Treatment options for vulval cancer
The main treatment for vulval cancer is surgery. You may also have radiotherapy and chemotherapy. A team of health professionals recommends the best treatment and care for you.
Treatment options for vulval intraepithelial neoplasm (VIN)
VIN is a skin condition of the vulva. It is when abnormal cells develop in the surface layers of the skin covering the vulva. It is not vulval cancer but could turn into cancer if it’s not treated. This may take many years.
Treatment for VIN is usually surgery, or a cream called imiquimod.
Deciding what treatment you need
A team of doctors and other professionals recommend the best treatment and care for you. They are called a multidisciplinary team (MDT). The team includes a:
- surgeon who specialises in treating female cancers
- medical cancer specialist (oncologist)
- skin doctor (dermatologist)
- specialist in plastic surgery for cancer
- gynaecology cancer nurse specialist
- physiotherapist
- psychologist or counsellor
- social worker
Your team reviews the results of your scans and tests and recommends the best treatment for you. They will explain its benefits and possible side effects.
Your treatment
The treatment you have depends on:
- the type of vulval cancer you have
- the stage of your cancer
- the part of your vulva affected
- any previous treatment you might have had
- your general health
Surgery
Most people with vulval cancer need surgery. Your surgeon removes the cancer and a margin of healthy tissue around it. This is a wide local excision.
For larger cancers, your surgeon may need to remove a larger part of your vulva. This is a partial vulvectomy. More rarely, you might need to have your whole vulva removed. This is a radical vulvectomy.
Removing the lymph nodes
Vulval cancer can spread to the 
in the groin. So your surgeon may recommend checking the lymph nodes for cancer cells.
You may have surgery to remove the lymph nodes in the groin if doctors find cancer cells in the sentinel lymph nodes. The sentinel lymph nodes are usually the first place where cancer cells spread from the vulva. Removing the lymph nodes from the groin is called a groin lymphadenectomy.
Your surgeon may remove the lymph nodes on one or both sides of your groin. It depends on where the cancer is.
Vulval reconstruction
Vulval reconstruction means creating a new vulva after you have had surgery to remove a large part of your vulva. Ask your surgeon if reconstruction is possible if you are going to have a large part of your vulva removed.
During this operation, a specialist doctor called a plastic surgeon, uses skin and muscle from other parts of the body to create a vulva.
Radiotherapy
Radiotherapy uses high energy waves similar to x-rays to kill vulval cancer cells. You may have radiotherapy after surgery to try to stop the cancer from coming back. This is adjuvant radiotherapy.
You usually have adjuvant radiotherapy if:
- 2 or more lymph nodes from the groin contain cancer cells
- the cancer has broken through the capsule that surrounds the lymph node
- you have cancer cells in the sentinel lymph node
- the cancer is too close to the border of healthy tissue (margin) removed during surgery
You may have radiotherapy on its own or in combination with chemotherapy.
Chemotherapy
Chemotherapy uses cytotoxic drugs to destroy quickly dividing cells, such as cancer cells. You usually have chemotherapy in combination with radiotherapy. This is chemoradiotherapy.
You might have chemoradiotherapy if you can’t have surgery for any reason. For example, if surgery would cause serious problems with your back passage (anus) or .
You may also have chemotherapy before surgery or radiotherapy. This is to shrink the cancer. It is also called neoadjuvant treatment.
Common chemotherapy drugs you may have include:
- cisplatin
- 5-fluorouracil (5FU)
- carboplatin
- paclitaxel
Treatment if the cancer comes back
The treatment you have depends on a number of factors. These include where the cancer is and what treatment you have had before.
Your doctor might recommend:
- more surgery
- more radiotherapy on its own or with chemotherapy
- chemotherapy
- treatment such as pain killers to help control your symptoms
- treatment as part of a clinical trial
Treatment if the cancer has spread to other parts of the body
Vulval cancer can sometimes spread to other parts of the body further away from the vulva. For example, it can spread to the lungs. This is advanced vulval cancer.
Unfortunately, advanced vulval cancer is no longer curable. But treatments such as chemotherapy and radiotherapy can help to shrink or control the cancer for some time.
You may also have surgery to help with symptoms.
Clinical trials
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
Your choices
Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:
- whether you need extra appointments
- if you need more tests
- the distance you need to travel to and from hospital
You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.
If you decide not to have treatment
You may decide not to have cancer treatments such as chemotherapy or surgery. But you can still have medicines to help control symptoms such as sickness or pain.
Your doctor or nurse will explain what treatment you can have. They can also refer you to a local symptom control team to give you support at home. This is also called community palliative care team.
Getting a second opinion
You might feel that you would like to get an opinion from a second doctor before deciding about your treatment. If so, ask your specialist or your GP to refer you to a doctor specialising in gynaecological cancers.
It can be better to arrange a second opinion through your specialist. Ask your doctor to give you all your notes and test results to take with you.
Do remember that a second opinion does not necessarily mean that the second doctor will take over your care. Your treatment will usually still be managed by your original specialist.
Coping and support
Coping with vulval cancer and its treatment can be difficult. Some of the treatments you have can make you feel uncomfortable and embarrassed. Your doctor and specialist nurse will try to make you as comfortable as possible.
There is help and support to help you cope with vulval cancer and its treatment.
