2c77ea7105daa010VgnVCM100000ed730ad1RCRDapproved/patient/Cancer Types/Cancer Type DocumentsVulvar Cancer2008-03-17T18:00:00Z

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Vulvar Cancer

vulvar vulva gynecologic women cancer

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emotional and physical concerns

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links to find clinical trials

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addressing such needs

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Clinical Trials

http://www.cancer.net/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=About Clinical Trials

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clinical trials

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coping strategies

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www.cancerstaging.net

http://www.cancerstaging.net

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Talking often with the doctor is important

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searchable drug databases

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the most common side effects of cancer and different treatments, along with ways to prevent or control them

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making treatment decisions

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risk factor

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Fear of treatment side effects

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list

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advanced cancer care planning

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Quitting smoking

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palliative or supportive care

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positive lifestyle changes

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organizations that offer information on this specific type of cancer

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Radiation Therapy for Gynecologic Cancers

http://www.rtanswers.org/treatmentinformation/cancertypes/gynecologic/index.aspx

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HPV and cancer

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caregiving

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common terms used after cancer treatment is complete

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second opinion

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Smoking

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managing the cost of your medical care

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next steps to take in survivorship

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dealing with cancer recurrence

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understanding statistics

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melanoma

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cancer treatment summary forms

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radiation therapy

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HPV vaccine

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what to expect when having common tests, procedures, and scans

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common statistical terms used in cancer research

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multidisciplinary team

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basic cancer terms used in this section

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Positron emission tomography (PET) scan

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search online clinical trial databases now

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common terms used during cancer treatment

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skin cancer

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Biopsy

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sexual function and fertility (ability to have children)

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melanoma

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Magnetic resonance imaging (MRI)

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clinical trials

http://www.cancer.net/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=About Clinical Trials

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sarcoma

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Computed tomography (CT or CAT) scan

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palliative or supportive care

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first steps to take after a diagnosis of cancer

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cancer surgery

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chemotherapy

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informed consent

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Endoscopy

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coping with gynecologic surgery

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coping with this fear

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placebos in cancer clinical trials

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late effect

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preparing for treatment

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Patient Information Resources

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In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=8667d2d1119c3210VgnVCM100000ed730ad1RCRD">list</a> of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=649903e8448d9010VgnVCM100000f2730ad1RCRD" alt="organizations that offer information on this specific type of cancer">organizations that offer information on this specific type of cancer</a>.

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Overview

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About the vulva The vulva is a woman’s external genitalia and 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 two folds, called the labia majora and labia minora. Cancer of the vulva occurs most often in or on the labia. Less frequently, it can occur on the clitoris or in the glands on the sides of the vaginal opening, called Bartholin’s glands, which produce a mucus-like lubricating fluid. About vulvar cancer Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Vulvar cancer is classified into three main types, named for the type of tissue where the cancer started. Squamous cell carcinoma. Squamous cell carcinoma is a type of <a href="http://www.cancer.net/vgn-ext-templating/v/index.jsp?vgnextoid=88d5ea97a56d9010VgnVCM100000f2730ad1RCRD">skin cancer</a> that accounts for about 90% of vulvar cancers. It is usually found on the labia. Adenocarcinoma. Adenocarcinoma starts in the Bartholin’s glands or vulvar sweat glands, and it accounts for a small percentage of vulvar cancers. 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 cancers. 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. Learn more about <a href="http://www.cancer.net/vgn-ext-templating/v/index.jsp?vgnextoid=5c14ea97a56d9010VgnVCM100000f2730ad1RCRD">melanoma</a>. Other, less common vulvar cancers include Paget’s disease of the vulva, in which adenocarcinoma cells are found in the vulvar skin; <a href="http://www.cancer.net/vgn-ext-templating/v/index.jsp?vgnextoid=1795ea97a56d9010VgnVCM100000f2730ad1RCRD">sarcoma</a>, a tumor of the connective tissue beneath the skin; and verrucous carcinoma, a slow-growing subtype of squamous cell carcinoma that resembles a wart. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=fcfea3f97915e010VgnVCM100000ed730ad1RCRD" alt="basic cancer terms used in this section">basic cancer terms used in this section</a>. Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel located on the right side of your screen.

