Treatments and Therapies for Vulvar Cancer

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Fred Hutch Cancer Center offers comprehensive care for vulvar cancer. We offer advanced therapies and new options available only through clinical studies. Vulvar cancer can often be cured, especially when diagnosed early before it has spread to the lymph nodes.

The most common treatment is surgery. This may be all the treatment you need, or you might have radiation therapy or chemotherapy. Some patients have immunotherapy. We’ll tailor your treatment to you and your cancer.

Vulvar Cancer Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.

Referrals are required for new patients. Please request your primary care provider or specialist fax all relevant medical information to the fax number listed below.

Phone: 206.598.8300
Fax: 206.598.3590

Vulvar Cancer Surgery

As a patient at Fred Hutch, you’ll have surgery by a UW Medicine gynecologic oncologist. Your surgeon will be specially trained in gynecologic oncology. They will recommend the best procedure to match your needs.

Gynecologic oncology is a unique specialty because your physician is a surgical oncologist and a medical oncologist, all in one. This enables continuity of care.

“Patients benefit from having a surgeon who can manage all aspects of their cancer care and understands all the new treatments,” said gynecologic oncologist Barbara Goff, MD. “By performing the right surgery, selecting the right chemotherapy, using genetic testing and connecting patients with clinical trials, we are slowly improving patient survival.”

How Surgery Can Treat Vulvar Cancer

The goal of surgery for vulvar cancer is to remove all of the cancer or as much cancer as possible. Some people need only surgery followed by checkups to monitor their condition. If your cancer has spread beyond the vulva or come back after treatment, your physician may recommend radiation, chemotherapy or both — along with or instead of surgery.

Laser Surgery

Laser surgery is used if you have abnormal cells that are precancerous, which means they probably would become cancer if not treated, like vulvar intraepithelial neoplasia (VIN). This is a relatively simple procedure that uses a beam of light to burn off the abnormal cells.

Local Excision

Local excision is surgery to remove precancer (VIN) or cancer plus a margin of healthy tissue. If you had an excisional biopsy (cutting out a small section of skin for testing and diagnosis), this may be all you need — as long as your sample had clean margins. In most cases, additional treatment will be required.

Based on the features of your cancer, your physician may recommend a wider excision (radical local excision). This means they’ll remove a larger margin of healthy tissue and maybe some lymph nodes in your groin as well (inguinal lymph node dissection).

The lymph nodes are removed for testing to see if the cancer has spread. Some people may have only one or two lymph nodes removed (sentinel node biopsy), and some have more removed.

Vulvectomy

Vulvectomy is surgery to remove part or all of the vulva. If you have precancer (VIN), your physician may only need to remove the top layer of skin (skinning vulvectomy). If you have true cancer, you may need more tissue removed, especially if your cancer is more advanced. In some cases, your physician will also remove lymph nodes in the groin to check if your disease has spread any further.

Reconstruction

In many cases, the gynecologic oncologist who removes the tumor can also close the incision after vulvectomy. When the cancer surgery is more extensive, a reconstructive surgeon may be involved. Often, they use skin from the same region of the body and rearrange it to make a new surface for the labia. If more tissue is needed, the surgeon may use tissue from your abdomen or thigh. Learn more about reconstructive surgery.

Pelvic Exenteration

Rarely, people need more extensive surgery to remove organs from the pelvis where cancer has spread. This could include the uterus, cervix, vagina, ovaries, lower colon, rectum and bladder. If you need additional surgery like this, your care team will work closely with each other and with you to preserve or restore your function and provide support for your recovery.

Chemotherapy for Vulvar Cancer

Chemotherapy helps to destroy cancer cells wherever they may be in your body. Usually, it means you get anti-cancer medicine through an intravenous (IV) line. Then the medicine travels throughout your body through your bloodstream.

For vulvar intraepithelial neoplasia, your physician might recommend a chemotherapy ointment (fluorouracil, 5-FU), which you rub on your skin in the area of abnormal cells.

How Chemotherapy Can Treat Vulvar Cancer

Some patients have chemotherapy, either with or without radiation therapy, to shrink their tumor before surgery. Some have chemotherapy after surgery to reduce the chance that the cancer will come back. Chemotherapy may also be one of your options if you don’t have surgery.

Chemotherapy Schedule

Chemotherapy schedules differ, based in part on which drugs you receive. Your care team will talk with you about how often you need to get chemotherapy and for how many months.

If you are getting chemotherapy along with radiation therapy, you will probably have one chemotherapy treatment during the first week of your radiation therapy, and another during the fourth and final week of radiation. Some people get chemotherapy every week during radiation therapy.

Radiation Therapy for Vulvar Cancer

Radiation therapy (also called radiotherapy) uses high-energy beams to damage the DNA inside cancer cells. After enough damage, the cells cannot multiply, and they die.

How Radiation Therapy Can Treat Vulvar Cancer

Your physician may recommend having radiation therapy before surgery to shrink your tumor or after surgery to keep cancer from returning. If you’re not having surgery, then radiation therapy may be helpful.

External-Beam Radiation Therapy

In external-beam radiation therapy (EBRT), radiation comes from a source outside your body. A machine sends a beam of photons (such as X-rays or gamma rays) or subatomic particles (tiny particles that are smaller than atoms, such as electrons or protons) at your cancer.

