Treatment

Most women who have cancer of the vulva are treated with surgery. The procedure your doctor recommends will depend on how advanced your cancer is.

Laser surgery

Laser surgery is used to treat women whose disease is in the "pre-cancerous" stage, meaning that there are irregular cells present that probably would become cancer if not treated. This is a relatively simple procedure that uses a laser to remove the irregular cells.

Local excision

Local excision is a surgery to remove the cancer plus a margin of healthy tissue. If your doctor recommends a "radical" local excision, a larger margin of healthy tissue will be removed and you may have lymph nodes in the groin removed as well.

The lymph nodes are removed so that they can be biopsied to determine if the cancer has spread. Some women are candidates for a sentinel node biopsy, in which as few as one or two lymph nodes are removed.

Vulvectomy

There are various types of vulvectomy, which is surgery to remove the vulva, or external sexual organs. Some procedures are more extensive than others, and will be recommended if your cancer is more advanced. In some cases, your doctor will remove lymph nodes in the groin as well, to check for the further spread of your disease.

If your surgery is fairly extensive, you may need plastic surgery and skin grafts. These procedures will be done by your gynecologic oncologist at the time of your cancer surgery.

If biopsies and other tests determine that your cancer has spread beyond the vulva, then your doctors may recommend adding radiation or chemotherapy or both to control the disease.

Surgery for SCCA gynecologic patients is performed at University of Washington Medical Center by surgeons who provide care at UW Medical Center.

Your doctor may recommend chemotherapy to treat your vulvar cancer. You may have chemotherapy or a combination of chemotherapy and radiation therapy prior to surgery in order to shrink your cancer. Or you may have these treatments after surgery as adjuvant therapy. Adjuvant therapy is done as an "extra protection" against the possible recurrence of your cancer, even though all visible cancer may have been removed surgically.

Chemotherapy is sometimes used in combination with radiation therapy to treat vulvar cancer because it enhances the effectiveness of radiation therapy. Chemotherapy is also sometimes prescribed to treat vulvar cancer that has spread too widely to be treated with surgery or radiation therapy.

"Chemotherapy" means treating cancer with drugs. You will probably receive a combination of two chemotherapy drugs given by infusion into a vein.

The most common combinations for vulvar cancer are:

• Cisplatin, or Platinol,® plus 5-FU (brand names are Flourouracil,® Adrucil® and Efudex®)
• Mitomycin C plus 5-FU.

Chemotherapy works by killing fast-growing cells, but the drugs cannot discriminate between cancer cells and other fast-growing cells such as hair follicles. That is one reason for many of the typical side effects of chemotherapy treatment, including hair loss.

Chemotherapy is given on various schedules. If you are receiving chemotherapy in conjunction with radiation therapy, you will probably receive one chemotherapy treatment during the first week of your radiation therapy, and another during the fourth and final week of radiation. Sometimes chemotherapy is given on a weekly basis during radiation therapy.

Chemotherapy is given at the University of Washington Medical Center. You may bring a friend or family member to sit with you during your treatment, which may last several hours.

If you have vulvar cancer, your doctor may recommend that you have radiation therapy. You may only have radiation therapy or your may have radiation in combination with surgery or chemotherapy. Some women will be treated with all three therapies: surgery, radiation, and chemotherapy.

External radiation

External radiation therapy typically is given five days a week for a period of five or six weeks, using a machine that looks much like a regular X-ray machine. The procedure is not painful and each treatment lasts only a few minutes.

You may have your radiation therapy at SCCA on an outpatient basis, under the supervision of UW Medicine radiation oncologist Dr. Wui-Jin Koh, who specializes in treating women with gynecologic cancers.

Adding chemotherapy

SCCA's parent organizations, UW Medicine and Fred Hutchinson Cancer Research Center, have been active in conducting research that has shown that adding chemotherapy to radiation therapy makes the treatment more effective. This is an example of research conducted at the parent organizations that benefits patients at SCCA and elsewhere.

Despite treatment, vulvar cancer sometimes recurs. It may come back in the vulva or elsewhere in the body. Although tumors may appear in distant sites, it is not a new cancer. It is a recurrence of the original cancer.

If you have recurrent vulvar cancer, SCCA can offer you new medical procedures and treatments, as well as access to clinical trials, that your community doctor may not know about. No one at SCCA will tell you that a diagnosis of recurrent disease is not serious, but there is hope.

The treatment you receive for a recurrence of your vulvar cancer may include surgery, chemotherapy, or radiation--or a combination of these treatments. Your treatment will depend on a number of factors, including the type of treatment you have received in the past, and the symptoms you are experiencing with the new cancer.

Depending on the extent of the disease, your doctors may recommend that you have a wide local excision, which may be followed by radiation therapy. Rarely, you may need a more extensive surgery, called pelvic exenteration. In this procedure, the uterus, cervix, and vagina are removed, as well as other organs to which the cancer has spread, such as the lower colon, rectum, or bladder.

If your doctors feel that surgery is not appropriate for you, they may recommend that you have radiation therapy, possibly in combination with chemotherapy, or alone. Radiation therapy is used for local recurrences and also to reduce symptoms of recurrent disease.

Ask your doctor about taking part in clinical trials of promising treatments for recurrent disease.

Living With Metastatic Disease

Any person who has faced cancer lives with the fear that cancer will return. And the first response many people have to the news of metastases is to fear that they will soon die.

If you have metastatic disease, you will learn a new definition of metastatic cancer—"a chronic disease that can be managed." It's a very different way of looking at cancer. You can expect to have periods of treatment, followed by periods of remission, with a fairly good quality of life throughout.

Emotionally, this can be tough. You may want to talk with a chaplain or social worker or join a support group. SCCA has several support groups for patients and for caregivers and family members.