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Vulvar Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Vulvar Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About the vulva

The vulva is the external genitalia of the female reproductive system. It is made up of the skin and fatty tissue that surround the clitoris and the openings of the vagina and urethra. The fatty tissue makes up 2 folds on each side of the vaginal opening, called the labia majora and labia minora. Cancer of the vulva occurs most often in or on the labia. Less often, it can occur on the clitoris or in glands on the sides of the vaginal opening, called the Bartholin’s glands, which produce a mucus­­-like lubricating fluid.

About vulvar cancer

Cancer begins when healthy cells change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Vulvar cancer is named for the type of tissue where the cancer started. However, vulvar skin can also develop skin cancers like all other skin on the body. The most common type of vulvar cancer is squamous cell carcinoma. Other, less common vulvar cancers include adenocarcinoma, melanoma, sarcoma, and verrucous carcinoma.

  • Squamous cell carcinoma. Squamous cell carcinoma is a type of skin cancer that accounts for about 90% of vulvar cancers, most of which are found on the labia.

    Squamous cancer can develop through a “precancerous” condition, which is when changes in cells may, but do not always, become cancer. This is called vulva intraepithelial neoplasia (VIN). VIN is a premalignant growth of cells on the vulva and is treated differently from invasive cancer. “Premalignant” means that it is not yet cancer. VIN is further classified into 2 groups based on how the cells look under a microscope called “usual-type VIN” and “differentiated VIN.” Usual-type VIN usually appears in younger people and is associated with human papillomavirus (HPV). Differentiated VIN is less common, usually appears in older people, and is not associated with HPV. Differentiated VIN often arises in people who have a skin condition called lichen sclerosus, which is likely to be diagnosed by a gynecologist and to be a known condition prior to VIN, but not always. This kind of VIN can develop into a fast-moving, aggressive squamous cancer. See Risk Factors and Prevention to learn more about HPV, precancerous conditions of the vulva, and lichen sclerosus.

  • Verrucous carcinoma. This is a slow-growing subtype of squamous cell carcinoma that looks like a wart.

  • Adenocarcinoma. Adenocarcinoma starts in the Bartholin’s glands or vulvar sweat glands. It accounts for a small percentage of vulvar cancers. It is usually found on the sides of the vaginal opening.

  • Melanoma. Melanoma is a type of skin cancer that accounts for about 2% to 4% of vulvar cancers. Melanoma is usually found on skin in parts of the body commonly exposed to the sun, but it can occasionally develop where there is no sun exposure. When it develops in the vulva, it occurs most often on the clitoris or the labia minora. Having melanoma diagnosed on another part of the body is a risk factor for developing vulvar melanoma. Vulvar melanoma is often treated using similar approaches for the treatment of melanoma in other parts of the body.

  • Sarcoma. Sarcoma is a tumor of the connective tissue beneath the skin.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with vulvar cancer and general survival rates. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with vulvar cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with vulvar cancer?

In 2023, an estimated 6,470 people in the United States will be diagnosed with vulvar cancer. Vulvar cancer makes up about 6% of cancers diagnosed in the female reproductive organs and less than 1% of all cancers in women. Worldwide, an estimated 45,240 people were diagnosed with vulvar cancer in 2020.

It is estimated that 1,670 deaths from this disease will occur in the United States in 2023. In 2020, an estimated 17,427 people worldwide died from vulvar cancer.

What is the survival rate for vulvar cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from vulvar cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with vulvar cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with vulvar cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for vulvar cancer in the United States is 70%.

The survival rates for vulvar cancer vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works. Another factor that can affect outcomes is the type of vulvar cancer.

The 5-year relative survival rate for vulvar cancer that has not spread beyond the vulva is 86%. An estimated 60% of vulvar cancers are diagnosed at this local stage. For cancer that has spread to surrounding tissues or organs and/or to the regional lymph nodes, the 5-year relative survival rate is 48%. The relative survival rate is 23% if the cancer has spread to a distant part of the body.

