Treatment
Treatment for vulvar cancer depends on the type and stage of the disease as well as the patient's age and general health. Here are some of the procedures your doctor may recommend.
Surgery
Surgery is the most commonly used treatment for vulvar cancer. It is common for vulvar cancer to spread to lymph nodes in the groin, so women often have these lymph nodes removed and checked for cancer during surgery to remove the tumor. Your doctor may recommend any of the following procedures:
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Laser Surgery
The doctor may recommend laser surgery to treat VIN and remove precancerous lesions. The doctor uses a laser beam to kill the abnormal cells. This procedure is not normally used for invasive cancer.
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Local Excision
In this procedure, the doctor removes the tumor as well as a margin (~1 cm) of healthy surrounding tissue from the vulva.
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Wide Radical Excision
In this procedure the doctor removes the tumor along with a wider (~2 cm) and deeper margin of healthy tissue. The doctor may also take out nearby lymph nodes in the groin.
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Vulvectomy
A vulvectomy is surgery to remove all or part of the vulva. In a modified radical vulvectomy, the surgeon removes part of the vulva and possibly nearby lymph nodes. In a radical vulvectomy, the surgeon removes the entire vulva and nearby lymph nodes. In a skinning vulvectomy, the surgeon removes only the top layer of skin from the vulva and may replace this skin with a skin graft from another part of the body.
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Sentinel Lymph Node Biopsy
In this procedure the doctor identifies and removes only the first lymph nodes to which the tumor is likely to drain. These nodes, known as sentinel nodes, are the ones most likely to contain cancer cells. If these nodes are free from cancer, it is likely that the rest of the lymph nodes are as well. This procedure can help a patient avoid the need for an inguinal lymphadenectomy (described below) and can help a doctor determine if you would benefit from additional adjuvant therapy.
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Inguinal Lymphadenectomy
In this procedure, the doctor removes the lymph nodes from one (unilateral) or both (bilateral) sides of the groin and has them examined for the presence of cancer cells.
Pelvic Exenteration
Your doctor may recommend a pelvic exenteration to treat advanced vulvar cancer that has spread outside the pelvis to nearby organs. The surgeon may remove the vulva, uterus, cervix, vagina, ovaries, lymph nodes, lower colon, rectum, and bladder. If your bladder is removed, your surgeon may form a new bladder out of intestine and drain your urine out of an opening in your abdomen (urostomy). If your rectum or colon is removed, your doctor may attach your intestine to an opening in your abdomen (colostomy) to allow feces to pass out of your body.
Additional Treatments
The doctor may also recommend any of the following treatments:
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Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. In external radiation therapy, the doctor targets the tumor with high energy rays from outside of the body. The doctor may recommend external radiation therapy to treat enlarged lymph nodes in the groin or pelvis. The doctor may also recommend radiation to shrink the tumor in more advanced cases of vulvar cancer.
Chemotherapy
Chemotherapy uses cancer-killing drugs that travel through the bloodstream and destroy any cancer cells they encounter. Intravenous chemotherapy may be combined with radiation therapy and used to shrink tumors before surgery. The doctor may also recommend topical chemotherapy to treat precancerous lesions on the vulva.
Topical Therapy
The doctor may recommend topical chemotherapy and/or immunotherapy to treat precancerous lesions on the vulva. Imiquimod is an immunotherapy that may be used to treat vulvar lesions and is applied to the skin in a cream.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
