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Conditions

Gynecology · Cancer care

Vulvar cancer

Recognise vulvar changes that need examination and understand diagnosis and care choices.

Editorial publication · Medical review pending.

Understand

Vulvar cancer develops in the tissues of the external genitals. The most common form starts in surface cells. Vulvar intraepithelial neoplasia (VIN) is a precancerous change rather than invasive cancer.

Possible symptoms

A lump, sore, ulcer or growth, persistent itching, an area of thickened or differently coloured skin, a changing mole, unusual bleeding or burning when passing urine may occur. These signs also have non-cancerous causes.

Causes and associated factors

The cause is not always known. Some cancers are linked to persistent infection with high-risk HPV; others may be associated with lichen sclerosus or other long-term vulvar conditions. Age, smoking and a weakened immune system may increase risk.

Diagnosis

A clinician examines the vulva and may use magnification during vulvoscopy. With your agreement, a small sample is taken from the abnormal area. Examination of this tissue confirms or rules out cancer and establishes its type.

Tests

After confirmation, the lesion’s size, depth and location and the lymph nodes are assessed. Depending on the findings, imaging or lymph-node sampling may help determine spread. Not everyone needs every test.

Course of the condition

Stage, tissue features and any lymph-node involvement guide care. Recurrence or new skin changes can occur; follow-up examines the vulva and lymph nodes and reviews symptoms and treatment effects.

Care options

Surgery is often the main treatment and, where possible, aims to remove the lesion with a margin while limiting damage to healthy tissue. Lymph-node assessment or treatment, radiotherapy or chemotherapy may be offered according to stage. Reconstruction, healing, lymphoedema, urinary comfort, body image and sexual health should be discussed.

When to consult

Seek advice if itching does not settle, or if you notice a lump, sore, thickened or coloured area, changing mole, bleeding or pain. You may request a female clinician or chaperone and can stop the examination at any time.

Urgent help

Seek immediate medical help for heavy bleeding, severe or rapidly worsening pain, faintness or loss of consciousness. A high fever, especially with a very painful sore, unusual discharge or after treatment, needs prompt assessment.

Questions for your doctor

  • What does the biopsy show, and what is the stage?
  • How much tissue and which lymph nodes would need treatment?
  • What alternatives, benefits and risks come with the proposed options?
  • How can pain, scarring, lymphoedema and sexual effects be prevented or managed?
  • What follow-up is planned, and which skin changes should I report?

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A procedure linked to a condition does not establish an indication for your individual situation.

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