Experts measure relative survival rate statistics for vulvar cancer every 5 years. This means the estimate may not reflect the results of advancements in how vulvar cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's website, the International Agency for Research on Cancer website, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. (All sources accessed March 2023.)

The next section in this guide is Risk Factors and Prevention. It describes the factors that may increase the chance of developing vulvar cancer. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find out more about the factors that increase the chance of developing vulvar cancer. Use the menu to see other pages.

What are the risk factors for vulvar cancer?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise the risk of developing vulvar cancer:

  • Human papillomavirus (HPV). Research indicates that infection with HPV is a risk factor for vulvar cancer. HPV may be the cause for about one-third to two-thirds of all vulvar cancers. Sexual activity with someone who has HPV is the most common way for someone to get HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancer. Many types of cancer caused by HPV are associated with precancerous conditions, which are changes in cells that may, but do not always, become cancer. HPV vaccines can prevent people from developing certain cancers. Learn more about HPV and cancer.

  • Smoking. Smoking tobacco may increase a person’s risk of developing vulvar cancer.

  • Age. Most people diagnosed with vulvar cancer are older than 50. Only a small percentage of invasive vulvar cancer occurs in people younger than 40.

  • Immune system deficiency. People with lowered immune systems have a higher risk of developing vulvar cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, organ transplantation, treatment for other types of cancer, or human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS). When a person has a lowered immune system, their body is more likely to develop infections and may be unable to clear the virus, including an HPV infection (see above).

  • Precancerous conditions and select other primary cancers. Precancerous conditions of the vulva and other primary cancers can increase a person’s risk of developing vulvar cancer. These include vulva intraepithelial neoplasia (VIN; see Introduction), Paget’s disease, cervical cancer, vaginal cancer, or melanoma elsewhere on the body.

  • Lichen sclerosus. This condition affects the vulvar skin, making it thin and itchy. About 4% of people with lichen sclerosus develop vulvar cancer.

Are there ways to prevent vulvar cancer?

Different factors cause different types of cancer. Researchers continue to look into what factors cause vulvar cancer, including ways to prevent it. Although there is no proven way to completely prevent vulvar cancer, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

To help detect vulvar cancer, the doctor will take a family medical history, perform a general physical examination, and perform a gynecologic exam of the pelvis, during which the doctor will look at the vulva and feel the uterus, vagina, cervix, and other reproductive organs to check for any unusual changes. Regular pelvic examinations can help find cancer or precancerous conditions at an early stage.

In addition, research has shown that certain factors that help reduce the risk of HPV infection can help prevent vulvar cancer:

  • Delaying first sexual intercourse until the late teens or older

  • Avoiding sexual intercourse with multiple partners

  • Avoiding sexual intercourse with someone who has had many partners

  • Practicing safe sex, including condom use. However, condoms cannot fully protect against HPV. Abstaining from sexual intercourse is the only full protection against HPV.

  • Having regular gynecologic examinations to find and treat precancerous conditions

  • Quitting tobacco use for people who smoke

The HPV vaccine Gardasil is approved by the U.S. Food and Drug Administration (FDA) for prevention of vulvar cancer. Although this vaccine protects against certain strains of the virus, the vaccine does not protect people who are already infected with HPV. Learn more about the HPV vaccine and talk with your doctor for more information.

Learn more about cancer prevention and healthy living.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems vulvar cancer can cause. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find out more about the changes and medical problems that can be a sign of vulvar cancer. Use the menu to see other pages.

What are the symptoms and signs of vulvar cancer?

Vulvar cancer can cause one or more of the following symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with vulvar cancer do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer.

