Vulvar Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 01/2021

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

This section explains the types of treatments that are the standard of care for vulvar cancer. “Standard of care” means the best treatments known. Clinical trials may also be an option for you, which is something you can discuss with your doctor. A clinical trial is a research study that tests a new approach to treatment. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How vulvar cancer is treated

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

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

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

Concerns about sexual health and having children

People with vulvar cancer may have concerns about if or how their treatment may affect their sexual health and fertility. These topics should be discussed with the health care team before treatment begins. Premenopausal women who are still potentially able to get pregnant and want to preserve their fertility may be referred to a reproductive endocrinologist (REI) before treatment starts. It may be helpful to discuss what options for fertility preservation are covered by health insurance.

Treatment overview for VIN

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

Treatment overview for vulvar cancer

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

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

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 performed is carefully considered. Surgical options for invasive vulvar cancer include the following:

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

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

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

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

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

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

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

Coping with vulvar surgery

It is common to experience a range of emotions after vulvar surgery, such as loss, sadness, or anxiety. Some women may feel that they have lost a part of their identity as a woman. Others have questions about whether sexual intercourse can continue after surgery. People 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. People 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 a very large vulvar tumor, radiation therapy is often combined with low-dose chemotherapy to shrink the tumor before surgery. This is called chemoradiation therapy. This treatment can help avoid the need to remove the entire vulva and reduce how much tissue is removed. The chemotherapy is given at the same time as the radiation therapy. This treatment option is very important when the tumor involves the urethra or anus so that urinary function and bowel function can be preserved. Radiation therapy and chemotherapy are each explained in detail below.

Radiation therapy

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

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

General side effects from radiation therapy may include fatigue, mild to severe skin reactions, upset stomach and loose bowel movements, damage to healthy vaginal tissue, or narrowing of the vagina. Most of these side effects go away soon after treatment is finished. However, 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. It's best to start usage of a vaginal dilator usage during or soon after your treatment to prevent permanent narrowing or shortening.

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

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

Chemotherapy

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

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

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

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

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

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

For metastatic vulvar cancer, patients are most often treated with platinum-based combination chemotherapy, typically carboplatin (available as a generic drug) and paclitaxel (Taxol). Sometimes a targeted therapy called bevacizumab (Avastin, Mvasi) 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, kidney function as measured by laboratory tests, and other medical factors.

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

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

Physical, emotional, and social effects of cancer

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

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

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

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

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

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

Metastatic vulvar cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. In this case, chemotherapy or immunotherapy may be recommended. Immunotherapy is a type of systemic cancer treatment that boosts the body’s natural defenses to fight cancer. It uses substances made by the body or in a laboratory to improve how your immune system works to find and destroy cancer cells. As described above, the drugs that are used to treat most metastatic vulvar cancer are typically the same as those used for metastatic cervical cancer.

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

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

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

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

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

If treatment does not work

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

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

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

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

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