Find out about how your doctor decides which treatment you need, the types of treatment you might have and treatment by stage.
The main treatments used for vulval cancer are surgery, radiotherapy and sometimes chemotherapy.
Your specialist may suggest a combination of treatments. You might 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.
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.
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
- laser treatment
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. It is extremely rare for stage 1A cancer to spread to the lymph nodes.
Treatment for stage 1B and stage 2 cancers
Doctors usually treat stage 1B or stage 2 cancer with surgery. Some people may have radiotherapy.
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 might suggest you have a:
- sentinel lymph node biopsy
- groin node dissection
A cancer that is smaller than 4cm means you might have a test called a sentinel lymph node biopsy. Here, the surgeon removes the lymph node (or nodes) that cancer cells are most likely to spread to.
However, if this node doesn't contain cancer cells, then the other nodes nearby probably don't either. In this case, you do not need 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.
After surgery, you may have radiotherapy to the lymph nodes in your groin if the doctor thinks any of them contain cancer cells. Your specialist might 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.
Anyone unable to have surgery for any reason is most likely to have radial radiotherapy treatment. Radical treatment means an intensive course of radiotherapy to try to cure your cancer. Your specialist might want you to have chemotherapy at the same time. This can help the radiotherapy to work.
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.
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.
You might 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 might 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. This is called concurrent chemoradiation. This type of treatment before surgery is called neoadjuvant concurrent chemoradiation.
Anyone that has 3 or 4 vulval cancer, but is unable to have surgery, might have radiotherapy with or without chemotherapy.
If the cancer has spread
Sometimes vulval cancer can spread to a body organ further away. The most common place it spreads to is the lungs.
Your doctor might 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.
If VIN comes back
You might have more surgery if your VIN comes back in the same area.
If the cancer comes back
Your treatment will depend on several factors if it comes back after treatment. These include whereabouts the cancer is, and what treatment you have already had.
You might have more surgery or you may have radiotherapy. Or your specialist could suggest chemotherapy, or chemotherapy and radiotherapy together.