  • A lump or growth in or on the vulvar area or groin (an enlarged lymph node)

  • A patch of skin that is differently textured or colored than the rest of the vulvar area

  • Persistent itching, pain, soreness, or burning in the vulvar area

  • Painful urination

  • Bleeding or discharge that is not menstrual blood

  • An ulcer, open wound, or cut that persists for more than 1 month

  • A change in the appearance of an existing mole (this symptom is for vulvar melanoma specifically)

  • Wart-like growths that are similar to genital warts

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will try to understand what is causing your symptom(s). They may do an exam and order tests to understand the cause of the problem, which is called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called "palliative and supportive care," which is not the same as hospice care given at the end of life. This type of care focuses on managing symptoms and supporting people who face serious illnesses, such as cancer. You can receive palliative and supportive care at any time during cancer treatment. Learn more in this guide’s section on Coping with Treatment.

Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose different section to read in this guide.

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Vulvar Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How vulvar cancer is diagnosed

There are different tests used for diagnosing vulvar cancer. Not all tests described here will be used for every person. Your doctor, gynecologist, or dermatologist may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

A physical examination, including a pelvic exam, is the first step in diagnosing vulvar cancer. During the examination, the doctor inspects the vulva and then feels the uterus, vagina, ovaries, bladder, and rectum to check for any unusual changes.

In addition to a physical examination, the following tests may be used to diagnose vulvar cancer:

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed will depend on the location of the suspicious tissue.

    If the biopsy shows invasive vulvar cancer, the doctor will refer the patient to a gynecologic oncologist, which is a doctor who specializes in treating this type of cancer.

  • Colposcopy. The doctor may perform a colposcopy to check the vagina, vulva, and cervix for any abnormalities, especially when Pap tests or human papillomavirus (HPV) tests return abnormal results. A colposcope is a special instrument, similar to a microscope, that magnifies the surface of the cervix, vagina, and vulva. The colposcope gives the doctor a lighted, magnified view of these areas. The colposcope is not inserted into the body. The examination may be uncomfortable but is not painful, can be done in the doctor’s office, and has no side effects. This examination can be performed during pregnancy.

  • Chest x-ray. An x-ray creates a picture of the structures inside of the body using a small amount of radiation. A chest x-ray may be used to see if cancer has spread to the lungs.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given by mouth and swallowed, usually as a liquid.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein.

  • Endoscopy. An endoscopy shows the inside of the body using a thin, lighted, flexible tube called an endoscope. The patient may be sedated as the tube is inserted through the urethra into the bladder, called cystoscopy, or through the anus into the rectum, called proctoscopy or colonoscopy. Sedation is giving medication to become more relaxed, calm, or sleepy.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, additional testing to describe the extent of the cancer will be performed. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Stages

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will learn how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

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What is cancer staging?

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other organs in the body.

For vulvar cancer, the stage is determined by performing surgery and evaluating the removed tissues, the vulva, the underlying and nearby tissues, and the lymph nodes in the groin, which are the small, bean-shaped organs that help fight infection. Imaging scans (see Diagnosis) are also used as part of staging. Knowing the stage helps the doctor recommend additional treatment should it be necessary and can help predict a patient's prognosis, which is the chance of recovery.

There are different stage descriptions for different types of cancer. For vulvar cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique, or FIGO), is most commonly used.

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FIGO stages for vulvar cancer

Doctors assign the stage of the cancer by evaluating the tumor and whether the cancer has spread to lymph nodes and other parts of the body.

Tumor size is measured in centimeters (cm). There are 10 millimeters (mm) in 1 cm.

Stage I: The tumor is only in the vulva. It has not spread.

  • IA: The tumor is only in the vulva, is 2 cm or smaller, and is no deeper than 1 mm.

  • IB: The tumor is larger than 2 cm or is deeper than 1 mm, but it is only in the vulva.

Stage II: The tumor is of any size and has spread to the lower one-third of nearby structures, including the lower part of the urethra, vagina, or anus. It has not spread to lymph nodes or other parts of the body.

Stage III: The tumor is of any size and has spread to the upper part of nearby structures, such as the vagina, anus, or urethra, or to the groin lymph nodes. There are no distant metastases.

