The treatment of vulvar cancer depends upon the type of cancer, its stage, and its location. Your age, overall health, and the importance of maintaining sexual function will affect treatment choices, too.
Surgery is the most common treatment for vulvar cancer. The exact type of surgery you have will depend on how much tissue needs to be removed:
Laser surgery burns off the layer of abnormal cells. Doctors treat VIN with laser surgery but not invasive cancer.
Excision (sometimes called wide local excision) removes the cancer and some surrounding normal tissue.
Vulvectomy removes part or all of the vulva and the underlying tissue. A simple vulvectomy removes only the vulva. A partial radical vulvectomy removes part of the vulva and the underlying tissue. A complete vulvectomy removes the entire vulva and the tissue underneath it, including the clitoris. The impact on sexual function depends on how much of the vulva is removed.
Pelvic exenteration is the most extensive surgery. It includes vulvectomy, the removal of the pelvic lymph nodes, and the removal of one or more these structures: the vagina, rectum, lower colon, bladder, uterus, and cervix.
The surgeon will try to remove all of the cancer cells while preserving as much sexual function as possible.
Radiation is usually started after surgery. However, if the cancer affects a large area, radiation may be used before surgery to reduce its size.
Chemotherapy (anticancer drugs) for vulvar cancer is being studied. Researchers are testing a new treatment for women with severe cases of vulvar cancer. This treatment involves receiving chemotherapy intravenously (into a vein) along with radiation therapy prior to surgery.
The greatest challenge is to select a treatment that maximizes the chances of removing all of the cancer while preserving sexual function, which can be lost with aggressive surgery.
Rare forms of vulvar cancer may be linked to cancers elsewhere in the body. That may require more testing, treatment, and monitoring.