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Risk Factors and Prevention

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A <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=f6e1ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="risk factor">risk factor</a> 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. However, 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. The majority of women diagnosed with vulvar cancer are older than 50. However, a significant percentage (15%) of women younger than 40 develop vulvar cancer. Generally, vulvar cancer in younger women is associated with HPV infection (see below) and smoking. Vulvar cancer in older women is most often associated with lichen sclerosus (a rare skin condition; see below) or changes in certain genes. HPV infection. Research indicates that infection with this virus is a risk factor for vulvar cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. HPV may be responsible for about one-third to two-thirds of vulvar cancers. Many types of cancer caused by HPV are associated with precancerous conditions (changes in cells that may, but do not always, become cancer) that develop before the cancer. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d652e09a32cff110VgnVCM100000ed730ad1RCRD" alt="HPV and cancer">HPV and cancer</a>. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=f93cacb1419d2110VgnVCM100000ed730ad1RCRD" alt="Smoking">Smoking</a>. 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 HPV. Lichen sclerosus. This condition affects the vulvar skin, making it thin and itchy. About 4% of women with lichen sclerosus develop vulvar cancer. Precancerous conditions. Precancerous conditions of the vulva, cervix, or vagina, or <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=5c14ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="melanoma">melanoma</a> elsewhere on the body, can increase a woman’s risk of developing vulvar cancer. Prevention and Early Detection All women should have an annual gynecologic examination. During this exam, the doctor will take a family medical history and perform a general physical examination 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 detect cancer or precancerous conditions at an early stage: In addition, research has shown that certain factors can help prevent vulvar cancer. <ul type="disc"> <li>Delaying first sexual intercourse until the late teens or older </li> <li>Avoiding sexual intercourse with multiple partners </li> <li>Avoiding sexual intercourse with someone who has had many partners </li> <li>Practicing safe sex, including condom use (although condoms cannot fully protect against HPV) </li> <li>Having regular gynecologic examinations to find and treat precancerous conditions </li> <li>Not starting to smoke </li> <li><a href="/vgn-ext-templating/v/index.jsp?vgnextoid=e2caa7a65140f110VgnVCM100000ed730ad1RCRD" alt="Quitting smoking">Quitting smoking</a>, if a smoker</li> </ul> In 2008, the vaccine used to prevent cervical cancer for girls and women between ages 9 and 26 was also approved to prevent vulvar cancer. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. The vaccine protects against certain strains of the virus. The vaccine does not protect people who are already infected with HPV. Learn more about the <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=c98c4c2e0e710110VgnVCM100000ed730ad1RCRD" alt="HPV vaccine">HPV vaccine</a>. Talk with your doctor for more information about the HPV vaccine.

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Symptoms and Signs

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Women with vulvar cancer may experience the following symptoms or signs. Sometimes, women with vulvar cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor. <ul type="disc"> <li>A lump or growth in or on the vulvar area </li> <li>A patch of skin that is differently textured or colored than the rest of the vulvar area </li> <li>Persistent itching, pain, soreness, or burning in the vulvar area </li> <li>Painful urination </li> <li>Bleeding or discharge that is not menstrual blood </li> <li>An ulcer that persists for more than one month </li> <li>A <a href="/patient/Cancer+Types/Melanoma?sectionTitle=Symptoms">change in the appearance of an existing mole</a> (specific to vulvar melanoma) </li> <li>Wart-like growths (similar to genital warts)</li> </ul> Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=Diagnosis">diagnosis</a>. This may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects 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.