  • IIIA: The cancer has spread to the upper two-thirds of nearby structures (the vagina, anus, urethra, or bladder mucosa) or to the regional lymph nodes, where the metastases are 5 mm or smaller. There are no distant metastases.

  • IIIB: The cancer has spread to the regional lymph nodes, and the metastases are larger than 5 mm. There are no distant metastases.

  • IIIC: The cancer has spread to the regional lymph nodes, where it is spreading outside of the lymph node capsule.

Stage IV: The cancer has fixed to the bone, has fixed to or caused ulceration of the lymph nodes, or has spread to a distant part of the body.

  • IVA: The tumor has spread to the pelvic bone; the cancer has spread to regional lymph nodes and caused ulceration; or the cancer has attached the lymph node to the tissue beneath it. There are no distant metastases.

  • IVB: The cancer has spread to a distant part of the body.

Source for FIGO staging system:

  1. Olawaiye, A., Cotler, J., Cuello, M., Bhatla, N., Okamoto, A., Wilailak, S., Purandare, C. N., Lindeque, G., Berek, J. S., & Kehoe, S. (2021). FIGO staging for carcinoma of the vulva: 2021 revision. International Journal of Gynecology & Obstetrics, 155(1), 43–47. https://doi.org/10.1002/ijgo.13880

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Recurrent cancer

Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis. Vulvar cancers that recur only on the vulva can often be treated effectively.

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Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with vulvar cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for vulvar cancer. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for vulvar cancer in the United States. Treatment options can vary from one place to another. Clinical trials may also be an option for you, which is something you can discuss with your doctor. A clinical trial is a research study that tests a new approach to treatment. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How vulvar cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Gynecologic oncologists perform surgery for vulvar cancer, and radiation oncologists and medical oncologists may also be involved in the treatment of vulvar cancer. Pathologists and radiologists help to confirm the diagnosis and the extent of disease. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations for vulvar cancer depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for vulvar cancer because there are different treatment options. Learn more about making treatment decisions.

The common types of treatment used for vulvar cancer are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

READ MORE BELOW:

Concerns about sexual health and having children in the future

People with vulvar cancer may have concerns about if or how their treatment may affect their sexual health and fertility. These topics should be discussed with your health care team before treatment begins. If the patient has not gone through menopause, is still potentially able to get pregnant, and wants to preserve their fertility, they may be referred to a reproductive endocrinologist (REI) before treatment starts. It may be helpful to discuss what options for fertility preservation are covered by your health insurance.

It is common to experience a range of emotions after vulvar cancer treatment, such as loss, sadness, or anxiety. Some people may feel that they have lost a part of their identity. Others have questions about whether sexual intercourse can continue after certain treatments, such as surgery. People may also worry about how the treatment will affect their relationship with their partner.

Before treatment, it is important to talk with the doctor about the treatment, the possible side effects, and when sexual intercourse can begin again. People should also talk with their doctors about finding additional information or support in coping with vulvar cancer treatment. Learn more about sexual health, intimacy, and cancer treatment.

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Treatment overview for vulva intraepithelial neoplasia (VIN)

As explained in the Introduction, VIN is a precancerous condition. VIN is usually treated with a simple surgical removal of the disease to test for adjacent cancer and to prevent the progression to cancer. The treatment plan may also include laser surgery and/or medication(s) applied to the vulva area. If the VIN is extensive, a partial (not radical) and superficial (only the removal of the skin without removing the fatty tissues beneath the skin) surgical removal of the vulva may be recommended. See below for more information on each of these treatment options.

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Treatment overview for vulvar cancer

The main treatment for vulvar cancer is surgery. If a biopsy shows that vulvar cancer is present and that it appears to only be in the vulva, the next step is surgery for most patients. Radiation therapy and chemotherapy may be used if the cancer cannot be entirely removed with surgery, if the cancer has a high risk of coming back, and/or if the cancer is found in lymph nodes.

