What are the treatment options?
Vulvar cancer is treated with surgery, radiation, chemotherapy or a combination of these, depending upon the stage of the cancer. Most often, your doctor will recommend that you start treatment within a few weeks of your diagnosis. If surgery is all that is required, treatment and recovery should be completed within six to eight weeks. If radiation or chemotherapy is required, this process may take longer. Your doctor can provide you with specific details about how long your individual treatment and recovery will take.
For cancer that does not appear to have spread beyond the vulva, your doctor will likely recommend surgical treatment. Depending upon the size and location of your cancer, this surgery is termed either a simple or radical vulvar excision. Often, a sampling of lymph nodes in the groin is also performed. If a simple excision is all that is required, this is done as an outpatient surgery. If a radical excision, or removal of lymph nodes, is required, usually you will have to stay a few days in the hospital. If lymph nodes are removed, you may be discharged with a drain in place for a few weeks. You will either be taught how to care for this, or nursing care will be arranged at home. On rare occasions, surgeons will recommend consultation with a plastic surgeon if a large area of skin needs to be removed.
Radiation is used most often in cases where cancer cells have spread to lymph nodes in the groin or inside your pelvis. This is most commonly performed after surgery, although sometimes radiation can be the primary form of treatment if the tumor extends into surrounding areas such as the urethra or anus. Radiation is not painful. It is usually given using a machine similar to an X-ray machine. A course of treatment usually lasts five to six weeks. It is provided on an outpatient basis. Occasionally, radiation is given directly to the vulvar area, which can cause skin discomfort. If this occurs your doctor will give you recommendations to minimize the discomfort. If your cancer is large, radiation is sometimes given with chemotherapy prior to surgery, to make the surgery that you will need less extensive.
Chemotherapy is used most often for cancer that has spread to areas that cannot be successfully treated with surgery or radiation alone. This can include lymph nodes, bones, lungs and the liver. It is also sometimes given in a lower dose with radiation. Chemotherapy for vulvar cancer is given intravenously and most often without requiring hospitalization.
Management of Recurrent Disease
Recurrent vulvar cancer is a complex problem and each patient has a different set of circumstances that play a role in determining the best course of management. These factors include:
- Number and location of recurrent tumors,
- Time interval since last cancer treatment,
- Type of treatment(s) previously given (surgery only, radiation, chemotherapy or both), and
- Overall health and activity level at the time of recurrence.