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Vulvar Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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 the complete guide.

About the vulva

The vulva is a woman’s external genitalia. 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.

  • Squamous cell carcinoma. Squamous cell carcinoma is a type of skin cancerthat 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.

Other, much less common vulvar cancers include:

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

  • Melanoma. Melanoma is another type of skin cancer that accounts for about 2% to 4% of vulvar cancer. It occurs most often on the clitoris or the labia minora. Women with melanoma on other parts of their body have an increased risk of 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.

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

The next section in this guide is Statistics. It helps explain the number of women who are diagnosed with this disease and their survival rates. You may use the menu to choose a different section to continue reading in this guide.

Vulvar Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will find information about the number of women who are diagnosed with vulvar cancer each year. You will read information about surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 5,950 women in the United States will be diagnosed with vulvar cancer. Its incidence is increasing in young women because of its association with the human papillomavirus (HPV). See the Risk Factors and Prevention section for more information on HPV.

It is estimated that 1,110 deaths from this disease will occur this year.

The 5-year survival rate tells you what percent of women live at least 5 years after the cancer is found. Percent means how many out of 100. Survival rates depend on several factors, including the type of vulvar cancer and the stage of disease at the time it is diagnosed.

The 5-year survival rate for cancer that has not spread beyond the vulva is 98% for FIGO surgical stage I and 85% for stage II disease (see Stages for explanation of the FIGO Staging system).  For stage III disease, survival is 74%, and for stage IV is 31%. For cancer that involves a number of lymph nodes in the groin, also known as the inguinal-femoral lymph nodes, the 5-year survival rate is 63% if it has spread, or metastasized, to 1 groin lymph node, 30% for 2 lymph nodes, 19% for 3 lymph nodes, and 13% for 4 or more lymph nodes that are involved with cancer. The survival rate is about 10% if the cancer has spread to a distant part of the body.

It is important to remember that statistics on the survival rates for women with this type of cancer are an estimate. The estimate comes from annual data based on the number of women with this cancer in the United States. Each patient should discuss their specific risk with their doctor. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2016, and the ACS website.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to continue reading in this guide.

Vulvar Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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

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 a woman’s risk of developing vulvar cancer:

  • Age. Most women diagnosed with vulvar cancer are older than 50. Only a small percentage of invasive vulvar cancer occurs in women younger than 40. Generally, vulvar cancer is associated with HPV infection (see below) and smoking.

  • HPV infection. Research indicates that infection with this virus is a risk factor for vulvar cancer. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. HPV may be responsible for about one-third to two-thirds of vulvar 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. There are vaccines available to protect you from some HPV strains. Learn more about HPV and cancer.

  • Smoking. Smoking may increase a woman’s risk of developing vulvar cancer if she has HPV.

  • Immune system deficiency. Women 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 woman has a lowered immune system, her body is more likely to develop infections, including an HPV infection.

  • Precancerous conditions. Precancerous conditions of the vulva, including VIN (see Introduction) and Paget’s disease, cervical cancer, vaginal cancer, or melanoma elsewhere on the body, can increase a woman’s risk of developing vulvar cancer.

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

Prevention and Early Detection

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

The doctor will take a family medical history and perform a general physical examination and a gynecologic exam of the pelvis, during which the doctor will feel a woman’s 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 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 (although condoms cannot fully protect against HPV)

  • Having regular gynecologic examinations to find and treat precancerous conditions

  • Quitting smoking, if a smoker

In 2008, a vaccine used to prevent cervical cancer for girls and women between ages 9 and 26 was also approved to prevent 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.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to continue reading in this guide.

Vulvar Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

Women with vulvar cancer may experience the following symptoms or signs. Sometimes, women with vulvar cancer do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • A lump or growth in or on the vulvar area

  • 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 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 ask how long and how often you’ve been experiencing any symptom, in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about 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. You may use the menu to choose different section to continue reading in this guide.  

Vulvar Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find out what’s wrong and identify the cause of the 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 this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. 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 whether 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.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

Physical examination, including a pelvic exam, is the first step in diagnosing vulvar cancer. In the examination, the doctor inspects the vulva and then feels the uterus, vagina, ovaries, fallopian tubes, 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 removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. 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 woman to a gynecologic oncologist, who specializes in treating this type of cancer.

  • Chest X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also 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 as a pill to swallow (orally).

  • Positron emission tomography (PET) or PET-CT scan. 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 PET scan is a way to create pictures of organs and tissues inside the body. 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. A scanner then detects this substance to produce images of the inside of the body.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also 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 can be injected into a patient’s vein or given as a pill to swallow (orally).

  • Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The woman 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.

Surgical removal of vulvar cancer

If a biopsy shows that vulvar cancer is present and that it appears to only be in the vulva, in most patients the next step is surgery. In most patients the surgery includes a radical local excision or modified radical vulvectomy of the vulvar lesion (see “Surgery” in Treatment Options) plus a removal of lymph nodes from 1 or both groins, called inguinal-femoral lymph nodes.

