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Cancer Medicine :: Vulvar Cancer

Vulvar Cancer

General treatment information

After the stage of your vulvar cancer has been established, your cancer care team will recommend a treatment strategy. Think about your options without feeling rushed. If there is anything you do not understand, ask to have it explained again.


The choice of treatment depends largely on the stage of the disease at the time of diagnosis, but other factors can play a part in choosing the best treatment plan, such as your age, your general health, your individual circumstances, and your preferences. Be sure you understand all the risks and side effects of the various therapies before making a decision.

You may want to get a second opinion. This can provide more information and help you feel confident about the treatment plan you choose. Some insurance companies require a second opinion before they will pay for treatments.

Depending on the type and stage of your vulvar cancer, you may need more than one type of treatment. Doctors on your cancer treatment team may include:

A gynecologist: a doctor who specializes in diseases of the female reproductive tract

A gynecologic oncologist: a doctor who specializes in the treatment of cancers of the female reproductive system (including surgery and chemotherapy)

A radiation oncologist: a doctor who uses radiation to treat cancer

A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer

Many other specialists may be involved in your care as well, including nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.

The 3 main types of treatment used for patients with vulvar cancer are


Radiation therapy


Vulvar pre-cancers (vulvar intraepithelial neoplasia or VIN) can also be treated with topical therapy.

Surgery for vulvar cancer

Choosing the best surgical treatment for each woman means balancing the importance of maintaining sexual functioning with the need to remove all the cancer. In the past, surgeons removing a vulvar cancer also took out a large amount of surrounding normal tissue and often nearby lymph nodes as well, regardless of the stage of the cancer. They did this because they wanted to be sure that no undetected cancer cells remained. Such extensive surgery resulted in a good chance of cure, but it was deforming and impaired the woman's sexual function if the clitoris had been removed. The removal of all the lymph nodes in the groin often led to disabling swelling of the leg (lymphedema) on that side.

Today, the importance of quality of life and sexuality is well recognized. It has also been established that, when cancer is detected early, it is not necessary to remove so much surrounding healthy tissue to achieve a cure. In addition, the sentinel node biopsy procedure has emerged as an alternative to removing many lymph nodes if the cancer has not spread (this is discussed further on). When cancer is more advanced, an extensive procedure may be necessary. Radiation can be combined with chemotherapy and surgery to kill more cancer cells in advanced cancers.

The following types of surgery are listed in order of how much tissue is removed (from least to most):

Laser surgery

A focused laser beam vaporizes (burns off) the layer of vulvar skin containing abnormal cells. Laser surgery is used as a treatment for VIN (vulvar pre-cancer). It is not used to treat invasive cancer.


The cancer and a margin of normal-appearing skin (usually about ½ inch) around it are excised (cut out). This is sometimes called wide local excision. If extensive (a lot of tissue is removed), it may be called a simple partial vulvectomy.


In this type of operation, all or part of the vulva is removed.

A skinning vulvectomy means only the top layer of skin affected by the cancer is removed. Although this is an option for treating extensive VIN, this operation is rarely done.

In a simple vulvectomy, the entire vulva is removed.

A radical vulvectomy can be complete or partial. When part of the vulva, including the deep tissue, is removed, the operation is called a partial radical vulvectomy. In a complete radical vulvectomy, the entire vulva and deep tissues, including the clitoris, are removed. This procedure is not often needed.

Sometimes these procedures remove a large area of skin from the vulva, requiring skin grafts from other parts of the body to cover the wound. However, most of the time the surgical wounds resulting from these procedures can be closed without grafts and still provide a very satisfactory appearance. If a skin graft is required, the gynecologic oncologist may do it. Otherwise, it may be done by a plastic/reconstructive surgeon after the gynecologic oncologist has done the vulvectomy.