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Diagnosis

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Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test: <ul type="disc"> <li>Age and medical condition </li> <li>Type of cancer suspected </li> <li>Severity of symptoms </li> <li>Previous test results</li> </ul> In addition to a physical examination, the following tests may be used to diagnose vulvar cancer: Pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=05911ba78422f010VgnVCM100000ed730ad1RCRD" alt="Biopsy">Biopsy</a>. 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 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 indicates that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. Lymph node sampling. The lymph nodes are tiny, bean-shaped organs that help fight infection. To determine whether a cancer has spread, it may be necessary to remove lymph nodes for a biopsy. The procedure for determining if cancer has spread to the lymph nodes is the sentinel lymph node biopsy. In this procedure, the first, or sentinel, lymph node is sampled. Recent research has shown that if the first lymph node is free of cancer, then the cancer most likely has not spread. 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. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=767141eca8daa010VgnVCM100000ed730ad1RCRD">Endoscopy</a>. This test 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 mouth, anus, vagina, urethra, or a small surgical opening. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=a8a6a67053480110VgnVCM100000ed730ad1RCRD" alt="Computed tomography (CT or CAT) scan">Computed tomography (CT or CAT) scan</a>. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=adb70bc51ce11110VgnVCM100000ed730ad1RCRD" alt="Magnetic resonance imaging (MRI)">Magnetic resonance imaging (MRI)</a>. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=62c61dc1af9ff010VgnVCM100000ed730ad1RCRD" alt="Positron emission tomography (PET) scan">Positron emission tomography (PET) scan</a>. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues 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. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d68f9cd5a93ba010VgnVCM100000ed730ad1RCRD" alt="what to expect when having common tests, procedures, and scans">what to expect when having common tests, procedures, and scans</a>. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=Staging">staging</a>. Learn more about the <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=2c3523a703609110VgnVCM100000ed730ad1RCRD" alt="first steps to take after a diagnosis of cancer">first steps to take after a diagnosis of cancer</a>.

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Staging

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Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer: <ul type="disc"> <li>How large is the primary tumor and where is it located? (Tumor, T) </li> <li>Has the tumor spread to the lymph nodes? (Node, N) </li> <li>Has the cancer metastasized to other parts of the body? (Metastasis, M)</li> </ul> Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below. TX: The primary tumor cannot be evaluated. T0: There is no tumor. Tis: The tumor is carcinoma in situ, an early cancer on the surface of the skin that has not spread to nearby tissue. T1: The tumor is only in the vulva, or the vulva and perineum (the area of skin between the anus and vagina), and is 2 centimeters (cm) or smaller. T1a: The tumor is only in the vulva, or the vulva and perineum, is 2 cm or smaller, and has spread no more than 1 millimeter (mm) into nearby structures. T1b: The tumor is only in the vulva, or the vulva and perineum, is 2 cm or smaller, and has spread more than 1 mm into nearby structures. T2: The tumor is only in the vulva, or the vulva and perineum, and is larger than 2 cm. T3: The tumor, of any size, has spread to the lower urethra and/or the vagina or anus. T4: The tumor has spread to any of the following: upper urethra, bladder mucosa, rectal mucosa, or is attached to the pubic bone. Node. The “N” in the TNM staging system stands for lymph nodes. Lymph nodes near the pelvis and groin are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. NX: The regional lymph nodes cannot be evaluated. N0: Cancer has not spread to the lymph nodes. N1: Cancer has spread to lymph nodes on the same side of the body as the tumor. N2: Cancer has spread to lymph nodes on both sides of the body. Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body. MX: Distant metastasis cannot be evaluated. M0: There is no distant metastasis. M1: There is metastasis to other parts of the body. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage 0: The cancer has not spread from where it started and is on the surface of the skin of the vulva only (Tis, N0, M0). Stage I: The tumor is smaller than 2 cm and has not spread (T1, N0, M0). Stage IA: The tumor is smaller than 2 cm, has not spread, and is no deeper than 1 mm (T1a, N0, M0). Stage IB: The tumor is smaller than 2 cm, has not spread, and is deeper than 1mm (T1b, N0, M0). State II: The tumor is larger than 2 cm, is in the vulva or perineum or both, but has not spread to nearby tissue (T2, N0, M0). Stage III: The cancer has spread to nearby tissue (vagina, anus, urethra) and/or lymph nodes on one side of the body, but there is no distant metastasis (T1 or T2, N1, M0; T3, N0 or N1, M0). Stage IVA: The cancer has spread to lymph nodes on both sides of the body or spread into the upper part of the urethra, bladder, rectum, or pelvic bone (T1, T2, T3; N2, M0; or T4, any N, M0). Stage IVB: Any cancer that has spread to a distant part of the body (Any T, any N, M1). Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above. Grading Tumor grade (G). In addition to the TNM system, doctors also describe a primary tumor by its grade, which is determined by using a microscope to examine tissue from a tumor. The doctor compares the tumor tissue with normal tissue. Healthy tissue contains many different types of cells grouped together, which is called differentiated. Tissue from a tumor usually has cells that look more alike, called poorly differentiated. Generally, the more differentiated the tissue, the better the prognosis. GX: The tumor grade cannot be evaluated. G1: The tumor cells are well differentiated (contain many healthy-looking cells). G2: The tumor cells are moderately differentiated (more cells appear abnormal than healthy). G3: The tumor cells are poorly differentiated (most of the cells appear abnormal). G4: The tumor cells are undifferentiated (the cells barely resemble healthy cells). Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010)published by Springer-Verlag New York, <a target="_blank" href="http://www.cancerstaging.net">www.cancerstaging.net</a>.

