader in his field. International studies have demostrated that surgeons performing higher volumes of particular procedures can often offer patients better outcomes, such as shorter hospital stays and fewer complications. Studies also confirm that vulval cancer patients initially treated by Gynaecological Oncologists have improved survival rates compared to those treated by general gynaecologists or general surgeons. Dr. Tranoulis is a Certified Gynaecological Oncologist  with further sub-specialisation in exenterative surgery and plastic reconstruction at the prestigious The Pan-Birmingham Gynaecological Cancer Centre. 

Depending upon the location and stage of your cancer, Dr Tranoulis may recommend:

• Radical vulval surgery
• Comprehensive groin lymph node dissection
• Sentinel lymph node biopsy using ^99mTc and indocyanine green (ICG) 
• Plastic reconstruction with various free flaps
• Exenterative procedures for advanced-stage or recurrent disease

Surveillance

Once you’re finished with treatment, you’ll enter a period of surveillance to make sure the cancer doesn’t return, and if it does, to catch it early. Dr Tranoulis will create an individualised follow-up plan for you which includes:

• Periodic clinical examination, including gynecological examination (every 3-6 months)
• Periodic screening tests. The available options include computed tomography or magnetic resonance imaging and PET/CT, so the relevant decisions are made based on the doctor’s judgment and the symptoms that the patient may have.

Recurrence

When cancer comes back after treatment, it’s called recurrence. Vulval cancer usually recur in vulva but sometimes it may involves surrounding structures or organs in your pelvis or abdominal cavity. The symptoms are usually the smae with those at initial presentation.

It’s important to communicate any of these symptoms of recurrence to your Gynaecological Oncologist.

Treatment of recurrence

Treatment depends upon what previous treatment you had and the site and extent of the disease. Your individualized care plan can include surgery, radiation, and chemotherapy.

Coping with fear

Being told you have vulval cancer can be scary, and you may have many questions. We are here to help you. Learning about your cancer and about the treatment options available to you can make you feel less afraid.