Reconstructive surgery is available for women who have had more extensive surgery. A reconstructive surgeon will take a piece of skin and underlying fatty tissue and sew it into the area where the cancer was removed. Several sites in the body can be used, but it is complicated by the fact that the blood supply to the transplanted tissue needs to be kept intact. This is where a skillful surgeon is needed because the tissue must be moved without damaging the blood supply. If you are having this procedure, ask the surgeon to explain how this will be done in your case, because there is no set way of doing it.

Pelvic exenteration

Pelvic exenteration is an extensive operation that when used to treat vulvar cancer includes vulvectomy and often removal of the pelvic lymph nodes, as well as removal of one or more of the following structures: the lower colon, rectum, bladder, uterus, cervix, and vagina. How much has to be removed depends on how far the cancer has spread.

If the bladder is removed, a new way to store and eliminate urine is needed. Usually a short segment of intestine is used to function as a new bladder. This may be connected to the abdominal wall so that urine is drained periodically when the woman places a catheter into a small opening (called a urostomy). Or urine may drain continuously into a small plastic bag attached to the front of the abdomen over the opening.

If the rectum and part of the colon are removed, a new way to eliminate solid waste will be needed. This is made by attaching the remaining intestine to the abdominal wall so that fecal material can pass through a small opening (called a colostomy) into a small plastic bag worn on the front of the abdomen. Sometimes it's possible to remove a piece of the colon and then reconnect it. In that case, the woman will not need bags or external appliances.

Inguinal lymph node dissection

Because vulvar cancer often spreads to lymph nodes in the groin, these may need to be removed. This procedure is called an inguinal lymph node dissection. Usually only lymph nodes on the same side as the cancer are removed. If the cancer is in or near the middle, then both sides may have to be done.

In the past, the incision (cut in the skin) that was used to remove the cancer in the vulva was made larger to remove the lymph nodes. Now, doctors prefer to remove the lymph nodes through a separate incision located about 1 to 2 cm (less than ½ to 1 inch) below and parallel to the groin crease. The incision is made fairly deep, down through membranes that cover the major inguinal vein and artery. This will expose most of the lymph nodes, which are then removed. A major vein, the saphenous vein, may or may not be closed off by the surgeon. Some surgeons will try to save it in an effort to reduce leg swelling (lymphedema), which is often a problem after this surgery. After the surgery, a suction drain is placed into the incision and the wound is closed. The drain remains in place until it is not draining much fluid.

Sentinel lymph node biopsy

This is a newer procedure that can help some women avoid having a full inguinal node dissection. This procedure finds and removes the lymph nodes that drain the area where the cancer is. These lymph nodes are known as sentinel lymph nodes because cancer would be expected to spread to them first. The lymph nodes that are removed are then looked at under the microscope to see if they contain cancer cells. If they do, then the remaining lymph nodes in this area need to be removed. If the sentinel nodes do not contain cancer cells, further lymph node surgery is not needed. Experts agree that sentinel lymph node biopsy may be as good as a complete lymph node dissection in certain patients with vulvar cancer as long as it is done by surgeons with skill and experience in the procedure. However, studies are still ongoing.

To find the sentinel lymph node(s), a small amount of radioactive material and/or blue dye is injected into the tumor site on the day before surgery. The groin is scanned to identify the side (left or right) that picks up the radioactive material. This is the side that where the lymph nodes will be removed. During the surgery to remove the cancer, blue dye will be injected again into the tumor site. This allows the surgeon to find the sentinel node by its blue color and then remove it. Sometimes 2 or more lymph nodes turn blue and are removed.

If a lymph node near a vulvar cancer is abnormally large, a sentinel lymph node biopsy is usually not done. Instead, a fine needle aspiration (FNA) biopsy or surgical biopsy of that lymph node is done to check for cancer spread.

Complications and side effects of vulvar surgery

After vulvar surgery, women often feel discomfort if they wear tight slacks or jeans because the "padding" around the urethral opening and vaginal entrance is gone. The area around the vagina also looks very different.

Removal of wide areas of vulvar skin may result in problems with wound healing, wound infections, or failure of the skin graft to take. The more tissue removed, the greater the risk of these complications.

