The main treatments used for vulval cancer are surgery, radiotherapy and sometimes chemotherapy.
A team of doctors and other professionals, called a multidisciplinary team (MDT) meet regularly. They discuss the best treatment and care for you.
Your team might include a:
- surgeon who specialises in treating female cancers (gynaecological oncologist)
- cancer specialist (a clinical or medical oncologist)
- skin doctor (dermatologist)
- specialist in plastic surgery for cancer (oncoplastic surgeon)
- gynaecology specialist nurse
- psychologist or counsellor
- social worker
The treatment that is best for you will depend on:
- the type of vulval cancer you have
- the stage of your cancer
- the part of your vulva affected
- any previous treatment you might have already had
- your general health
Treatment for pre cancerous cells (VIN)
Vulval intraepithelial neoplasm (VIN) is a skin disease in which you have abnormal cells on 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 will explain which treatment is best for you. They may include:
- treatment with a cream called imiquimod
- laser treatment
- a period of no treatment, with close follow up
You will have regular follow up if you have VIN. This helps pick up any early signs of it coming back.
Your specialist will discuss your treatment options if VIN comes back. You may have the same treatment as before, or they may suggest a different type.
Treatment for vulval cancer by stage
The treatment options described below are for squamous cell cancer, the most common type of vulval cancer.
Treatment for stage 1A cancer
For stage 1A cancer, your surgeon will take away the affected area. They also take away a margin of healthy tissue around it. This operation is called a radical wide local excision.
You do not need surgery to check for cancer in your lymph nodes. It is 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. This involves surgery to the vulva and lymph nodes in the groin. Some people may also have radiotherapy.
The surgeon aims to remove the cancer and a margin of healthy tissue around it. This is called a radical wide local excision. Some women may need surgery to remove the whole vulva (radical vulvectomy).
The doctor will want to check your lymph nodes for signs of spread. They might suggest you have a:
- sentinel lymph node biopsy
- groin node dissection
You might have a sentinel lymph node biopsy if you have a small cancer less than 4cm. The surgeon removes a lymph node (or a few nodes) that cancer cells are most likely to spread to. In vulval cancer these are the nodes in the groin.
If the nodes don't contain cancer cells, then it is unlikely other nodes nearby are cancerous. In this case you do not need any more surgery.
Your specialist will usually recommend a full groin node dissection if the sentinel node biopsy is cancerous. This is also recommended for larger vulval cancers that are 4 cm or bigger. A groin node dissection is an operation to remove all the lymph nodes in the groin. Surgeons also call this a groin lymphadenectomy.
The surgeon may remove your lymph nodes on one or both sides of your groin. This depends on where the cancer is.
You may hear your surgeon talk about negative or positive nodes. A negative node does not contain cancer and a positive node is cancerous.
After surgery, you may have radiotherapy to your groin area.
Your specialist might also suggest radiotherapy if they were not able to remove a clear margin of healthy tissue around the cancer.
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 4A cancers
The main treatments for stage 3 and stage 4A vulval cancer are surgery, radiotherapy and chemotherapy.
You may have one, or a combination of the following operations:
- surgery to remove the cancer and a margin of healthy tissue (a wide local excision)
- surgery to remove the whole of your vulva (a radical vulvectomy)
- surgery to remove the lymph nodes near the vulva (a groin lymph node dissection or a groin lymphadenectomy)
- surgery to remove cancer that has spread to other parts of your pelvis (a pelvic exenteration)
- surgery to rebuild the vulva (reconstructive surgery)
Doctors are very aware of the impact of major surgery on women with vulval cancer. For example, it can affect your sex life and relationships. They will try to do the smallest operation while trying to reduce the risk of the cancer coming back.
You might have radiotherapy in one of the following situations:
- before surgery, to try and shrink the cancer so you can have a smaller operation
- after surgery, for example if the margins are not clear or the groin nodes are cancerous
- instead of surgery, if you are unable to have an operation
Radiotherapy before surgery is neoadjuvant radiotherapy. Radiotherapy after surgery is called adjuvant radiotherapy.
You might have concurrent chemoradiotherapy. This means having radiotherapy and chemotherapy together. Specialists think this treatment can be more effective by having them at the same time.
If the cancer has spread (stage 4B)
Occasionally vulval cancer can spread to other parts of the body away from the vulva. The most common place it spreads to is the lungs.
Your doctor might offer you chemotherapy or radiotherapy. The aim of treatment is to try to control the cancer and relieve any symptoms you have. Doctors can use a variety of drugs or combinations of chemotherapy drugs in this situation.
If the cancer comes back
Your treatment will depend on several factors if it comes back after treatment. These include where the cancer is, and what treatment you have already had.
Your specialist may suggest more surgery or radiotherapy. You might have chemotherapy if the cancer has spread to other parts of the body.