Vulvar Cancer: Treatment Options

Approved by the Cancer.Net Editorial Board, 12/2016

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

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients may be encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations for vulvar cancer depend on several factors, including:

  • The type and stage of cancer

  • Possible side effects

  • The patient’s preferences and overall health

Your care plan may include treatment for symptoms and side effects, an important part of cancer care. 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. Learn more about making treatment decisions.

Treatment overview for VIN

As explained in the Introduction, VIN is a precancerous condition. VIN is usually treated by simple surgical removal of the disease. 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.

Treatment overview for vulvar cancer

The main treatment for vulvar cancer is surgery. Radiation therapy and chemotherapy may be used if the cancer cannot be entirely removed with surgery, if the cancer has a high risk for recurrence, and/or if the lymph nodes are involved with cancer.

If the tumor has spread to the point that initial surgical removal is not possible, sometimes the patient’s treatment plan starts with radiation therapy, often with simultaneous low-dose chemotherapy given weekly during the radiation treatments. Surgical removal of the vulvar lesion sometimes considered if the entire tumor does not go away after these treatments.

Women with vulvar cancer may have concerns about if and how these treatments may affect their sexual function and fertility (ability to have children). These topics are important and should be discussed with the health care team before treatment begins.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A gynecologic oncologist is a doctor who specializes in treating gynecologic cancer using surgery. Due to the location and sensitivity of vulvar tissue, the type of surgery is carefully considered.

Surgical options for invasive vulvar cancer include the removal of part or all of the vulva, depending on the size and spread of the primary tumor. This is called a vulvectomy.

Vulvectomy. 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 used for most primary tumors that are less than 4 centimeters (cm) in diameter and are 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 one 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 is the use of a focused beam of light that vaporizes a premalignant skin lesion. It cannot be used to treat an invasive tumor.

Lymphadenectomy. As explained in Diagnosis, this is a surgical procedure to remove lymph nodes in the groin in order to check for cancer.  

Learn more about the basics of cancer surgery.

Coping with vulvar surgery

Many women experience a range of emotions after vulvar surgery, such as loss, sadness, or anxiety. Some women may feel that they have lost their identity as women. Others have questions about whether sexual intercourse can continue after surgery. Women may also worry about how the surgery will affect their relationships with their partners.

Before surgery, it is important to talk with the surgeon about the procedure, the possible side effects, and when sexual intercourse can begin again. Women should talk with their doctors about finding additional information or support in coping with this type of surgery. Learn more about sexual health and cancer treatment in women

Chemoradiation therapy for advanced-stage vulvar cancers

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

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-bean 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, the vagina may shorten and narrow so much that sexual intercourse is not possible. To prevent this, the vagina may need to be stretched with a plastic tube called a vaginal dilator several times a week.

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.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. Chemotherapy is given by a gynecologic oncologist or medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed.

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 combinations of different drugs given at the same time.

If the patient is to receive external radiation therapy for locally spread vulvar cancer, chemotherapy with cisplatin (Platinol) is sometimes given intravenously every week at the same time as the radiation therapy.

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 HPV-induced squamous cell gynecologic cancers. 

For metastatic vulvar cancer, patients are most often treated with platinum-based combination chemotherapy, typically carboplatin (Paraplatin) and paclitaxel (Taxol). Sometimes bevacizumab (Avastin) is added to this combination.

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, their kidney function measured as by laboratory tests, and other medical factors.

Learn more about the basics of chemotherapy and preparing for treatment. 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. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer at the same time they receive treatment to ease side effects, including topical treatments applied to the skin, such as creams, to relieve symptoms like itching and burning. Patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible.

Learn more about palliative care.

Metastatic vulvar cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. In these situations, chemotherapy may be recommended. 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 in treating metastatic vulvar cancer, such as a gynecologic oncologist. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might 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 care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

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). 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 the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a new cycle of testing will begin to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your 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. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

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

If treatment fails

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

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. Patients may consider staying at home instead of in a different or facility-based environment. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative 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.

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. You may use the menu to choose a different section to continue reading in this guide.