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Types of treatment for vulval cancer

Women discussing vulval cancer

This page gives an overview of the treatments doctors use for different stages of vulval cancer. You can find information about

 

A quick guide to what's on this page

Types of treatment for vulval cancer

The main treatments used for vulval cancer are surgery, radiotherapy and sometimes chemotherapy. Your specialist may suggest a combination of treatments. The treatment you need depends on the stage of the cancer when it is diagnosed.

VIN

With VIN, your treatment will depend on where the disease is, your symptoms, and your risk of developing cancer. You may have surgery to remove the affected skin. Or the surgeon may use a laser to kill off the abnormal skin cells. Some women may have treatment with a cream called imiquimod. And some women may decide not to have any treatment, and the doctor will monitor them closely.

Stage 1A

For stage 1A cancer, your surgeon will take away the affected area and a margin of healthy tissue around it. This is called a wide local excision. You do not need surgery to check for cancer in your lymph nodes. 

Stage 1B and stage 2

Most people have surgery. You may have an operation to remove the cancer and a margin of healthy tissue around it. This is called a wide local excision. Some people need an operation to remove the whole vulva, called a radical vulvectomy. The doctor will want to check your lymph nodes to check for signs of spread. To do this, they may suggest you have a sentinel lymph node biopsy or a groin lymph node dissection.  

Some women may have radiotherapy after surgery. And if you are unable to have surgery, you may have an intensive course of radiotherapy. Your specialist may want you to have chemotherapy at the same time. 

Stage 3 and 4

The main treatments for stage 3 and stage 4 vulval cancer is surgery. You may have radiotherapy. And sometimes chemotherapy. You may need quite a big operation. But the doctors will try to do the smallest operation possible while trying to keep the risk of the cancer coming back as low as possible too. 

You may have radiotherapy before or after surgery. Or if you cannot have surgery, you may have radiotherapy instead of an operation. You may have chemotherapy at the same time as radiotherapy. 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating vulval cancer section.

 

 

The main treatments

The main treatments used for vulval cancer are surgery, radiotherapy and sometimes chemotherapy.

Your specialist may suggest a combination of treatments. So you may need to see a variety of doctors who specialise in different types of treatment. This might include a specialist surgeon called a gynaecologist, a cancer chemotherapy specialist (medical oncologist) and a radiotherapy specialist (clinical oncologist).

The treatment you need depends on the stage of the cancer when it is diagnosed.

Read more about surgery, radiotherapy and chemotherapy. And read more about the stages of vulvar cancer.

 

Treatment for precancerous cells (VIN)

VIN is a skin disease in which you have abnormal cells in the surface layer of the vulva. It is not cancer but can sometimes turn into cancer. 

Read more about VIN.

The treatment for VIN depends on where the disease is, your symptoms, and the risk of your VIN developing into cancer. Your doctor may offer you

  • no treatment, and follow you up closely
  • treatment with a cream called imiquimod
  • surgery
  • laser treatment

Read more about treatment for VIN and surgery to the vulva

 

Treatment for stage 1A cancer

For stage 1A cancer, your surgeon will take away the affected area.They also take away at least a 15mm margin of healthy tissue around it. This operation is called a wide local excision. 

You do not need surgery to check for cancer in your lymph nodes. This is because it is extremely rare for stage 1A cancer to spread to the lymph nodes.

Read more about surgery for vulval cancer.

 

Treatment for stage 1B and stage 2 cancers

Doctors usually treat stage 1B or stage 2 cancer with surgery. Some people may have radiotherapy.

Surgery

The surgeon aims to remove the cancer and at least a 15mm margin of healthy tissue around it. This called a wide local excision. Some women may need surgery to remove the whole vulva. This is called a radical vulvectomy. 

