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Treatment Options For Vulvar Cancer
By peace | July 17, 2006
Vulvar cancer is cancer that starts in the vulva, which is the outer part of the female reproductive system. The vulva includes the skin folds under the pubic hair that protects the urethra and vagina. Vulvar cancer is rare, in that it represents only about 4% of all female reproductive organ cancers. If it is found in its early stages, vulvar cancer is highly curable.
About 3,740 women will be diagnosed with vulvar cancer this year in the United States . The majority of women with vulvar cancer are older than 50. Half are older than 70 at the time they learn they have cancer. However, 15% of people diagnosed with vulvar cancer are younger than 40.
Like most cancers, cancer of the vulva is best treated when it is found (diagnosed) early. If you have symptoms, your doctor may do certain tests to see if you have cancer, usually beginning by looking at the vulva and feeling for any lumps. Your doctor may then go on to cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. You will be given some medicine to numb the area when the biopsy is done. You may feel some pressure, but you usually won’t feel any pain. This test is often done in a doctor’s office.
Your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the vulva or has spread to other places) and your general state of health. Your treatment options depend on the type of vulvar cancer you have, the results of lab tests, and the stage of the cancer. Your doctor will also consider your age and general health when making recommendations about treatment.
The goal of treatment is to cure you, which is possible in many cases. If it is not possible, then your doctor will try to control the cancer for as long as possible and keep you comfortable. It’s normal to want to learn all you can about vulvar cancer and your treatment choices. You probably have many questions and concerns. Your doctor is the best person to answer your questions about your treatment, how successful it is expected to be, and what the risks and side effects may be.
Types Of Treatment For Vulvar Cancer
Treatment for vulvar cancer is either local or systemic. Local treatments remove, destroy, or control the cancer cells in a certain area. Surgery and radiation are examples of local treatments. They are the most common treatments for vulvar cancer. Systemic treatments are used to destroy or control cancer cells throughout the entire body. When taken by pill or injection, chemotherapy is a systemic treatment sometimes used for vulvar cancer. You may have just one treatment or a combination of these treatments.
1. Surgery removes the cancer while keeping as much surrounding normal tissue as possible. Surgery is the most common treatment for cancer of the vulva. Often with vulvar cancer, several areas are affected, and large amounts of tissue may be removed. When the cancer has invaded to a depth greater than 1 mm, the cancer may have spread to the lymph nodes in the groin. These nodes are removed surgically and biopsied to determine how much the cancer has spread. Surgical treatment for vulvar cancer consists generally of two parts: the removal of diseased tissue and the removal of lymph nodes. Your doctor may take out the cancer using one of the following operations:
- Wide local excision takes out the cancer and some of the normal tissue
around the cancer.
- Radical local excision takes out the cancer and a larger portion of normal
tissue around the cancer. Lymph nodes may also be removed.
- Laser surgery uses a narrow beam of light to remove cancer cells.
- Skinning vulvectomy takes out only the skin of the vulva that contains the
cancer.
- Simple vulvectomy takes out the entire vulva, but no lymph nodes.
- Partial vulvectomy takes out less than the entire vulva.
- Radical vulvectomy takes out the entire vulva. The lymph nodes around it
are usually removed as well. If the cancer has spread outside the vulva and the other female organs, your doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (pelvic exenteration). You may need to have skin from another part of your body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.
2. Radiation uses high-energy X-rays to kill cancer cells or shrink the tumor before surgery. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation). External radiation is occasionally used as a supplement to surgery when metastatic disease is found. Radiation may be used alone or before or after surgery.
Radiation is often an option for patients whose lymph nodes have been invaded by cancer or who have primary tumors that cannot be entirely removed without jeopardizing the patient’s safety. When a patient’s condition requires a colostomy or urinary diversion, external radiation can sometimes be substituted for surgical removal. In this situation, radiation is often combined with chemotherapy.
3. Chemotherapy uses anticancer drugs to kill cancer cells. Drugs may be given by mouth, or they may be put into the body by a needle in the vein or muscle. Chemotherapy is called systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.
Treatment By Stage
Treatment for cancer of the vulva depends on the stage of your disease, the type of disease, your age, and your overall condition. You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are going on in most parts of the country for stages III and IV of cancer of the vulva.
STAGE 0 VULVAR CANCER
Your treatment may be one of the following:
1. Wide local excision or laser surgery or a combination of both.
2. Skinning vulvectomy.
3. Ointment containing a chemotherapy drug.
STAGE I VULVAR CANCER
Your treatment may be one of the following:
1. Wide local excision.
2. Radical local excision plus taking out all nearby lymph nodes in the groin and upper part of the thigh on the same side as the cancer.
3. Radical vulvectomy and removal of the lymph nodes in the groin on one or both sides of the body. 4. Radiation therapy alone (in selected patients).
STAGE II VULVAR CANCER
Your treatment may be one of the following:
1. Radical vulvectomy and removal of the lymph nodes in the groin on both sides of the body. Radiation may be given to the pelvis following the operation if cancer cells are found in the lymph nodes.
2. Radiation therapy alone (in selected patients).
STAGE III VULVAR CANCER
Your treatment may be one of the following:
1. Radical vulvectomy and removal of the lymph nodes in the groin and upper part of the thigh on both sides of the body. Radiation may be given to the pelvis and groin following the operation if cancer cells are found in the lymph nodes or only to the vulva if the tumor is large but has not spread.
2. Radiation therapy and chemotherapy followed by radical vulvectomy and removal of lymph nodes on both sides of the body.
3. Radiation therapy (in selected patients) with or without chemotherapy.
STAGE IV VULVAR CANCER
Your treatment may be one of the following:
1. Radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the uterus, cervix, and vagina (pelvic exenteration). 2. Radical vulvectomy followed by radiation therapy.
3. Radiation therapy followed by radical vulvectomy.
4. Radiation therapy (in selected patients) with or without chemotherapy, and possibly following surgery.
RECURRENT VULVAR CANCER
If the cancer has come back, your treatment may be one of the following:
1. Wide local excision with or without radiation therapy.
2. Radical vulvectomy and removal of the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the uterus, cervix, and vagina (pelvic exenteration). 3. Radiation therapy plus chemotherapy with or without surgery.
4. Radiation therapy for local recurrences or to reduce symptoms such as pain, nausea, or abnormal body functions.
5. Clinical trials of new forms of therapy.
Doctors are always looking for new ways to treat vulvar cancer. These new methods are tested in clinical trials. Before beginning treatment, ask your doctor if there are any clinical trials you should consider.
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