The lymph nodes are tiny, bean-shaped organs that help fight infection. To determine whether a vulvar cancer has spread, or metastasized, it is necessary to remove groin lymph nodes during the surgery to determine whether the disease has metastasized to the lymph nodes.

The procedure for removing the groin lymph nodes is called a “lymphadenectomy.” If the cancer is only on one side of the vulva, removal of the lymph nodes may be done in the groin only on that side. If there are metastases to the groin lymph nodes, additional treatment may be necessary, using radiation therapy as described in Treatment Options.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results help the doctor describe the cancer. 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. You may use the menu to choose a different section to continue reading in this guide. 

Vulvar Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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.

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.

Knowing the stage helps the doctor to decide if additional treatment may 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.

Vulvar cancer stage

Vulvar cancer is staged using the FIGO (International Federation of Obstetrics and Gynecology) staging system.

Stage I: The tumor is only in the vulva or the vulva and perineum, and it has not spread.

  • IA: The tumor is only in the vulva or the vulva and perineum, is 2 cm or smaller, has not spread, and is no deeper than 1 mm.
  • IB: The tumor is larger than 2 cm or is deeper than 1 mm, but is only in the vulva or the vulva and perineum.

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

  • IIIA: The cancer has spread to nearby tissue (the vagina, anus, or urethra). There are 1 or 2 metastases to lymph nodes, but they are smaller than 5 mm, or there is 1 metastasis that is 5 mm. There are no distant metastases.
  • IIIB: The cancer has spread to nearby tissue (the vagina, anus, or urethra). There are 3 or more metastases to lymph nodes, but they are smaller than 5 mm, or there are 2 or more metastases that are 5 mm. There are no distant metastases.
  • IIIC: The cancer has spread to nearby tissue (the vagina, anus, or urethra) and to 1 or more lymph nodes and their surrounding lymph node capsule, or covering. There are no distant metastases.

Stage IV: The cancer has spread to the upper part of the vagina or upper part of the urethra, or it has spread to a distant part of the body.  

  • IVA: The tumor has spread to the upper part of the urethra, vagina, or anus; the cancer has spread to regional lymph nodes and caused ulceration; or it has attached the lymph node to the tissue beneath it. There are no distant metastases.
  • IVB: Cancer has spread to a distant part of the body.

Sources for FIGO staging system:

  1. FIGO Committee on Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet 2009;105:103–104.
  1. Hacker NF. Revised FIGO staging for carcinoma of the vulva. Int J Gynecol Obstet 2009;105:105–106.

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. Vulvar cancers that recur only on the vulva can often be treated effectively. These tests and scans are often similar to those done at the time of the original diagnosis.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to continue reading in this guide. 

Vulvar Cancer - Treatment

This section has been reviewed and 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.  

Vulvar Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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

What are clinical trials?

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

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors already use.

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. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, 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. Other patients 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 patients with vulvar cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

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

  • List all of the patient's 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 patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. 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 patients 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 the patient chooses 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 a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. You may use the menu to choose a different section to continue reading in this guide.   

Vulvar Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

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.

  • 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 care. Clinical trials are underway to find better ways of reducing side effects of current vulvar cancer treatments to improve patients’ quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding 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 in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. You may use the menu to choose a different section to continue reading in this guide.  

Vulvar Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t 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.

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. Doctors call this part of cancer treatment “palliative 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 Treatment Options section. Learn more about side effects of 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.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment 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.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. These may include dealing with difficult emotions, such as depression, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. 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.

Coping with financial effects

Cancer treatment can be expensive. It is often a big 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 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. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with vulvar cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers encounter:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

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 are likely to happen?

  • What can we do to prevent or relieve them?

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

Ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. You may use the menu to choose a different section to continue reading in this guide.  

Vulvar Cancer - Follow-up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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 doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, 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 Oncologists has published guidelines for the follow-up of patients with gynecologic cancers, including vulvar cancer. Patients 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. Patients with more advanced disease 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

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

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. 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 originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience 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 afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, 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. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, 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 him or her 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. You may use the menu to choose a different section to continue reading in this guide. 

Vulvar Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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” 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 includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong 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.

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, sexuality 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 program of the center where you received treatment.

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 in this article.

A new perspective on your health

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

People recovering from vulvar cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, 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. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical 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 and productive as possible.

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

Looking for More Survivorship Resources?

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

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. You may use the menu to choose a different section to continue reading this guide.  

Vulvar Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your 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 your doctor 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, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

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 clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help 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?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Question 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?

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

  • Is reconstructive surgery an option?

Questions to ask about having radiation therapy or chemotherapy

  • 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?

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

  • What can be done to 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 I need them?

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

  • 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 some more website resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to continue reading in this guide.  

Vulvar Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2016

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 review 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.

Beyond this guide, 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 select a different section to continue reading this guide.