The doctor will want to check your lymph nodes to check for signs of spread. They may suggest you have a 

  • sentinel lymph node biopsy
  • groin node dissection

If your cancer is smaller than 4 cm, you may have a test called a sentinel lymph node biopsy. Sentinel lymph node biopsy means the surgeon removes the lymph node (or nodes) that cancer cells are most likely to spread to. If this node doesn't contain cancer cells, then the other nodes nearby probably don't either. So if your sentinel node is negative you do not need to have surgery to remove all the lymph nodes. 

A groin node dissection is an operation to remove all the lymph nodes in the groin. This is also called a groin lymphadenectomy. The surgeon may remove your lymph nodes on one or both sides of your groin. This depends on where exactly the cancer is, and whether they find cancer in any of your lymph nodes. 

Read more about surgery for vulval cancer and sentinel node biopsy.

Radiotherapy

After your surgery, you may have radiotherapy to the lymph nodes in your groin if the doctor thinks any of them contain cancer cells. Your specialist may also suggest radiotherapy if they were not able to remove a clear margin of healthy tissue. The aim of radiotherapy is to help lower the risk of the cancer coming back later. 

If you are unable to have surgery for any reason, you are most likely to have radial radiotherapy treatment. Radical treatment means an intensive course of radiotherapy to try to cure your cancer. Your specialist may want you to have chemotherapy at the same time. This can help the radiotherapy to work.

Read about radiotherapy for vulval cancer

 

Stage 3 and stage 4 cancers

The main treatments for stage 3 and stage 4 vulval cancer is surgery. You may have radiotherapy. And sometimes chemotherapy. 

Surgery

You may have one, or a combination of the following operations

  • surgery to remove the cancer and a margin of healthy tissue, which is called a wide local excision
  • surgery to remove the whole of your vulva, which is called a radical vulvectomy
  • surgery to remove the lymph nodes near the vulva, which is called a groin lymph node dissection or a groin lymphadenectomy
  • surgery to remove cancer that has spread to other parts of your pelvis, which is called a pelvic exenteration
  • surgery to rebuild the vulva, which is called reconstructive surgery

Doctors are very aware of the impact of major surgery on women with vulval cancer. They will try to do the smallest operation possible while trying to keep the risk of the cancer coming back as low as possible too. 

Read more about surgery for vulval cancer.

Radiotherapy and chemotherapy

You may have radiotherapy

  • before surgery, to try and shrink the cancer so you can have a smaller operation
  • after surgery, if the doctor thinks there are cancer cells in your lymph nodes or they were unable to remove a clear margin of healthy tissue
  • instead of surgery, if you are unable to have an operation

Radiotherapy before surgery is called neoadjuvant radiotherapy. It is still a new treatment. Radiotherapy after surgery is called adjuvant radiotherapy.

You may have chemotherapy at the same time as your radiotherapy. This is still under investigation, but doctors know that particular chemotherapy drugs can help radiotherapy to work. You may hear this treatment called concurrent chemoradiation. This just means chemotherapy and radiotherapy at the same time. This type of treatment before surgery is called neoadjuvant concurrent chemoradiation.

If you have stage 3 or 4 vulval cancer, but are unable to have surgery, you may have radiotherapy with or without chemotherapy.

Read more about radiotherapy for vulval cancer. And read more about chemotherapy for vulval cancer

 

If the cancer has spread further

Sometimes vulval cancer can spread to a body organ further away. If it does, this is most likely to be the lungs.

Your doctor may offer you chemotherapy or radiotherapy to try to control the cancer and relieve any symptoms you may have. Doctors use a variety of drugs or combinations of chemotherapy drugs in this situation. So far, no one drug or combination of drugs has proved better than any other. 

Read about cancer that has spread to the lungs. And read about chemotherapy for vulval cancer

 

If the cancer comes back

If your VIN comes back in the same area, you may have more surgery. 

If your cancer comes back, your treatment will depend on several factors. These include whereabouts the cancer is, and what treatment you have already had.

You may have more surgery or you may have radiotherapy. Or your specialist may suggest chemotherapy, or chemotherapy and radiotherapy together. 

Read more about surgery, radiotherapy and chemotherapy for vulval cancer. 

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Updated: 6 July 2016