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

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

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

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

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

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

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

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

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

Prevention and early detection

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

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

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

• Delaying first sexual intercourse until the late teens or older

• Avoiding sexual intercourse with multiple partners

• Avoiding sexual intercourse with someone who has had many partners

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

• Having regular gynecologic examinations to find and treat precancerous conditions

• Quitting tobacco use for people who smoke

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

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

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

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

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

How vulvar cancer is diagnosed

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

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

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

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

• Biopsy. A biopsy is the 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 patient to a gynecologic oncologist, which is a doctor who specializes in treating this type of cancer.

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

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

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

• Positron emission tomography (PET) or PET-CT scan. A PET scan 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. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

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

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

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

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

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

This section explains the types of treatments, also known as therapies, that are the standard of care for vulvar cancer. “Standard of care” means the best treatments known. 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.

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.

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 overview for vulva intraepithelial neoplasia (VIN)

• Treatment overview for vulvar cancer

• Surgery

• Chemoradiation therapy for advanced-stage vulvar cancers

• Radiation therapy

• Chemotherapy

• Physical, emotional, and social effects of cancer

• Metastatic vulvar cancer

• Remission and the chance of recurrence

• If treatment does not work

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 your health care team before treatment begins. If the patient has not gone through menopause, is still potentially able to get pregnant, and wants to preserve their fertility, they may be referred to a reproductive endocrinologist (REI) before treatment starts. It may be helpful to discuss what options for fertility preservation are covered by health insurance.

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

Before treatment, it is important to talk with the surgeon about the treatment, 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 vulvar cancer treatment. Learn more about sexual health, intimacy, and cancer treatment.

Treatment overview for vulva intraepithelial neoplasia (VIN)

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

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Treatment overview for vulvar cancer

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

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

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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 usually used when the tumor is less than 4 centimeters (cm) in diameter and is either stage I or stage II disease.

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

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

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

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

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

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Chemoradiation therapy for advanced-stage vulvar cancers

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

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Radiation therapy

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

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

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

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

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

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Chemotherapy

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

Systemic therapies for vulvar cancer are prescribed by a gynecologic oncologist or a medical oncologist, 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 them.

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

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

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

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

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

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

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

Learn more about the basics of chemotherapy.

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

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

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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 recommended treatment plan. 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 peer 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.

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Metastatic vulvar cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. In this case, chemotherapy or another type of systemic therapy called immunotherapy may be recommended. Immunotherapy is a treatment approach 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 your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

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

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning and what will be done to watch for a recurrence (see “Watching for recurrence” in Follow-Up Care). 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).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace from those used during initial treatment. Your doctor may suggest clinical trials that are studying new ways to treat recurrent vulvar cancer. Your doctor may also want to do biomarker testing of your tumor in order to help guide further treatment decisions, which 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 your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

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

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

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.

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

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

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

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

• New ways of delivering radiation therapy.

• Testing new drugs.

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

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

Looking for More About the Latest Research?

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

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases.

• Read news, information, and patient perspectives about gynecologic cancer on the Cancer.Net Blog.

• Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

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

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

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

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

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

• Every 3 months for 2 years

• Then every 6 months for 3 to 5 years

• Then once a year after that

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

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

Learn more about the importance of follow-up care.

Watching for recurrence

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

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

Managing long-term and late side effects

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

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

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

Keeping personal health records

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

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

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

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

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

Talking frequently with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of vulvar cancer do I have?

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

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

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What 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 me feel better, or both?

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

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

• Who will be leading my overall treatment?

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

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

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

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

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

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

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

Questions to ask about having surgery

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

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

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

• How long will the operation take?

• How long will I be in the hospital?

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

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

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

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

• Is reconstructive surgery an option?

Questions to ask about having radiation therapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

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

• What side effects can I expect during treatment?

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

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

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

Questions to ask about therapy using medication

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

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

• What side effects can I expect during treatment?

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

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

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

Questions to ask about planning follow-up care

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

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

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

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

• Who will be leading my follow-up care?

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

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