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 for carcinoma in situ and for less advanced pre-cancerous changes (vulvar intraepithelial neoplasia, or VIN) are the same. Laser surgery, wide local excision, or a skinning vulvectomy may be used, depending on the size and location of the cancer. Fluorouracil (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, the cancer is removed along with a 1-cm margin of the normal tissue around it.

For stage IB cancers, treatment includes a partial radical vulvectomy and inguinal lymph node dissection (removal of nearby groin lymph nodes). Sentinel lymph node biopsy may be done instead of the lymph node dissection (although this is not standard).

Another option that is rarely used for cancers that are larger and quite extensive is a complete radical vulvectomy and removal of the groin lymph nodes. More often, the doctor will perform a radical wide local excision and either a lymph node dissection or a sentinel node biopsy. If the lymph nodes are not removed because the patient is not healthy enough to withstand the surgery, radiation therapy to the groin areas 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. 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 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, a newer approach is to give 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 is an option, although it is used rarely. This operation includes vulvectomy and removal of the pelvic lymph nodes plus removal of some of the following : the lower colon, rectum, bladder, uterus, cervix, and vagina. The standard approach is to combine surgery, radiation, and chemotherapy. Radiation therapy may be done before or after surgery. Chemotherapy may also be given before surgery. Radiation and possibly chemotherapy can also be given to women who cannot have surgery because of prior medical problems.

Recurrent vulvar cancer

When a cancer has come back after treatment, it is called recurrent. 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 the cancer comes back locally 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.

Last Medical Review: 12/30/2008
Last Revised: 05/14/2009