Your physician will determine the best treatment option for you based on the stage of the disease and the tumor grade. Your doctor also considers other factors, including your age and general health. Some of the most widely recommended treatment options for vulvar cancer are listed below.
The goal of surgery is to remove all the cancer without any loss of a woman's sexual function. One of the following types of surgery may be done:
- Wide local excision: A surgical procedure to remove the cancer and some of the normal tissue around the cancer.
- Radical local excision: A surgical procedure to remove the cancer and a large amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.
- Vulvectomy: A surgical procedure to remove part or all of the vulva.
- Skinning vulvectomy: The top layer of vulvar skin where the cancer is found and removed. Skin grafts from other parts of the body may be needed to cover the area.
- Simple vulvectomy: The entire vulva is removed.
- Modified radical vulvectomy: The part of the vulva that contains cancer and some of the normal tissue around it are removed.
- Radical vulvectomy: The entire vulva, including the clitoris, and nearby tissue are removed. Nearby lymph nodes may also be removed.
- Pelvic exenteration: A surgical procedure to remove the lower colon, rectum and bladder. The cervix, vagina and ovaries and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.
Additional Treatments after Surgery
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
In radiation therapy, high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area. External radiation is typically used to treat vulvar cancer.
In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation five days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for external radiation therapy.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. It may be used after surgery to treat vulvar cancer that has an increased risk of returning after treatment.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, a body cavity such as the abdomen or onto the skin, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy for vulvar cancer may be applied to the skin in a cream or lotion.
CO2 Laser Therapy
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells on the surface of the skin. It is typically used to treat vulvar intraepithelial neoplasia (VIN) or vulvar pre-cancer and not invasive vulvar cancer.
Making an Informed Decision
You may find that your options for treatment here are greater than anywhere else, which can be reassuring but also overwhelming. We are committed to providing you with the information you need to make an informed decision about your treatment. Here are some points to consider as you evaluate your options:
- Sexuality: Because treatment for vulvar cancer often involves the genital organs, it is important to understand how this will impact your sexual function. If you are concerned about this issue, talk to your care team about what to expect after treatment and steps you might take prior to treatment that may preserve your sexual desire.
- Side effects: Cancer treatments often damage healthy cells and tissues along with the cancer cells, so side effects are common. These side effects vary depending on the type and extent of treatment, and from one patient to the next. Knowing what to expect prior to treatment will allow you to be proactive in managing side effects or, taking quality of life into consideration, may also help you rule out particular treatment options.
- Second opinion: Before starting treatment, a woman might want a second opinion about the diagnosis, the stage of cancer, and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the woman requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay does not make treatment less effective.