The urine stream might go to one side because tissue on one or both sides of the urethral opening has been removed.

Other complications of vulvar and groin node surgery include formation of fluid-filled cysts near the surgical wounds, blood clots that may travel to the lungs, urinary infections, and reduction of sexual desire or pleasure.

Lymphedema: Removal of groin lymph nodes (lymphadenectomy) can result in poor fluid drainage from the legs. This causes the fluid to build up and leads to leg swelling that is severe and doesn’t go down at night. This is called lymphedema. Support stockings or special compression devices may help reduce swelling. Women with lymphedema need to be very careful to avoid infection in the affected leg or legs. They can do this by taking these precautions:

Protect the leg and foot from sharp objects and care for any cuts, scratches, or burns right away

Avoid sunburn of the affected leg(s) and avoid cutting or tearing the cuticles of the toenails

Report any redness, swelling, or other signs of infection to the nurse or doctor without delay

Sexual impact of vulvectomy: Women often fear their partners will feel turned off by the scarring and loss of the outer genitals, especially during oral sex. Some women may be able to have surgery to rebuild the outer and inner lips of the genitals.

It may be difficult for women who have had a vulvectomy to reach orgasm. The outer genitals, especially the clitoris, are important in a woman's sexual pleasure. For many women, the vagina is just not as sensitive. Women may also notice numbness in their genital area after a radical vulvectomy, but feeling may return over the next few months.

When touching the area around the vagina, and especially the urethra, a light caress and the use of a lubricant can help prevent painful irritation. If scar tissue narrows the entrance to the vagina, penetration may be painful. Vaginal dilators can sometimes help stretch the opening. When scarring is severe, the surgeon can sometimes use skin grafts to widen the entrance. Sometimes, a special type of physical therapy called pelvic floor therapy may help.

Lymphedema resulting from removal of lymph nodes in the groin area can cause pain and fatigue. This also can be a problem during sex. A couple will need to use good communication to cope with such problems.

Radiation therapy for vulvar cancer

Radiation therapy uses high-energy rays (such as gamma rays or x-rays) and particles (such as electrons, protons, or neutrons) to kill cancer cells. In treating vulvar cancers, radiation is delivered from outside the body in a procedure that is much like having a diagnostic x-ray. This is called external beam radiation therapy. It is sometimes used along with chemotherapy to treat more advanced cancers to shrink them so they can be removed with surgery. This can sometimes allow the cancer to be removed with a less extensive surgery. Radiation alone may be used to treat lymph nodes in the groin and pelvis.

Common side effects of radiation therapy include


Upset stomach, nausea, or vomiting

Loose bowels or diarrhea

Serious fatigue, might also occur, but sometimes not until about 2 weeks after treatment begins. Diarrhea can usually be controlled with over-the-counter medicines. Nausea and vomiting can also be treated with medicines. These side effects tend to be worse when chemotherapy is given with radiation.

Radiation to the pelvis can also irritate the bladder (radiation cystitis), causing discomfort and an urge to urinate often. Pelvic radiation can also lead to premature menopause.

Skin changes are also common. As the radiation passes through the skin to the cancer, it may damage the skin cells. This can cause irritation ranging from mild, temporary redness to permanent discoloration. This can affect the vulvar area, making the area sensitive and sore. The skin may release fluid, which can lead to infection, so the area exposed to radiation must be carefully cleaned and protected.

Radiation can also lead to low blood counts, causing anemia (low red blood cells) and leukopenia (low white blood cells). The blood counts usually return to normal after radiation is stopped.

Women who receive radiation to the inguinal (groin) area after a lymph node dissection may have problems with the surgical wound site. It may open up or have trouble healing.

Radiation to the lymph nodes also increases the risk of lymphedema.

If you have side effects from radiation, discuss them with your cancer care team. There are often methods to relieve these symptoms.

