The stage of a vulvar cancer is the most important factor in choosing treatment. However, other factors that affect this decision include the exact location of the cancer on the vulva, the type of cancer, your age, and your overall condition.

Stage 0 (carcinoma in situ): Treatment options are the same for carcinoma in situ and for less advanced pre-cancerous changes (vulvar intraepithelial neoplasia, or VIN). Laser surgery, wide local excision, or a skinning vulvectomy (a little thicker amount of skin is taken) may be used, depending on the size and location of the cancer. 5-FU ointment may be prescribed. Stage 0 cancers may recur (come back) or new stage 0 cancers may form on other areas of the vulva. The 5-year survival rate is nearly 100%, similar to pre-invasive skin cancers in other body sites.

Stage I: Treatment options depend on the size and depth of the cancer and whether the patient also has VIN. If the depth of invasion is 1 mm or less (stage IA) and there are no other areas of cancer or VIN, an excisional biopsy that includes a 1-cm normal tissue margin is done. For more deeply invasive and larger stage I cancers (stage IB), a partial radical vulvectomy is necessary along with removal of nearby lymph nodes in the groin (superficial and deep groin lymph nodes) on the same side of the body as the cancer or sentinel node biopsy.

If the cancer is larger and quite extensive, another option (although rarely used) is a complete radical vulvectomy and removal of the groin lymph nodes. More often, the doctor will perform a radical wide local excision and lymph node sampling. Radiation would only be used if there were cancer in the lymph nodes, but then this would make the stage change to Stage III. For those who do not have their lymph nodes removed or who are not healthy enough to withstand the surgery, radiation therapy to the groin(s) may be used instead of the lymph node dissection.

Stage II: The treatment for most stage II vulvar cancers is partial radical vulvectomy and removal of the lymph nodes in the groin on both sides of the body or sentinel node biopsies. Rarely, radiation therapy to the area of surgery will be needed if cancer cells are present at or near the margins (edges of the tissue removed by surgery).

Stage III: Some of these bulky cancers can be cured by radical operations. A radical vulvectomy with removal of the lymph nodes in the groin (superficial and deep groin lymph nodes) may be successful in completely removing the tumor. However, most recent therapeutic efforts have focused on combining treatments. One option is chemotherapy along with radiation therapy followed by surgery. Clinical trials are underway to evaluate the use of radiation therapy and/or systemic chemotherapy with cisplatin with or without 5-FU, followed by surgery in cases with a good response to chemotherapy or radiation.

Stage IV: The extent of the surgery beyond a radical vulvectomy depends on what organs contain cancer cells. Pelvic exenteration includes vulvectomy and removal of the pelvic lymph nodes and one or more of the following structures: the lower colon, rectum, bladder, uterus, cervix, and vagina. Radiation therapy may be done before or after surgery. Chemotherapy may also be given prior to surgery. In some cases where surgery is not advised, radiation and possibly chemotherapy are options.

Recurrent vulvar cancer: This means that the disease has recurred (come back) after treatment. Treatment options will depend on how soon the cancer comes back and whether it is local (in the vulva), regional (in nearby lymph nodes), or distant (has spread through the bloodstream to organs such as the lungs or bone).

If the recurrence is local, it may still be possible to remove the cancer by surgery or by using combinations of chemotherapy, radiation therapy, and surgery. When local recurrence occurs more than 2 years after the initial treatment, the prognosis is better than if the cancer had recurred sooner.

When the cancer is unresectable (has grown too large or spread too far to be surgically removed), chemotherapy and/or radiation therapy may be used to help relieve symptoms such as pain caused by the cancer, or to shrink the tumor so that surgery may become an option. If treatment is given only to relieve pain or bleeding, it is called palliative (symptom relief) therapy.

It's very important to understand that palliative treatment is not expected to cure a cancer. Women with stage IV vulvar cancer are encouraged to enter a clinical trial where they may receive new forms of therapy that may be beneficial but are as yet unproven.

Revised: 06/21/2006