Vulval and Vaginal Cancer

Vulval and Vaginal Cancer are not common. These cancers are often preceded by vulval or vaginal intra-epithelial neoplasia (VIN or VAIN). In the case of VIN and VAIN, cells have undergone change but are confined to the epithelium - these are precursor conditions to cancer. In cancers there has been invasion into the underlying tissue. Cancers of the vulva and vagina are very slow growing and take years to develop. Vulval cancer comprises only 4% of gynaecologic malignancies.

Symptoms

The most common symptom is a vulval itch. Redness, ulceration and development of a mass can also occur. Pain is often a late feature of the disease. There may be difficulty in passing urine or a bowel motion if the cancer encroaches the urethra or anus. In more advanced cases swelling or hardness of lymph nodes in the groin can occur.

Diagnosis and Investigations

Diagnosis involves a biopsy of any suspicious areas of the vulva or vagina. This can be performed by your local doctor, however you are usually referred to a general gynaecologist for this biopsy to be performed. Once a diagnosis has been confirmed you will be referred to a specialist gynaecologic oncologist. You will need to have a CT scan of the chest, abdomen and pelvis to check for any spread of disease.

Treatment

The treatment of vulval and vaginal cancer differs, however the aim is to remove all visible disease.

Vulval Cancer - The vulval lesion is radically excised (cut out). If the lesion has invaded greater than 1mm, groin nodes need to be sampled. If the vulval lesion is less than 4cm in size, the groin nodes are sampled by a technique known as sentinel lymph node dissection. Larger lesions require a full groin node dissection to be performed. If the lesion is close to the midline groin nodes on both sides are sampled. Radiation therapy may be required if there are positive groin nodes or if margins of the excised lesion are close. Primary radiation is sometimes used if the cancer arises from the clitoris or close to structures such as the urethra or anus - this allows anatomy and function to be preserved.

Vaginal Cancer - If the lesion is small and superficial an excision is the primary form of treatment. In most cases, adequate clearance of the cancer is difficult due to the close proximity of the bladder and bowel, therefore radiation therapy is more commonly used.

Follow Up

Once you have completed treatment for Vulval or Vaginal Cancer you will be monitored regularly over the next several years. In some cases disease will recur. Further imaging and blood tests will be performed at that time and management options will be discussed. These include further surgery, chemotherapy or radiation therapy.

Staging and Prognosis

The Stage of disease describes how advanced your cancer is and to what organs it has spread to at the time of diagnosis. Your stage is determined after the surgical procedure. Once your disease is staged we have a better idea about prognosis or outlook. This will be discussed with you once we have all the necessary information.

Further information can be obtained from the websites listed in the Links Section or by contacting the Queensland Cancer Council.