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Treatment

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This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the <a href="http://www.cancer.net/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=About Clinical Trials">Clinical Trials</a> and <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=Current%20Research">Current Research</a> 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 <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=215241eca8daa010VgnVCM100000ed730ad1RCRD" alt="multidisciplinary team">multidisciplinary team</a>. Descriptions of the most common treatment options for vulvar cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. The main treatment for vulvar cancer is surgery. Radiation therapy and chemotherapy may be used if the cancer cannot be entirely removed with surgery. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=e9e241eca8daa010VgnVCM100000ed730ad1RCRD" alt="making treatment decisions">making treatment decisions</a>. Women with vulvar cancer may have concerns about if and how these treatments may affect their <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d1a7ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="sexual function and fertility (ability to have children)">sexual function and fertility (ability to have children)</a>, and these topics should be discussed with the health care team before treatment begins. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Due to the location and sensitivity of vulvar tissue, the type of surgery is carefully considered. Surgical options for vulvar cancer include: Laser surgery. Laser surgery is the use of a focused beam of light that burns the cancer off the skin. It can be used to treat precancerous conditions, but cannot be used to treat an invasive tumor. Excision. This is the removal of the tumor and some of the surrounding healthy tissue (called a margin). If the procedure is extensive, this may be called a partial vulvectomy (see below). Vulvectomy. This is the removal of part or all of the vulva. In a skinning vulvectomy, only the top layer of skin is removed. A simple vulvectomy is the removal of the entire vulva. A radical vulvectomy is the removal of part or all of the vulva and deep tissue, including the clitoris. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=c0a114bf260eb010VgnVCM100000ed730ad1RCRD" alt="cancer surgery">cancer surgery</a>. Coping with vulvar surgery Many women experience a range of feelings 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. Before surgery, it is important to ask the surgeon about the procedure, the possible side effects, and when sexual intercourse can resume. Women should talk with their doctors about finding additional information or support in coping with this surgery. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=cdb7ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="emotional and physical concerns">emotional and physical concerns</a> and <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=06342a0a00213310VgnVCM100000ed730ad1RCRD">coping with gynecologic surgery</a>. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill 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 (schedule) usually consists of a specific number of treatments given over a set period of time. General side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most of these side effects go away soon after treatment is finished. Specific side effects may include narrowing of the vagina, damage to healthy vaginal tissue, and irritation of the intestines. 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. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=f77441eca8daa010VgnVCM100000ed730ad1RCRD" alt="radiation therapy">radiation therapy</a>. For more information about radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, <a target="_NEW" href="http://www.rtanswers.org/treatmentinformation/cancertypes/gynecologic/index.aspx">Radiation Therapy for Gynecologic Cancers</a>. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=474541eca8daa010VgnVCM100000ed730ad1RCRD&vgnextchannel=95d5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="chemotherapy">chemotherapy</a> and <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d7b541eca8daa010VgnVCM100000ed730ad1RCRD&vgnextchannel=95d5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="preparing for treatment">preparing for treatment</a>. 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 <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=9c0991fad184b010VgnVCM100000ed730ad1RCRD" alt="searchable drug databases">searchable drug databases</a>. Recurrent vulvar cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d76241eca8daa010VgnVCM100000ed730ad1RCRD">coping with this fear</a>. 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 cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. 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 <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=c56241eca8daa010VgnVCM100000ed730ad1RCRD" alt="dealing with cancer recurrence">dealing with cancer recurrence</a>. Metastatic vulvar cancer If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=455241eca8daa010VgnVCM100000ed730ad1RCRD" alt="second opinion">second opinion</a> before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include <a href="http://www.cancer.net/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=About Clinical Trials">clinical trials</a>. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with her physical, emotional, and social needs, an approach called <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=7e3341eca8daa010VgnVCM100000ed730ad1RCRD">palliative or supportive care</a>. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. 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. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=7bc925daee7bd210VgnVCM100000ed730ad1RCRD" alt="advanced cancer care planning">advanced cancer care planning</a>. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=68bca28cf7a9e010VgnVCM100000ed730ad1RCRD">common terms used during cancer treatment</a>.

