Vulvar cancer is cancer of the external female sexual organs. Most often, it is a type of skin cancer. It is a fairly rare disease, affecting only about one-half of one percent of all American people who are diagnosed with cancer each year. If detected early, before it has spread to the lymph nodes, the chances of a cure are quite high, 90 percent or better.
Here are some of the treatment choices you may be offered at Fred Hutchinson Cancer Center. Remember, each people's cancer is different, as are their circumstances, preferences and beliefs. A treatment that works well for another person may not be right for you.
Your treatment will depend in part on the results of a biopsy. Tissue samples from your cancer will be removed either in the clinic or during surgery, and examined by a pathologist. Fred Hutch has a dedicated pathologist who only works with gynecologic cancer patients.
The examination of these tissues will show whether your cancer is likely to grow slowly or quickly, whether it is likely to recur and whether it is likely to respond to certain types of treatment. The treatment recommended by your physicians will depend to a large degree on the "stage" of your cancer, meaning how far it has progressed at the time of diagnosis.
Women who come to Fred Hutch for treatment of disease that is still in the pre-cancerous stage will likely be treated with an excisional biopsy or a laser procedure. If your vulvar cancer has progressed, or become "invasive," your physicians will most likely recommend that you have surgery, chemotherapy and/or radiation therapy.
You may also want to consider participating in a clinical trial to gain access to treatments that are not otherwise available.
Most people who have cancer of the vulva are treated with surgery. The procedure your physician recommends will depend on how advanced your cancer is.
Laser surgery is used to treat women whose disease is in the "pre-cancerous" stage, meaning that there are irregular cells present that probably would become cancer if not treated. This is a relatively simple procedure that uses a laser to remove the irregular cells.
Local excision is a surgery to remove the cancer plus a margin of healthy tissue. If your physician recommends a "radical" local excision, a larger margin of healthy tissue will be removed and you may have lymph nodes in the groin removed as well.
The lymph nodes are removed so that they can be biopsied to determine if the cancer has spread. Some people are candidates for a sentinel node biopsy, in which as few as one or two lymph nodes are removed.
There are different types of vulvectomy (surgery to remove the vulva, or external sexual organs). Some procedures are more extensive than others, and will be recommended 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.
In many cases, the gynecologic oncologist who removes the tumor can also close the incision. 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.
If biopsies and other tests show that your cancer has spread beyond the vulva, your physicians may recommend adding radiation, chemotherapy or both to control the disease.
Surgery for Fred Hutch gynecologic patients is done at UW Medical Center - Montlake by UW Medicine surgeons.
Your physician may recommend chemotherapy to treat your vulvar cancer. You may have chemotherapy or a combination of chemotherapy and radiation therapy prior to surgery in order to shrink your cancer. Or you may have these treatments after surgery as adjuvant therapy. Adjuvant therapy is done as an "extra protection" against the possible recurrence of your cancer, even though all visible cancer may have been removed surgically.
Chemotherapy is sometimes used in combination with radiation therapy to treat vulvar cancer because it enhances the effectiveness of radiation therapy. Chemotherapy is also sometimes prescribed to treat vulvar cancer that has spread too widely to be treated with surgery or radiation therapy.
"Chemotherapy" means treating cancer with drugs. You will probably receive a combination of two chemotherapy drugs given by infusion into a vein.
The most common combinations for vulvar cancer are:
Chemotherapy works by killing fast-growing cells, but the drugs cannot discriminate between cancer cells and other fast-growing cells, such as hair follicles. That is one reason for many of the typical side effects of chemotherapy treatment, including hair loss.
Chemotherapy is given on various schedules. If you are receiving chemotherapy in conjunction with radiation therapy, you will probably receive one chemotherapy treatment during the first week of your radiation therapy, and another during the fourth and final week of radiation. Sometimes chemotherapy is given on a weekly basis during radiation therapy.
Chemotherapy is given at the UW Medical Center - Montlake. You may bring a friend or family member to sit with you during your treatment, which may last several hours.
If you have vulvar cancer, your physician may recommend that you have radiation therapy. You may only have radiation therapy or your may have radiation in combination with surgery or chemotherapy. Some women will be treated with all three therapies: surgery, radiation and chemotherapy.
External radiation therapy typically is given five days a week for a period of five or six weeks, using a machine that looks much like a regular X-ray machine. The procedure is not painful and each treatment lasts only a few minutes.
You may have your radiation therapy at Fred Hutch on an outpatient basis, under the supervision of UW Medicine radiation oncologist Dr. Wui-Jin Koh, who specializes in treating women with gynecologic cancers.
Fred Hutch and UW Medicine have been active in conducting research that has shown that adding chemotherapy to radiation therapy makes the treatment more effective. This is an example of research conducted at the parent organizations that benefits patients at Fred Hutch and elsewhere.
Despite treatment, vulvar cancer sometimes recurs. It may come back in the vulva or elsewhere in the body. Although tumors may appear in distant sites, it is not a new cancer. It is a recurrence of the original cancer.
If you have recurrent vulvar cancer, Fred Hutch can offer you new medical procedures and treatments, as well as access to clinical trials, that your community physician may not know about. No one at Fred Hutch will tell you that a diagnosis of recurrent disease is not serious, but there is hope.
The treatment you receive for a recurrence of your vulvar cancer may include surgery, chemotherapy or radiation--or a combination of these treatments. Your treatment will depend on a number of factors, including the type of treatment you have received in the past and the symptoms you are experiencing with the new cancer.
Depending on the extent of the disease, your physicians may recommend that you have a wide local excision, which may be followed by radiation therapy. Rarely, you may need a more extensive surgery, called pelvic exenteration. In this procedure, the uterus, cervix and vagina are removed, as well as other organs to which the cancer has spread, such as the lower colon, rectum or bladder.
If your physicians feel that surgery is not appropriate for you, they may recommend that you have radiation therapy, possibly in combination with chemotherapy, or alone. Radiation therapy is used for local recurrences and also to reduce symptoms of recurrent disease.
Ask your physician about taking part in clinical trials of promising treatments for recurrent disease.
Any person who has faced cancer lives with the fear that cancer will return. And the first response many people have to the news of metastases is to fear that they will soon die.
If you have metastatic disease, you will learn a new definition of metastatic cancer — "a chronic disease that can be managed." It's a very different way of looking at cancer. You can expect to have periods of treatment, followed by periods of remission, with a fairly good quality of life throughout.
Emotionally, this can be tough. You may want to talk with a chaplain or social worker or join a support group. Fred Hutch has several support groups for patients and for caregivers and family members.
Your team at Fred Hutch offers long-term follow-up care for as long as you choose after your treatment for vulvar sarcoma. 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 doctors as well as advanced registered nurse practitioners (ARNPs).
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.
People who reach the two-year mark without having a recurrence of their disease are less likely to have a recurrence and can be seen less often. From that point, 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, and we offer long-term follow-up for as long as you choose to come here through our Women’s Wellness Clinic.