If the tumor has spread to the point that initial surgical removal is not possible, sometimes the treatment plan starts with radiation therapy, often with low-dose chemotherapy given weekly (usually with cisplatin, which is available as a generic drug) at the same time as the radiation treatments. This approach is called "chemoradiation." Surgical removal of the vulvar lesion is sometimes considered if the entire tumor does not go away after these treatments. Talk with your doctor about your recommended treatment plan.

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Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Due to the location and sensitivity of vulvar tissue, the type of surgery performed is carefully considered. Surgical options for invasive vulvar cancer include the following:

Vulvectomy. A vulvectomy is the removal of part or all of the vulva, depending on the size and spread of the primary tumor. Different vulvectomy approaches to treat invasive vulvar cancer include:

  • Radical local excision of the vulva. This surgery is done to remove the tumor and a large amount of tissue around it, called a margin. It is usually used when the tumor is less than 4 centimeters (cm) in diameter and is either stage I or stage II disease.

  • Modified radical vulvectomy. This term describes a surgical procedure in which less than the full vulva is removed. For example, in a radical hemivulvectomy, only 1 side of the vulva is removed.

  • Radical vulvectomy. A radical vulvectomy is the removal of part or all of the vulva, along with the underlying deep tissue. This is a very uncommon operation because most vulvectomies are modified in some way, and very large tumors are usually treated with chemoradiation, as described below.

Laser surgery. This procedure uses a focused beam of light that vaporizes a precancerous skin lesion. It cannot be used to treat an invasive tumor.

Lymphadenectomy. It is often necessary to remove groin lymph nodes, called inguinal-femoral lymph nodes, during surgery to find out if the cancer has spread to the lymph nodes. The surgical procedure to remove lymph nodes is called lymphadenectomy. If the cancer is only on 1 side of the vulva, then lymph nodes may only need to be removed from the groin on that side. For a small vulvar tumor, only the nearest lymph node, called a sentinel lymph node, may need to be removed.

Before surgery, talk with your health care team about the possible side effects, such as lymphedema, from the specific surgery you will have. Learn more about the basics of cancer surgery.

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Chemoradiation therapy for advanced-stage vulvar cancers

For a very large vulvar tumor, radiation therapy is often combined with low-dose chemotherapy to shrink the tumor before surgery. This is called chemoradiation therapy. This treatment can help avoid the need to remove the entire vulva and reduce how much tissue is removed. The chemotherapy is given at the same time as the radiation therapy. This treatment option is very important when the tumor involves the urethra or anus so that urinary function and bowel function can be preserved. Radiation therapy and chemotherapy are each explained in detail below.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Learn more about the basics of radiation therapy.

General side effects from radiation therapy may include fatigue, mild to severe skin reactions, upset stomach and loose bowel movements, damage to healthy vaginal tissue, or narrowing of the vagina. Most of these side effects go away soon after treatment is finished. However, it is possible for the vagina to shorten and narrow so much that sexual intercourse is not possible without appropriate treatment. To prevent this, the vagina may need to be stretched with a plastic tube called a vaginal dilator several times a week. It is best to start usage of a vaginal dilator during or soon after your treatment to prevent permanent narrowing or shortening of the vagina.

Radiation therapy's effects on vaginal and vulvar tissue may occur or change for months to years after completion of treatment. Talk with your doctor about the side effects you may experience before treatment begins and how they can be managed.

For more information about radiation therapy for gynecologic cancer, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.

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Chemotherapy

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

Systemic therapies for vulvar cancer are prescribed by a gynecologic oncologist or a medical oncologist, which is a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The type of systemic therapy used for vulvar cancer is chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

If the patient will receive external radiation therapy for locally spread vulvar cancer, chemotherapy with cisplatin is sometimes given intravenously every week at the same time as the radiation therapy (see "Chemoradiation therapy for advanced-stage vulvar cancers," above).