Chemotherapy for vulvar cancer

Chemotherapy (chemo) uses anti-cancer drugs that are usually given intravenously (into a vein), by mouth, or applied to the skin in an ointment. Drugs taken by mouth or injected into a vein, called systemic chemo, enter the bloodstream and reach throughout the body, making this treatment potentially useful for cancer that has spread to distant sites.

Drugs most often used in treating vulvar cancer include cisplatin with or without fluorouracil (5-FU). Another chemo drug, mitomycin, may rarely be used.

The role of chemo in treating vulvar cancer remains to be determined. In more advanced disease, chemo might be given with radiation therapy before surgery. This combined treatment may shrink the tumor, making it easier to remove it with surgery. So far, the results of treating vulvar cancers that have spread to other organs with chemo have been disappointing.

Many of the drugs used in cancer chemo work by attacking cells that are rapidly dividing. This is helpful in killing cancer cells, but these drugs can also affect normal cells, leading to side effects. Side effects of chemo depend on the type of drugs, the amount taken, and the length of time you are treated. Common side effects include:

Nausea and vomiting

Loss or increase of appetite

Temporary loss of hair

Mouth or vaginal sores

Changes in the menstrual cycle, premature menopause, and infertility (inability to become pregnant). Most women with vulvar cancer, however, have already gone through menopause.

Chemo often affects the blood-forming cells of the bone marrow, leading to low blood counts. This can cause:

Increased chance of infections (due to low white blood cell count)

Increased chance of bleeding and bruising (due to low blood platelet count)

Tiredness (due to anemia, that is, low red blood cell count)

Other side effects can occur depending on what drug is used. Most side effects are temporary and stop when the treatment is over, but chemo drugs can have some long-lasting or even permanent effects. For example, cisplatin can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet.

Ask your cancer care team about the chemo drugs you will receive and what side effects you can expect. Also be sure to talk with them about any side effects you do have so that they can be treated. For example, you can be given medicine to reduce or prevent nausea and vomiting.

Topical therapy for vulvar cancer

Topical therapy applies the drug directly onto the cancer. This is another way to treat vulvar intraepithelial neoplasia (VIN), but is not used to treat invasive vulvar cancer.

One choice is to apply the chemotherapy drug, fluorouracil (5-FU), directly to the skin of the vulva. This is called topical chemotherapy. Chemotherapy applied directly to the skin as an ointment will cause local irritation and peeling. This is normal and is part of the local destruction of cancer cells. Medicated ointments suggested by the health care team can help relieve the discomfort of this treatment. Topical chemotherapy for VIN is less effective than laser treatment or surgery.

A second drug that can be used topically is called imiquimod. This drug comes in a cream to be applied to the area of VIN. Imiquimod is not a chemotherapy drug. Instead, it acts by boosting the body's immune response to the area of abnormal tissue. This treatment has improved VIN, and in some women, it has caused VIN to go away completely.

Treatment options for squamous cell vulvar cancer by stage

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 health.

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. If left untreated, nearly all will progress to invasive vulvar cancer. Surgery, such as laser surgery, wide local excision, or a skinning vulvectomy may be used, depending on the size and location of the cancer. A topical therapy such as Fluorouracil (5-FU) ointment or imiquimod cream may be applied to the abnormal areas. Even if treated, stage 0 cancers may recur (come back) or new stage 0 cancers may form on other areas of the vulva, so good follow-up is important. 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 surgically removed along with a 1-cm (less than half an inch) margin of the normal tissue around it.

For stage IB cancers, treatment may include 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.

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.

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 given. If the lymph nodes are enlarged, a needle biopsy may be done before treatment to see if the nodes contain cancer cells.

Patients who are not healthy enough to have any surgery may be treated with radiation therapy alone.

Stage II :Stage II cancers have spread to structures near the vulva, such as the anus, the lower third of the vagina, and/or the lower third of the urethra. One option for treatment is partial radical vulvectomy (removal of the tumor, nearby parts of the vulva, and other tissues containing cancer). Surgery may also include 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 may be needed if cancer cells are at or near the margins (edges of the tissue removed by surgery).

