Vulvar cancer

Treatment

Vulvar cancer is cancer of the external female sexual organs. Most often, it is a type of skin cancer. It is a fairly rare disease, affecting only about one-half of one percent of all American women who are diagnosed with cancer each year. If detected early, before it has spread to the lymph nodes, the chances of a cure are quite high, 90 percent or better.

Here are some of the treatment choices you may be offered at Fred Hutchinson Cancer Center. Remember, each woman's cancer is different, as are her circumstances, preferences, and beliefs. A treatment that works well for another woman may not be right for you.

Standard treatment

Your treatment will depend in part on the results of a biopsy. Tissue samples from your cancer will be removed either in the clinic or during surgery, and examined by a pathologist. Fred Hutch has a dedicated pathologist who only works with gynecologic cancer patients.

The examination of these tissues will show whether your cancer is likely to grow slowly or quickly, whether it is likely to recur, and whether it is likely to respond to certain types of treatment. The treatment recommended by your doctors will depend to a large degree on the "stage" of your cancer, meaning how far it has progressed at the time of diagnosis.

Women who come to Fred Hutch for treatment of disease that is still in the pre-cancerous stage probably will be treated with an excisional biopsy or a laser procedure. If your vulvar cancer has progressed, or become "invasive," your doctors will most likely recommend that you have surgery, chemotherapy, and/or radiation therapy.

You may also want to consider participating in a clinical trial to gain access to treatments that are not otherwise available.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recur To come back. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch.

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Surgery

Most people 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 different types of vulvectomy (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 also remove lymph nodes in the groin to check if your disease has spread any further.

In many cases, the gynecologic oncologist who removes the tumor can also close the incision. When the cancer surgery is more extensive, a reconstructive surgeon may be involved. Often, they use skin from the same region of the body and rearrange it to make a new surface for the labia. If more tissue is needed, the surgeon may use tissue from your abdomen or thigh. Learn more about reconstructive surgery.

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

Surgery for Fred Hutch gynecologic patients is done at UW Medical Center by UW Medicine surgeons.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Surgery

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

Chemotherapy

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.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Chemotherapy

Radiation therapy

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 Fred Hutch 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

Fred Hutch and UW Medicine 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 Fred Hutch and elsewhere.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.

Radiation therapy

Treatment for recurrent vulvar cancer

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, Fred Hutch 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 Fred Hutch 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. Fred Hutch has several support groups for patients and for caregivers and family members.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Treatment for recurrent vulvar cancer

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