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Side Effects

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Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=66cc3856f2d4b010VgnVCM100000ed730ad1RCRD" alt="Fear of treatment side effects">Fear of treatment side effects</a> is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=Treatment">Treatment</a> section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about the side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=7e3341eca8daa010VgnVCM100000ed730ad1RCRD">palliative or supportive care</a>. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=01e7ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="the most common side effects of cancer and different treatments, along with ways to prevent or control them">the most common side effects of cancer and different treatments, along with ways to prevent or control them</a>. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a woman with vulvar cancer. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=a087ea97a56d9010VgnVCM100000f2730ad1RCRD">caregiving</a>. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of vulvar cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=7bb7ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="coping strategies">coping strategies</a>. Learn more about the importance of <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=7132ee3b20016110VgnVCM100000ed730ad1RCRD" alt="addressing such needs">addressing such needs</a>, including concerns about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=2c7947a77924f110VgnVCM100000ed730ad1RCRD" alt="managing the cost of your cancer care">managing the cost of your medical care</a>. A side effect that occurs months or years after treatment is called a <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d611b9260cc24110VgnVCM100000ed730ad1RCRD" alt="late effect">late effect</a>. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=After%20Treatment">After Treatment</a> section or talking with your doctor.

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Questions to Ask the Doctor

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<a href="/vgn-ext-templating/v/index.jsp?vgnextoid=575241eca8daa010VgnVCM100000ed730ad1RCRD" alt="Talking often with the doctor is important">Talking often with the doctor is important</a> 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 also encouraged to ask additional questions that are important to you. <ul type="disc"> <li>What type of vulvar cancer do I have? </li> <li>What is the stage of my cancer? What does this mean? </li> <li>Can you explain my pathology report (laboratory test results) to me? </li> <li>What are my treatment options? </li> <li>What clinical trials are open to me? </li> <li>What treatment do you recommend? Why? </li> <li>Who will be doing the surgery? How experienced is this surgeon with this type of cancer? </li> <li>Who will be part of my health care team, and what does each member do? </li> <li>Who will be coordinating my overall treatment and follow-up care? </li> <li>Will I need reconstructive surgery? </li> <li>What are the possible side effects of treatment, both in the short term and the long term? </li> <li>How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities? </li> <li>If I’m worried about managing the costs related to my cancer care, who can help me with these concerns? </li> <li>Could this treatment affect my sex life? If so, how and for how long? </li> <li>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? </li> <li>How can I keep myself as healthy as possible during treatment? </li> <li>What are the chances that the cancer will recur? </li> <li>What follow-up tests will I need, and how often will I need them? </li> <li>What support services are available for me? For my family? </li> <li>Whom do I call for questions or problems?</li> </ul>

