Vulvar Cancer – Diagnosis and Treatment
Diagnosis
Checking the Vulva
A healthcare provider begins with a careful look at the outside parts of the genital area for unusual spots, lumps, or color changes.
They often use a magnifying device called a colposcope to get a closer view of the vulva, vagina, and sometimes the cervix.
This helps the provider find even small changes that might need more tests. Other signs like ulcers, thickened areas, or raised lesions guide the doctor on where to look more closely.
Some doctors may apply a mild solution, such as acetic acid, to help highlight abnormal skin on the vulva, especially if certain infections or vulvar intraepithelial neoplasia are suspected.
During this appointment, the doctor may also ask questions about risk factors, such as age, history of human papillomavirus (HPV) infection, or past gynecologic cancer.
Collecting Tissue for Testing
If the doctor sees an area that looks suspicious, the next step is to remove a small piece of tissue for study. This is called a biopsy.
Most of the time, a local numbing medicine prevents pain during the procedure in the office. The doctor uses a small blade for an excisional biopsy or a circular instrument for a punch biopsy.
After collecting the tissue, a pathologist examines the sample under a microscope to check for cancer cells. If the test shows cancer, the provider may order further tests soon after.
In some cases, especially if the suspicious area is large or in a tricky location, the doctor performs the biopsy in a hospital with stronger medicine to help the patient sleep.
Confirming the Cancer’s Spread
After finding cancer, doctors work to see how far it has grown. This is called staging. Staging often includes:
- A physical exam of the pelvic area to check for spread.
- Imaging tests like MRI, CT, X-ray, or PET scans to look at the chest, abdomen, and pelvis.
- In some cases, a sentinel node biopsy checks if cancer has reached the lymph nodes.
The cancer is then assigned a stage from 1 to 4.
| Stage | Description |
|---|---|
| 1 | Small, limited to the vulva |
| 2 | Larger, but not spread to nearby organs |
| 3 | Spread to lymph nodes |
| 4 | Spread beyond the pelvis or to distant body parts |
Treatment
Surgical Procedures to Remove Vulvar Cancer
Surgery is usually the main approach for vulvar cancer. Doctors often start by removing the cancer along with some healthy tissue.
This is called a wide local excision or radical excision. The purpose is to make sure no cancer cells are left behind.
In some cases, part or all of the vulva needs to be taken out. A partial vulvectomy removes only part of the vulva, while a radical vulvectomy means all of the vulva and some nearby tissue are removed.
These surgeries are chosen based on the cancer’s size and location. For larger tumors, treatments like radiation or chemotherapy may be given first to shrink the cancer before operating.
Doctors may also do surgery on lymph nodes. A sentinel lymph node biopsy helps find out if cancer has spread. Only the nodes that are most likely to have cancer are removed and checked.
If cancer is present in these nodes, doctors might remove more lymph nodes (through a procedure called lymphadenectomy) to stop the cancer from moving to other parts of the body.
Complications after surgery can include infection, slow healing, or swelling in the legs (lymphedema), especially if lymph nodes are removed. Sometimes, reconstructive surgery is needed after large areas are removed.
Summary Table of Common Surgical Procedures
| Procedure | Purpose |
|---|---|
| Wide Local Excision/Radical Excision | Removes tumor and surrounding tissue. |
| Partial Vulvectomy | Removes part of the vulva. |
| Radical Vulvectomy | Removes all vulva and some tissues. |
| Sentinel Lymph Node Biopsy | Checks if cancer spreads to lymph nodes. |
| Lymphadenectomy | Removes multiple lymph nodes if needed. |
| Reconstructive Surgery | Repairs or rebuilds affected areas. |
Using Radiation to Target Cancer Cells
Radiation therapy uses high-energy rays, like X-rays, to kill cancer cells. Patients usually lie on a table while a special machine moves around, aiming radiation at the exact spot where the cancer is.
Doctors may use radiation before surgery to help shrink the tumor. Sometimes, radiation combines with a low dose of chemotherapy to make the effects stronger.
If there is concern that cancer has spread to the lymph nodes or is left behind after surgery, radiation might be focused on those areas.
A radiation oncologist plans and oversees the treatment. External radiation is the most common type. Advanced radiation techniques might be used if cancer has spread to the pelvis or other nearby areas.
Medicines Used for Treating Vulvar Cancer
Chemotherapy uses strong drugs to attack and kill cancer cells. The medication is usually given through a vein (IV). Some drugs can be taken as pills.
For vulvar cancer that has spread far from the vulva, chemotherapy can help slow the cancer’s growth or shrink it. Sometimes, doctors use chemotherapy together with radiation therapy before surgery or for treating cancer found in lymph nodes.
There are different kinds of chemotherapy drugs, and the combination is chosen based on the patient’s needs and cancer stage.