Typically, you’ll have EBRT five days a week (Monday to Friday) for five to six weeks. It’s not painful, and each treatment lasts only about five to seven minutes.

Radiation Plus Chemotherapy

Physicians sometimes use chemotherapy along with radiation therapy (chemoradiation) to treat vulvar cancer because chemotherapy makes radiation therapy more effective. Fred Hutch and UW Medicine have been active in research that has shown this approach can benefit patients.

Immunotherapy for Vulvar Cancer

Immunotherapies use the power of your immune system to fight your cancer. There are several types of immunotherapies used against different forms of cancer.

How Immunotherapy Can Treat Vulvar Cancer

For vulvar intraepithelial neoplasia, physicians may use a drug called imiquimod. It’s a cream applied to the skin, and it boosts your body’s natural response to the abnormal cells.

For advanced vulvar cancer, your care team might recommend immune checkpoint inhibitors. These are monoclonal antibodies that help your immune system identify your cancer cells and destroy them.

Examples of immune checkpoint inhibitors used for vulvar cancer include pembrolizumab, dostarlimab, nivolumab and cemiplimab. These drugs block a protein (PD-1) found on tumor cells or immune cells. Blocking the protein helps enhance your immune system’s response.

Why Choose Fred Hutch for Vulvar Cancer Treatment 

At Fred Hutch, we understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.

Team-Based Care from Specialists

Fred Hutch has surgeons, medical oncologists and pathologists who specialize in colorectal cancer. We offer the most advanced diagnostic, treatment and recovery programs. Along with treating your cancer, we also offer a range of services to support you and your caregiver. This is part of how we take care of you — not just your disease. From registered dietitians to Spiritual Health clinicians to social workers, our experts know how to care for people with vulvar cancer.

The Newest Treatments Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options. We’ll recommend a treatment plan to get you the best results based on the stage and size of your cancer, where it is and your overall health. We have access to the latest developments in treating cancer and offer patients the chance to get promising therapies through clinical trials done by physician-scientists from Fred Hutch and UW Medicine.

Follow-Up Care

When your treatment is complete, we’ll keep close watch on your health with periodic follow-up visits. You’ll see the same team members who treated your disease. It’s specially designed to provide follow-up care for women who are five years out from their primary treatment.

Vulvar Cancer Treatment FAQ

The best way to treat vulvar cancer depends on many factors, like the size of the tumor, where it is and if it has spread. For many people, the main treatment is surgery to remove any tumor from the body, if possible. For some women, this may be the only treatment they need.

In some cases, surgery might not work well enough on its own. You might need other treatments, too, like radiation therapy, chemotherapy or immunotherapy. And there are times when surgery may not be helpful, but other treatments may help control the disease. At Fred Hutch, we design your treatment plan around what will be most effective for you.

In general, people who have the same stage of vulvar cancer often have the same or similar treatments. Common treatments by stage may include:

  • Stage I (1): Surgery to remove the tumor. Sometimes surgeons need to remove nearby lymph nodes. Some people have radiation therapy after surgery or instead of surgery.
  • Stage II (2): Surgery to remove the tumor. Sometimes surgeons need to remove nearby lymph nodes. Some people have radiation therapy after surgery or instead of surgery, sometimes along with chemotherapy.
  • Stage III (3): Surgery to remove the tumor along with nearby lymph nodes. Some people have radiation therapy (or chemotherapy plus radiation therapy) before surgery, or they have radiation therapy after surgery, or they have only radiation therapy.
  • Stage IV (4): Surgery to remove the tumor and sometimes other pelvic organs where the cancer has spread. Some people have radiation therapy (or chemotherapy plus radiation therapy) before surgery, or they have radiation therapy after surgery. Some people don’t have surgery; instead, they have radiation therapy, chemotherapy or both.

Fred Hutch offers all standard treatment for vulvar cancer. Our patients also have access to newer options or treatment combinations that you can only get through research, called clinical trials.

Your care team at Fred Hutch is here to help you prevent or prepare for side effects and to relieve any side effects you have. The most important step you can take is to speak up and let your team know what you’re feeling. We’ve helped many patients and families through this process and know how to ease your experience.

Often, there are medicines to help, like anti-nausea drugs. There may be a range of other helpful options too, like diet changes, physical therapy and emotional and practical support. Fred Hutch researchers continue to look for the best ways to keep side effects at bay.

Your team at Fred Hutch offers long-term follow-up care for as long as you choose after your treatment for vulvar cancer. Our patients find it reassuring to see the same team members who treated them — experts in gynecologic cancers — for their follow-up visits. This includes physicians as well as advanced registered nurse practitioners.

Typically, people come for checkups, including pelvic exams, every three months for the first two years after treatment. Some patients choose to have all these follow-up visits at Fred Hutch. Some alternate between coming to Fred Hutch and seeing their local primary gynecologist.

After you reach the two-year mark without your disease coming back, you are less likely to have a recurrence. From that point, you can come in less often. We usually ask you to come in every six months for a checkup until you are five years out from your primary treatment. After five years, an annual checkup is all that we recommend.