- Vulvar cancer
Vulvar cancer can start in any part of the external female sex organs (genitals). It most commonly develops in the labia majora, labia minora and the perineum. Less often, it involves the clitoris, mons pubis or Bartholin glands.
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The vulva and the vagina are parts of the female reproductive system, which also includes the ovaries, fallopian tubes, uterus and cervix.
The vulva is a general term for a female’s external sexual organs (genitals). The main parts of the vulva are the:
- mons pubis – the soft, fatty mound of tissue covered with pubic hair, above the labia
- labia majora – two large, outer fleshy lips, which surround and protect the inner lips known as labia minora
- labia minora – two inner lips (may be smaller or thinner than the labia majora)
- clitoris – the main organ for sexual pleasure in females. It is located where the labia minora join at the top of the vulva. During arousal, the clitoris fills with blood and becomes erect, and touching it can lead to sexual climax (orgasm)
- Bartholin glands – two small glands near the opening of the vagina. They produce mucus to moisten (lubricate) the vagina.
Sometimes called the birth canal, the vagina is a muscular tube about 7–10 cm long that extends from the cervix to the vulva. The vaginal opening is where menstrual blood flows out of the body during a period, sexual intercourse occurs, and a baby leaves the body.
Urethra, anus and perineum
Below the clitoris is the urethra, for passing urine. Further down is the entrance to the vagina, and behind that is the anus. The area of skin between the vagina and the anus is called the perineum.
The female reproductive system
What are the types of vulvar cancer?
The types of vulvar cancer are named after the cells they start in:
Squamous cell carcinoma (SCC)
The most common type, accounting for about 90% of all vulvar cancers in Australia. It starts in the thin, flat (squamous) cells covering the vulva. The two main subtypes of vulvar SCC are keratinising and warty or basaloid. Verrucous carcinoma is a rare subtype that looks like a large wart and grows slowly.
Vulvar (mucosal) melanoma
About 2–4% of vulvar cancers. It starts in the cells that give the skin its colour (melanocytes), which are also found in the lining of the vulva. Vulvar melanomas are not related to having too much ultraviolet radiation from the sun.
A rare type that starts in cells in muscle, fat and other tissue under the skin. It tends to grow faster than other types.
A rare type that develops from the mucus-producing (glandular) cells in the Bartholin glands or other vulvar glands.
Basal cell carcinoma (BCC)
Although the most common form of skin cancer, BCC is a very rare type of vulvar cancer. It starts in the tall (basal) cells in the skin’s lower layer.
Who gets vulvar cancer?
Vulvar cancer is not common – each year in Australia, about 390 women are diagnosed with vulvar cancer. Although it most commonly affects women who have gone through menopause, diagnoses of vulvar cancer in women under 60 have increased in recent years. This is likely to be due to rising rates of infection with human papillomavirus (HPV).
Anyone with a vulva can get vulvar cancer – women, transgender men and intersex people. For information specific to your situation, speak to your doctor.
What causes vulvar cancer?
The exact cause of vulvar cancer is unknown, but there are several things that increase the risk of developing it.
Vulvar intraepithelial neoplasia (VIN)
This is a precancerous condition that causes changes in the skin of the vulva. The vulva may itch, burn or feel sore. Often there are no symptoms at all. VIN may disappear on its own, but some people need treatment. The condition sometimes becomes cancerous – about one in three women diagnosed with vulvar cancer also has VIN.
Human papillomavirus (HPV)
HPV is a sexually transmitted infection that can cause people to develop VIN. It can be many years between infection with HPV and the first signs of VIN or vulvar cancer. HPV is a common virus and most people with this virus don’t develop vulvar or any other type of cancer. Although HPV is sexually transmitted, vulvar cancer itself is not contagious and it can’t be passed on to other people through sexual contact.
HPV has been linked to several cancers, including vulvar, vaginal, cervical, anal, mouth and throat cancers. Studies have shown that HPV vaccination can reduce the risk of developing abnormal cell changes that may lead to cancer, even at an older age. Talk to your doctor about whether the HPV vaccination may be of benefit to you.
Abnormal cervical screening test
If any abnormal cell changes are found on a cervical screening test, you have a slightly higher risk of developing vulvar cancer.
Other skin conditions
Vulvar lichen planus, vulvar lichen sclerosus and extramammary Paget’s disease are skin conditions that can cause itching and soreness. If not treated, they can cause permanent scarring, narrow the vaginal opening and, in a small number of people, develop into vulvar cancer after many years.
If you have had cervical cancer or vaginal cancer, you have an increased risk of developing vulvar cancer.
Cigarette smoking increases the risk of developing VIN and vulvar cancer. This may be because smoking can make the immune system work less effectively.
Weakened immune system
People who have had an organ transplant or have human immunodeficiency virus (HIV) are at higher risk of developing vulvar cancer because their immune system is not working normally.
Download a PDF booklet on this topic.
A/Prof Alison Brand, Director, Gynaecological Oncology, Westmead Hospital, NSW; Ellen Barlow, Clinical Nurse Consultant, Royal Hospital for Women, NSW; Jane Conroy-Wright, Consumer; Rebecca James, 13 11 20 Consultant, Cancer Council SA; Suparna Karpe, Clinical Psychologist, Gynaecological Oncology, Westmead Hospital, NSW; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Sally McCoull, Consumer; A/Prof Orla McNally, Gynaecological Oncologist and Director, Oncology/Dysplasia, The Royal Women’s Hospital, and Director, Gynaecology Tumour Stream,Victorian Comprehensive Cancer Centre, VIC; Haley McNamara, Social Worker and Project Manager, Care at End of Life Project, Queensland Health, QLD; Tamara Wraith, Senior Clinician – Physiotherapy, The Royal Women’s Hospital, VIC.
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