If the cancer has spread beyond the pelvis or has recurred, doctors sometimes consider using drugs that are used to treat cervical cancer and vaginal cancer, which are other squamous cell gynecologic cancers caused by human papillomavirus (HPV).

For metastatic vulvar cancer, patients are most often treated with platinum-based combination chemotherapy, typically carboplatin (available as a generic drug) and paclitaxel (Taxol). Sometimes, another type of systemic therapy called targeted therapy is added to this combination, specifically the targeted therapy drug bevacizumab (Avastin, Mvasi). Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.

The side effects of chemotherapy depend on the individual and the drugs and doses used. They can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, or diarrhea. These side effects usually go away after treatment is finished.

Whether these drugs are used depends on the patient’s overall health, kidney function as measured by laboratory tests, and other medical factors.

Learn more about the basics of chemotherapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

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Immunotherapy

Immunotherapy uses the body’s natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. Immunotherapy may be an option for some patients with vulvar cancer, including those with metastatic disease. One type of immunotherapy that may be used to treat vulvar cancer is called an immune checkpoint inhibitor. An immune checkpoint is a protein that can stop the body’s immune system from responding to cancer cells. Immune checkpoint inhibitors work by targeting and blocking these proteins, which then allows the immune system to find and attack cancer cells.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies, including topical treatments applied to the skin, such as creams to relieve symptoms like itching and burning. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in peer support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic vulvar cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. In this case, chemotherapy or another type of systemic therapy called immunotherapy may be recommended. Immunotherapy uses the body’s natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. As described above, the drugs that are used to treat most metastatic vulvar cancer are typically the same as those used for metastatic cervical cancer.

It is a good idea to talk with doctors who have experience treating metastatic vulvar cancer, such as gynecologic or medical oncologists. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of the treatments discussed above. Palliative and supportive care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning and what will be done to watch for a recurrence (see “Watching for recurrence” in Follow-Up Care). A recurrence happens when the cancer returns after the original treatment. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace from those used during initial treatment. Your doctor may suggest clinical trials that are studying new ways to treat recurrent vulvar cancer. Your doctor may also want to do biomarker testing of your tumor in order to help guide further treatment decisions, which may also be called molecular or targeted tumor testing. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - About Clinical Trials

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with vulvar cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of vulvar cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating vulvar cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with vulvar cancer.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for vulvar cancer, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials.

There are many resources and services to help you search for clinical trials for vulvar cancer, including the following services. Please note that these links will take you to separate, independent websites:

  • ClinicalTrials.gov. This U.S. government database lists publicly and privately supported clinical trials.

  • World Health Organization (WHO) International Clinical Trials Registry Platform. The WHO coordinates health matters within the United Nations. This search portal gathers clinical trial information from many countries’ registries.

Read more about the basics of clinical trials matching services.

The next section in this guide is Latest Research. It explains areas of scientific research for vulvar cancer. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Latest Research

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ON THIS PAGE: You will read about the scientific research being done to learn more about vulvar cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about vulvar cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Different surgical techniques. Researchers are studying new techniques, including reconstruction, to reduce the effects of vulvar surgery or to reconstruct the fatty tissue of the vulva after surgery.

  • New ways of delivering radiation therapy.

  • Testing new drugs, including new immunotherapy treatments.

  • Human papillomavirus (HPV) and vulvar cancer. Research continues to study the link between HPV and vulvar cancer, leading to a better understanding of the types of vulvar cancer and how each type grows.

  • Palliative and supportive care. Clinical trials are underway to find better ways of reducing side effects of current vulvar cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in vulvar cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

READ MORE BELOW:

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative and supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for vulvar cancer are described in the Types of Treatment section. This includes possible changes to sexual health and fertility. Learn more about other side effects of vulvar cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-Up Care section of this guide or talking with your doctor.