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Current Research

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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 <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=About Clinical Trials">clinical trials</a>. Always talk with your doctor about the diagnostic and treatment options best 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 regarding the link between HPV and vulvar cancer, leading to a better understanding of the types of vulvar cancer and how each type grows. Supportive care. Clinical trials are underway to find better ways of reducing side effects of current vulvar cancer treatments to improve patients’ quality of life. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=ca55c4b89c27e010VgnVCM100000ed730ad1RCRD" alt="common statistical terms used in cancer research">common statistical terms used in cancer research</a>. To find clinical trials specific to your diagnosis, talk with your doctor or <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=0402ea97a56d9010VgnVCM100000f2730ad1RCRD">search online clinical trial databases now</a>.

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About Clinical Trials

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Doctors and scientists are always looking for better ways to treat patients with vulvar cancer. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. 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 are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. 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 the only way to make 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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=73c6915c1bea7110VgnVCM100000ed730ad1RCRD">placebos in cancer clinical trials</a>. To join a clinical trial, patients must participate in a process known as <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=bcadc63d749f1110VgnVCM100000ed730ad1RCRD" alt="informed consent">informed consent</a>. 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. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must 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. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=62f1ea97a56d9010VgnVCM100000f2730ad1RCRD">clinical trials</a>, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=0402ea97a56d9010VgnVCM100000f2730ad1RCRD">links to find clinical trials</a>. For specific topics being studied for vulvar cancer, learn more in the <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=Current%20Research">Current Research</a> section. 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. 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 trials ends, and/or if the patient chooses to leave the clinical trial before it ends.

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After Treatment

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After treatment for vulvar cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Although there are no specific guidelines, women should visit their doctors regularly for physical and pelvic examinations. Follow-up care is essential for women who have finished vulvar cancer treatment. The doctor may also recommend other tests, including x-rays, CT scans, ultrasounds, or MRI scans. Tell your doctor about any new symptoms. ASCO offers <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=112abfbefabe5110VgnVCM100000ed730ad1RCRD">cancer treatment summary forms</a> to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. Women recovering from vulvar cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=df5903e8448d9010VgnVCM100000f2730ad1RCRD" alt="next steps to take in survivorship">next steps to take in survivorship</a>, including making <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=903541eca8daa010VgnVCM100000ed730ad1RCRD" alt="positive lifestyle changes">positive lifestyle changes</a>. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=1d46a987fa2ce010VgnVCM100000ed730ad1RCRD" alt="common terms used after cancer treatment is complete">common terms used after cancer treatment is complete</a>.

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Statistics

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This year, an estimated 4,490 women in the United States will be diagnosed with vulvar cancer. It is estimated that 950 deaths from this disease will occur this year. Vulvar cancer accounts for about 4% of cancers in female reproductive organs and 0.6% of all cancers in women. Its incidence is increasing in young women because of its association with the human papillomavirus (HPV). See the <a href="/patient/Cancer+Types/Vulvar+Cancer?sectionTitle=Risk%20Factors%20and%20Prevention">Risk Factors</a> section for more information on HPV. Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of women with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with vulvar cancer. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=aa1b6cf66f08a110VgnVCM100000ed730ad1RCRD">understanding statistics</a>. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2012.

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