Vulvar cancer is a rare type of gynaecological cancer that develops in the vulva—the external part of the female genitalia, including the labia, clitoris, and vaginal opening. It usually affects older women, with most cases diagnosed in women over 70. However, it can occur at any age, particularly in those with risk factors such as persistent human papillomavirus (HPV) infection, smoking, or chronic skin conditions like lichen sclerosus.

The most common type of vulvar cancer is squamous cell carcinoma, which starts in the skin. Other, less common types include vulvar melanoma, adenocarcinoma, basal cell carcinoma, and sarcoma. Vulvar cancer often develops slowly, sometimes starting as a precancerous condition called vulvar intraepithelial neoplasia (VIN). Symptoms may include persistent itching, pain, a lump, or skin changes.

Early detection is key to successful treatment. Regular check-ups, HPV vaccination, and quitting smoking can help reduce the risk. If you notice any unusual changes in the vulva, it’s important to see a doctor promptly.

Vulvar cancer often develops gradually, and symptoms can be subtle at first. Common symptoms include:

• Persistent itching, burning, or pain in the vulvar

• Changes in skin colour or texture, such as thickening, redness, or white patches

• A lump, sore, or ulcer on the vulvar that doesn’t heal

• Unusual bleeding or discharge, not related to periods

• Pain or discomfort during sex or urination

• Swelling in the vulvar or groin area

Many of these symptoms can be caused by other conditions, such as infections or skin disorders, but if they persist for more than a few weeks, see your doctor. Early diagnosis leads to better treatment options and health outcomes.

While the exact cause of vulvar cancer isn’t always known, certain factors can increase the risk, including:

• Age: Most cases occur in women over 70.

• HPV infection: Persistent infection with high-risk human papillomavirus (HPV) increases the risk.

• Vulvar intraepithelial neoplasia (VIN): A precancerous condition that can develop into vulvar cancer if left untreated.

• Lichen sclerosus: A chronic skin condition that causes irritation and can increase the risk of vulvar cancer.

• Smoking: Weakens the immune system and makes it harder to clear HPV infections.

• A weakened immune system: Due to conditions like HIV or medications that suppress immunity.

• A history of cervical or vaginal cancer: These cancers share common risk factors with vulvar cancer.

HPV vaccination, quitting smoking, and regular check-ups can help reduce the risk.

If vulvar cancer is suspected, a doctor will perform tests to confirm the diagnosis, such as:

• Physical examination: The doctor will check the vulvar for abnormalities, lumps, or sores.

• Biopsy: A small tissue sample is taken from the affected area and examined under a microscope.

• Imaging tests: If cancer is confirmed, MRI, CT, or PET scans may be used to check if it has spread to other areas.

• Colposcopy: A magnified examination of the vulvar to assess abnormal cells more closely.

Early detection is key, so if you notice persistent symptoms, speak to your doctor as soon as possible.

Treatment for vaginal cancer depends on the type, stage, and individual health factors. Common treatments include:

• Surgery: Small cancers may be removed with a local excision, but more advanced cases may require vaginectomy (removal of part or all of the vagina) or, in some cases, a hysterectomy.

• Radiation therapy: Often used as a primary treatment or after surgery to destroy remaining cancer cells.

• Chemotherapy: Used for advanced cases or when cancer has spread beyond the vagina.

• Targeted therapy and immunotherapy: Newer treatments that may be available through clinical trials for certain types of vaginal cancer.

Your healthcare team will tailor a treatment plan to your needs, and support services can help manage side effects and emotional wellbeing during treatment.