Once the vulvar cancer is diagnosed, it is staged to determine the exact treatment strategy and the possible chance of survival or cure.
The choice of treatment depends mainly on the time of diagnosis but there are other factors that affect the choice of modality of therapy. This includes age of the patient, general health as well as patient preferences.
Treatment includes three major modalities – Surgery, radiation therapy and chemotherapy. (1-4)
Surgery for vulvar cancer
Surgery involves removal of the part affected by the cancer. Earlier surgery for vulvar cancer meant removing a large part of the surrounding tissue as well.
Nearby lymph nodes were also removed. This was to ensure that there were no remaining cancer cells that could make the cancer come back or relapse.
However, this also impairs the woman’s sexual life. The removal of all the lymph nodes in the groin also lead to swelling of the leg called lymphedema.
Nowadays surgery is restricted to the cancer alone. Types of surgery that are performed include laser surgery, excision or removal of the cancer, vulvectomy where whole or part of the vulva is removed etc.
After surgery some women may want to undergo a resonstructive surgery to restore normal appearance. This might require the assistance of a cosmetic surgeon.
Pelvic exenteration involves complete removal of the vulva (vulvectomy) and removal of the pelvic nodes. The lower colon, rectum, bladder, uterus, cervix, and vagina are also removed. The bladder and the colon are restored artificially or by reconstruction.
Sentinel lymph node biopsy is a new surgical procedure where only lymph nodes that drain the area of the cancer are removed and examined for spread of cancer.
Radiation therapy for vulvar cancer
Radiation therapy uses high-energy rays like gamma rays or x-rays or particles such as electrons, protons, or neutrons to kill cancer cells.
If the beams are projected using a machine on regular hospital visits it is called external beam radiation therapy.
Internal radiotherapy is used where a radioactive implant is placed directly into cancerous tissue.
Radiation alone may be used to treat lymph nodes that have been affected with the cancer. Common side effects of radiation therapy include nausea, fatigue and skin rashes and burns etc.
Chemotherapy for vulvar cancer
This uses anti-cancer drugs usually given intravenously or by mouth to kill the cancer cells.
Drugs most often used in treating vulvar cancer include cisplatin with or without fluorouracil (5-FU).
Common side effects include:
- nausea and vomiting
- loss of appetite
- loss of hair
- sores in the mouth and vagina
- risk of infections
- bleeding and anemia
Vulvar cancer may also use application of drugs directly onto the cancer. This is useful in Vulvar intraepithelial neoplasia (VIN).
One choice is to apply the chemotherapy drug, fluorouracil (5-FU) and another is imiquimod. These are applied as creams or ointments.