Vulvar Cancer Treatment Options

Topical treatments

Doctors may recommend topical treatments for a type of vulvar precancer called vulvar intraepithelial neoplasia (VIN). However, this type of treatment is not effective against invasive vulvar cancer.

Topical treatment involves applying a medicated cream or ointment directly to the skin of your vulva.

One topical treatment option contains the chemotherapy drug fluorouracil (5FU), which helps destroy the precancerous cells.

Another option contains a non-chemotherapy drug called imiquimod, which works by boosting your body’s immune response to the area of abnormal cells.

Both treatments can cause localized skin irritation and pain. However, both can be effective against VIN. According to the American Cancer Society (ACS), topical imiquimod has completely resolved VIN in some women.

Laser therapy

Laser therapy involves using a high-energy beam of light to vaporize abnormal cancer cells and tissues.

Laser therapy may be a treatment option for VIN. But before offering laser therapy, doctors must confirm that the cancer cells have not spread to your vulva from nearby parts of your body.

If you receive laser therapy for VIN, you’ll need checkups every 6 months for the first year after the treatment, followed by yearly checkups thereafter. These checkups help doctors ensure that the precancerous cells have not returned.

Surgery

Surgery is the first-line treatment for vulvar cancer, especially when the cancer is in its early stages. The goal of surgery is to remove all the cancer without compromising your sexual function.

According to the ACS, several types of surgery are available for vulvar cancer. The type of surgery you need will depend on the extent to which the cancer has grown into nearby organs and tissues. The different types of surgery are outlined below.

Wide local excision

Wide local excision involves removing the tumor along with a margin of healthy skin and a thin layer of fat beneath the tumor. Removing this extra tissue helps remove as many cancer cells as possible.

Vulvectomy

A vulvectomy is the surgical removal of all or part of your vulva. There are four main types:

• Skinning vulvectomy: A surgeon removes only the top layer of skin in the area where the cancer is located. This procedure may be an option if you have extensive VIN.
• Simple vulvectomy: A surgeon removes your entire vulva, including the inner and outer labia, as well as the tissue just beneath the skin. In some cases, they may also remove your clitoris.
• Partial or modified radical vulvectomy: A surgeon removes part of your vulva, including the deep tissues.
• Complete radical vulvectomy: A surgeon removes your entire vulva as well as the deep tissues and clitoris. This type of surgery is rare.

In most cases of vulvectomy, the surgeon can close the surgical wounds without using skin grafts from other parts of your body. However, if you undergo more extensive surgery, you may need a skin graft procedure or vulvar reconstructive surgery.

Pelvic exenteration

Pelvic exenteration is an extensive and complex procedure. It typically involves a vulvectomy and the removal of your pelvic lymph nodes to treat vulvar cancer.

It also includes the removal of one or more of the following structures:

• lower colon
• rectum
• bladder
• uterus
• cervix
• vagina

The area in which your surgery will be performed depends on where the cancer has spread. If your bladder or colon is removed, you’ll need further surgery to enable your body to eliminate waste.

Lymph node surgery

Vulvar cancer often spreads to lymph nodes in the groin. Removing these lymph nodes helps reduce the risk that the cancer will come back.

However, lymph node removal can cause side effects, such as lymphedema in your legs. This is a potentially painful condition in which fluid builds up in your legs, resulting in severe and persistent swelling.

It’s important to talk with your care team about the potential risks and benefits of lymph node surgery.

There are two main types of lymph node surgery:

• Inguinal lymph node dissection (ILND): A surgeon removes the lymph nodes in your groin. If the cancer affects only one side of your body, they remove only the lymph nodes on that side. If the cancer develops in or near the middle of your body, they remove the lymph nodes on both sides.
• Sentinel lymph node biopsy: A surgeon finds and removes your sentinel lymph nodes, which drain the area where the cancer is located. This procedure can potentially eliminate the need for an ILND. Cancer is likely to spread to the sentinel lymph nodes first because of their proximity to the tumor.

After removing the sentinel lymph nodes, a doctor assesses them under a microscope for signs of cancer. If cancer is present, surgeons will perform a follow-up ILND. If cancer is not present, no further lymph node surgery is needed.

Radiation therapy

Radiation therapy uses high-energy particles or waves to destroy cancer cells or prevent them from growing.

Surgeons most often use radiation therapy to destroy cancer that has spread to the lymph nodes in the groin or to tissues inside the pelvis.

Doctors may recommend radiation therapy at various stages of cancer treatment, depending on the extent of the cancer. They may recommend radiation treatment:

• after surgery to help destroy any remaining cancer cells
• before surgery, in combination with chemotherapy, to help shrink a large tumor so that the surgery can be less extensive
• as the primary treatment for vulvar cancer if the tumor extends to your anus or urethra

A course of radiation treatment typically lasts 5 to 6 weeks.

Chemotherapy

Chemotherapy involves the use of drugs that stop or slow the growth of rapidly dividing cells, including cancer cells.

Because vulvar cancer is relatively rare, there are no standard chemotherapy treatment plans for this type of cancer.

Nonetheless, doctors may recommend chemotherapy for vulvar cancer that has spread to areas that are not treatable with surgery or radiation therapy alone, such as your:

• lymph nodes
• bones
• lungs
• liver

Chemotherapy drugs that doctors sometimes use to treat more advanced vulvar cancer include:

• cisplatin
• carboplatin
• vinorelbine
• paclitaxel
• erlotinib

Doctors may also recommend chemotherapy in combination with radiation therapy to help shrink a large tumor before surgery. The medical term for this treatment combination is “chemoradiation.”

According to a 2021 research review, chemoradiation is the standard of treatment for Stage 3 and Stage 4A vulvar cancer. It can improve treatment response rates and overall survival more than radiation therapy alone.

The bottom line

Many treatment options are available for vulvar cancer. The type of treatment a doctor recommends will depend largely on the stage of the cancer and the extent to which it has grown into other organs and tissues.

Topical treatments, such as creams or ointments containing either chemotherapy or immune-boosting medications, may help treat vulvar precancers. Laser therapy may be another treatment option for these precancers.

Surgery is the first-line treatment for vulvar cancer, and the extent of the surgery depends on the extent of the cancer. Surgical treatment options may include wide local excision or vulvectomy with or without lymph node removal.

In some cases, doctors may recommend radiation therapy before or after surgery or as an alternative to surgery. Chemotherapy or chemoradiation may be another option for vulvar cancer. Chemoradiation may improve treatment responses and overall survival in Stage 3 and Stage 4A vulvar cancer.

Treatments for vulvar cancer can be complex and may cause physical complications and mental health effects. You can talk with your doctor or treatment team for more information and advice about the potential benefits and risks of various treatments.