Treatments and drugs
Treatment options for vulvar cancer depend on the type and stage of your cancer, your overall health and your preferences.
Surgery to remove vulvar cancer
Operations used to treat vulvar cancer include:
- Removing the cancer and a margin of healthy tissue (excision). This procedure, which may also be called a wide local excision or radical excision, involves cutting out the cancer and a small amount of normal tissue that surrounds it. Cutting out what doctors refer to as a margin of normal-looking tissue helps ensure that all of the cancerous cells have been removed.
- Removing a portion of the vulva (partial vulvectomy). During a partial vulvectomy, a portion of the vulva is removed, along with its underlying tissues.
- Removing the entire vulva (radical vulvectomy). Radical vulvectomy involves removal of the entire vulva, including the clitoris and underlying tissues.
Extensive surgery for advanced cancer. If cancer has spread beyond the vulva and involves nearby organs, your doctor may recommend removing all of the vulva and the involved organs in a procedure called pelvic exenteration.
Depending on where your cancer has spread, your surgeon may remove the lower colon, rectum, bladder, cervix, uterus, vagina, ovaries and nearby lymph nodes. If your bladder, rectum or colon is removed, your doctor will create an artificial opening in your body (stoma) for your waste to be removed in a bag (ostomy).
- Reconstructive surgery. Treatment of vulvar cancer often involves removal of some skin from your vulva. The wound or area left behind can usually be closed without grafting skin from another area of your body. However, depending on how widespread the cancer is and how much tissue your doctor needs to remove, your doctor may perform reconstructive surgery — grafting skin from another part of your body to cover this area.
Surgery to remove the entire vulva carries a risk of complications, such as infection and problems with healing around the incision. In addition, with part or all of the vulvar padding gone, it can be uncomfortable to sit for long periods. Your genital area may feel numb, and it may not be possible to achieve orgasm during sexual intercourse.
Surgery to remove nearby lymph nodes
Vulvar cancer often spreads to the lymph nodes in the groin, so your doctor may remove these lymph nodes at the time you undergo surgery to remove the cancer. Depending on your situation, your doctor may remove only a few lymph nodes or many lymph nodes.
Removing lymph nodes can cause fluid retention and leg swelling, a condition called lymphedema.
In certain situations, surgeons may use a technique that allows them to remove fewer lymph nodes. Called sentinel lymph node biopsy, this procedure involves identifying the lymph node where the cancer is most likely to spread first. The surgeon then removes that lymph node for testing. If cancer cells aren't found in that lymph node, then it's unlikely that cancer cells have spread to other lymph nodes.
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy for vulvar cancer is usually administered by a machine that moves around your body and directs radiation to precise points on your skin (external beam radiation).
Radiation therapy is sometimes used to shrink large vulvar cancers in order to make it more likely that surgery will be successful. Radiation is sometimes combined with chemotherapy, which can make cancer cells more vulnerable to radiation therapy.
If cancer cells are discovered in your lymph nodes, your doctor may recommend radiation to the area around your lymph nodes to kill any cancer cells that might remain after surgery.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically administered through a vein in your arm or by mouth.
For women with advanced vulvar cancer that has spread to other areas of the body, chemotherapy may be an option. Sometimes chemotherapy is combined with radiation therapy to shrink large vulvar cancers in order to make it more likely that surgery will be successful.
Follow-up tests after treatment
After completing vulvar cancer treatment, your doctor may recommend periodic follow-up exams to look for a cancer recurrence. Even after successful treatment, vulvar cancer can return. Your doctor will determine the schedule of follow-up exams that's right for you, but doctors generally recommend exams two to four times each year for the first two years after vulvar cancer treatment.