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Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. These may include dealing with a variety of emotions, such as sadness, depression, anxiety, fear, or anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

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Coping with the stigma of vulvar cancer

Vulvar cancer, like other cancers that affect the sex organs, can be difficult to discuss. People with many different types of cancer, such as cervical, testicular, penile, and vaginal cancers, can experience feelings of embarrassment when discussing these “sensitive” areas of their bodies. However, this should never stop you from requesting and receiving the emotional, physical, and social support you deserve, and your treatment team will never be embarrassed by discussing these issues with you. Your team can help you feel comfortable talking about this with others as well.

Because vulvar cancer is associated with human papillomavirus (HPV), patients may feel that they will not receive as much support or help from people around them because they believe that others may think that their behavior caused the disease. Although many vulvar cancers are caused by HPV, it is important to remember that most genital HPV infections will not cause cancer. Vulvar cancer can affect anyone.

Living with this stigma can make patients feel guilty, hopeless, embarrassed, ashamed, and isolated. Patients and their families should tell the health care team if they are affected by any of these emotions. There are resources to help those living with vulvar cancer. Some patients feel comfortable discussing their disease and experiences with their doctor, nurse, family, and friends. Other people find help through a support group or other support options.

Learn more about counseling and finding a support group.

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Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to mention financial concerns with a member of their health care team. There are often resources to address these concerns. An oncology social worker may be able to help connect you with those. Learn more about managing financial considerations in a separate part of this website.

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Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, adults older than 65, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

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Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should I call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

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Caring for a loved one with vulvar cancer

Family members and friends often play an important role in taking care of a person with vulvar cancer. This function is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One With Cancer in English or Spanish.

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Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, constipation, diarrhea, and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

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The next section in this guide is Follow-Up Care. It explains the importance of checkups after you finish cancer treatment. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Follow-up Care

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

The Society of Gynecologic Oncology (SGO) has published guidelines for the follow-up of patients treated for gynecologic cancers, including vulvar cancer. People diagnosed with early-stage vulvar cancer treated with only surgery are seen for a physical exam, including a vulvar and gynecologic exam, every 6 months for 2 years and then once a year following that period. People diagnosed with more advanced disease that is treated with initial chemotherapy, initial radiation therapy, or surgery followed by chemotherapy or radiation therapy should be seen for a physical exam:

  • Every 3 months for 2 years

  • Then every 6 months for 3 to 5 years

  • Then once a year after that

The doctor may also recommend other tests, including x-rays, computed tomography (CT) scans, ultrasounds, or magnetic resonance imaging (MRI) scans. If a person has no symptoms, then there is little evidence to support using certain imaging tests in follow-up care.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Patients recovering from vulvar cancer have other side effects that may continue after treatment. Learn about ways of coping with cancer-related fatigue, a drop in cognitive function that is sometimes called “chemobrain,” nerve problems or neuropathy, and other late effects of cancer treatment.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. To learn more about navigating the challenges of gynecologic cancer survivorship, listen to this interview with 2 ASCO experts.

This is a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Survivorship

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ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

For some, the term “survivorship” itself does not feel right, and they may prefer to use different language to describe and define their experience. Sometimes long-term treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. They may also feel a sense of grief about changes in their sense of identity, physical capability, or emotional health. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from vulvar cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-Up Care) to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking frequently with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of vulvar cancer do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • What is the stage of my cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What types of research are being done for vulvar cancer in clinical trials? Do clinical trials offer additional treatment options for me?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • How will this treatment affect my sex life, and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • How can I keep myself as healthy as possible during treatment?

  • What support services are available for me? For my family?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • If there is a plan to do lymph node surgery, is sentinel lymph node biopsy an option? What does this mean?

  • Who will be doing the surgery? How experienced is the surgeon with this type of operation?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this surgery?

  • What can be done to prevent or relieve side effects?

  • Is reconstructive surgery an option?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about therapies using medication

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • When should I return to my primary care doctor for regular medical care?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

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Vulvar Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 07/2023

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Vulvar Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Vulvar Cancer. Use the menu to choose a different section to read in this guide.

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