Treatments That Target Cancer’s Special Features
Targeted therapies go after certain molecules within cancer cells. These medicines block the signals cancer cells use to grow and divide.
Doctors may consider targeted treatments for vulvar cancer when standard therapies do not work or if the cancer returns after treatment. These options offer more personalized cancer care.
Such therapies are not always used for everyone. Their use depends on the specific features of the cancer and may be discussed with a cancer treatment specialist.
Helping the Immune System Fight Cancer
Immunotherapy helps the body’s own defense system (the immune system) find and destroy cancer cells. Some cancer cells hide from the immune system, but immunotherapy medicines can help unmask them.
Doctors may suggest immunotherapy for patients with advanced vulvar cancer, especially when other cancer treatments are not working. These medicines can boost the immune response so it attacks cancer more effectively.
Immunotherapy options are growing as more research is done, but not all patients will qualify for them. Decisions are based on different factors, such as the type of cancer and previous treatments.
Ongoing Checks After Treatment
After finishing treatment, patients have scheduled visits to make sure the cancer has not come back. Regular check-ups usually happen two to four times a year for the first two years.
During these visits, the provider may do a physical exam, imaging tests, or lab work. Follow-up visits help to find any signs of cancer returning early.
Coping and Support
Understand Vulvar Cancer to Take Charge of Your Care
Learning about vulvar cancer can help people feel more prepared to make decisions about treatment and supportive care.
It is helpful to talk with doctors and nurses about the type of cancer, available treatments, side effects, and test results. Some choose to get a second opinion to feel more confident.
Knowledge can ease some worries and lead to better choices for improving quality of life.
Rely on Loved Ones for Support
Building a network of family and friends can make a big difference during and after cancer treatment. Loved ones can help with daily tasks, provide transportation, or help manage pain and other side effects.
Even just having someone to sit and listen can be comforting.
Ways friends and family can help:
| Task | Example |
|---|---|
| Practical support | Groceries, rides to appointments |
| Emotional support | Listening, sharing time, encouragement |
Share Feelings with Someone You Trust
Talking about fears or hopes with others can reduce stress. This might be a close friend, a member of the care team, or a support group focused on vulvar cancer.
Medical social workers, spiritual advisors, and support groups also help people discuss emotions and adjust to changes, which can boost quality of life and coping skills.
Stay Connected with Your Partner
People sometimes worry about changes to intimacy after vulvar cancer treatment. There are many ways to show care, such as hugging, touching, or holding hands.
Meeting with a counselor or therapist, alone or together, can help manage changes and support a successful recovery.
- Focus on comfort and closeness.
- Explore new ways to express affection.
- Ask care providers about sexual health resources.
Getting Ready for Your Medical Visit
Steps You Can Take Beforehand
Preparation can help each visit go more smoothly. Here are a few ways to get set for appointments with a gynecologist, gynecologic oncologist, or at a cancer center:
Check for Any Special Instructions: Contact the office or talk to your doctor’s staff to ask if you should follow any diet rules or avoid certain activities before your visit.
Record Your Symptoms: Write down every symptom, even small changes. This includes symptoms that might not seem linked to your main concern.
- List Your Health Details: Note big life events, recent stress, or other things that may affect your health. A written list can help the medical team understand your background better.
- Bring a Medication List: Make a complete list of all medicines, supplements, and vitamins you use, plus the amounts you take.
Consider Having Someone With You: Bringing a family member or a friend can let you focus on speaking to the doctor. They can also listen and remember anything you miss.
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Write Down Questions to Ask: It is helpful to write questions in order of importance. Because time can be short, start with your biggest concerns.
Some topics to bring up could be:
| Question Topic | Possible Examples |
| Tests | What tests will I need? |
| Diagnosis | What type of vulvar cancer is this? |
| Surgery and Treatments | Which options are available? |
| Side Effects | What side effects could I have? |
| Success Rates | How successful are these treatments? |
| Future Planning | Will I be able to have children later on? |
| Recovery and Prognosis | What are my chances of the cancer coming back? |
If visiting a gynecologic oncologist or a medical oncologist, consider asking how your care at a cancer center is planned and who will be on your care team.
What Your Health Professional Might Ask
During the appointment, your doctor or gynecologic oncology expert may ask questions such as:
- When did you first notice your symptoms?
- Are your symptoms there all the time or do they come and go?
- How strong or severe are your symptoms?
- Have you found anything that helps your symptoms feel better?
- Does anything make your symptoms worse?
- Have you ever been diagnosed with conditions like lichen sclerosus?
- Did you ever receive an unusual Pap test result?
- Do you know if you have had HPV?
Preparing ahead helps the medical team and ensures you get clear answers to your questions.
