Treatment and care of people with cancer is usually provided by a team of health professionals, including doctors, nurses and allied health professionals, called a multidisciplinary team.
Treatment for vulvar cancer depends on:
- the type of vulvar cancer
- whether the cancer has spread, and where it has spread to
- your general health
- your personal preferences.
Treatment options include surgery, chemotherapy and radiation therapy.
Surgery
Surgery is the main treatment for vulvar cancer. It may be used either alone or in combination with radiotherapy and chemotherapy. Your doctor will talk to you about the most appropriate type of surgery.
There are several different operations for cancer of the vulva. Which operation you have usually depends on the stage of the cancer. The surgeon will aim to remove the cancer while preserving as much normal tissue as possible. However, it is important that a margin of healthy tissue around the cancer is removed, to reduce the risk of the cancer coming back (recurring) in this area.
Usually only a small amount of unaffected skin is removed with the cancer, so it is often possible to stitch the remaining skin neatly together. If it is necessary to remove a large area of skin, reconstructive surgery is available using a skin graft or skin flaps. To do this, the surgeon may take a thin piece of skin (graft) from another part of the body (usually the thigh or abdomen) and stitch it onto the operation site. It may be possible to move (rotate) flaps of skin in the vulval area to cover the wound. The graft or flaps will be done straight after the cancer is removed, as part of the same operation.
Local excision
Wide local excision takes out the cancer and a border (margin) of healthy cells, ideally at least 1 centimetre, all around the cancer.
Radical local excision takes out the cancer and a larger area of normal tissue all around the cancer. The groin lymph nodes may also be removed (known as lymph node dissection).
Vulvectomy
A partial vulvectomy removes part of the vulva.
A radical vulvectomy removes the entire vulva, including the clitoris and, usually, the surrounding lymph nodes.
Pelvic exenteration
Pelvic exenteration is usually only used for recurrent vulvar cancer that has come back even after radiation therapy.[4]
Pelvic exenteration is surgery to remove the lower colon, rectum and bladder. In women, the cervix, vulva, vagina, ovaries and nearby lymph nodes are also removed. Openings called stoma are made to bring the small or large intestine out onto the abdomen. This allows urine and faeces to flow from inside the body to a collection bag.
Common stoma include:
- an ileostomy (formed from the lower half of the small bowel, called the ileum, which joins up with the colon)
- a colostomy (formed from the colon)
- an ideal conduit (formed by isolating a small piece of ileum and implanting the tubes from the kidney – the ureters – into it).
For more information about adapting to life with a stoma, ask your treatment team or contact your local stoma association.
Plastic surgery to reconstruct the vulva and vagina may also be needed after pelvic exenteration.
Radiation therapy
Radiation therapy is a commonly used treatment for vulvar cancer. In some women, radiation therapy may be combined with chemotherapy before surgery to help shrink the tumour.
You might have external radiation therapy to your pelvic area to treat vaginal cancer. Radiation therapy may also be recommended if the cancer has come back (recurrent cancer) or spread.
Chemotherapy
In women with vulvar cancer, chemotherapy is mainly used if the cancer has spread, or if the cancer returns after treatment (recurrent cancer). It may also be used with radiation therapy before surgery to help shrink the tumour. Chemotherapy is usually given through a vein (intravenously) as an outpatient. The treatment is repeated on a regular basis, with intervals of a few weeks called a cycle.
Chemotherapy is usually given as single drug or multiple drug combination. The type of regimen used depends on the stage of the disease.
If you have not had a hysterectomy or have not been through menopause, you should avoid getting pregnant during your chemotherapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor.
Recurrent or advanced disease
Recurrent vulvar cancer is cancer that has recurred (come back) after it has been treated.
Recurrence is when the cancer comes back in the same part of the body. Secondary cancer is when the cancer spreads to another part of the body.
Vulvar cancer may recur in the vulva, the groin, the pelvis or elsewhere in the body.
Treatment of recurrent vulvar cancer will depend very much on the site (location) of the recurrence. It may involve surgical removal of the recurrence followed by radiotherapy, or radiotherapy by itself or with chemotherapy. These choices have to be made on an individual case-by-case basis.
Treating vulvar intraepithelial neoplasia (VIN)
Laser treatment or surgery may be used to remove the affected tissue.
If the VIN is close to the clitoris, care will be taken in the choice and extent of treatment.
Some doctors use chemotherapy drugs formulated into creams, which are applied topically (on the skin). These can cause a lot of inflammation and not all specialists support using them. Another topical treatment is a drug called imiquimod.[5] It works by boosting your own immune response to the VIN. But this drug can cause pain and inflammation to the affected area as well.
Whatever treatment is given, careful follow-up is needed in case the VIN comes back.