For women who are too sick or weak from other medical problems to have surgery, radiation (with or without chemotherapy) may be used as the main treatment.

Stage III: Stage III cancers have spread to nearby lymph nodes. Treatment may include surgery to remove the cancer (either a radical wide local incision or partial or complete radical vulvectomy) and lymph nodes in the groin. This may be followed by radiation therapy. Sometimes chemotherapy (chemo) with 5-FU or cisplatin is given along with the radiation to help it work better.

These cancers may also be treated with radiation (with or without chemo) first, followed by surgery to remove any remaining cancer. This is often done to try to preserve normal structures such as the vagina, urethra and anus.

Radiation and chemo (without surgery) may be used as the main treatment for patients who cannot have surgery due to underlying medical problems.

Stage IVA: These cancers have spread more extensively to organs and tissues in the pelvis, such as the rectum (above the anus), the bladder, the pelvic bone, the upper part of the vagina, and the upper part of the urethra. When treated with surgery, the goal is to remove as much of the cancer as possible. 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 chemo. Radiation therapy may be done before or after surgery. Chemo may also be given before surgery. Radiation and possibly chemo can also be given to women who cannot have surgery because of prior medical problems.

Stage IVA also includes T1 and T2 tumors with less severe nearby spread but extensive spread to nearby lymph nodes that has caused the lymph nodes to become fixed (stuck to the underlying tissue) or ulcerated (become open sores). These cancers are often treated with radical vulvectomy and removal of the groin lymph nodes. Radiation (often with chemo) may be given either before or after surgery.

Stage IVB: These cancers have spread to lymph nodes in the pelvis or to organs and tissues outside the pelvis (like the lungs or liver). Surgery is not expected to cure these cancers, but may be helpful in relieving symptoms of bowel or bladder blockages. Radiation may also be helpful in shrinking the cancer and improving symptoms. Chemo may also be an option, as is enrolling in a clinical trial.

Recurrent vulvar cancer

When cancer comes back after treatment, it is called recurrent. Treatment options will depend on how soon the cancer comes back and whether the recurrence is local (in the vulva), regional (in nearby lymph nodes), or distant (has spread 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 chemo, radiation therapy, and surgery. Vulvar cancer that comes back locally more than 2 years after the initial treatment has a better prognosis (outlook) than cancers that recur sooner.

When the cancer is unresectable (has grown too large or spread too far to be surgically removed), chemo 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 advanced vulvar cancer are encouraged to enter a clinical trial where they may receive new forms of therapy that may be helpful but are as yet unproven.

What will happen after treatment for vulvar cancer?

For some people with vulvar cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. 

For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. 

Follow-up care

When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.

It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

If treatment for vulvar cancer stops working

If cancer keeps growing or comes back after one kind of treatment, it is possible that another treatment plan might still cure the cancer, or at least shrink it enough to help you live longer and feel better. But when a person has tried many different treatments and the cancer has not gotten any better, the cancer tends to become resistant to all treatment. If this happens, it's important to weigh the possible limited benefits of a new treatment against the possible downsides. Everyone has their own way of looking at this.

This is likely to be the hardest part of your battle with cancer -- when you have been through many medical treatments and nothing's working anymore. Your doctor may offer you new options, but at some point you may need to consider that treatment is not likely to improve your health or change your outcome or survival.

If you want to continue to get treatment for as long as you can, you need to think about the odds of treatment having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to treatment you are considering. For instance, the doctor may say that more chemo or radiation might have about a 1% chance of working. Some people are still tempted to try this. But it is important to think about and understand your reasons for choosing this plan.

No matter what you decide to do, you need to feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.

Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose - the main purpose of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer.

At some point, you may benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it is given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn't mean you can't have treatment for the problems caused by your cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. You can learn more about hospice in our document called Hospice Care.

Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends -- times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.

What`s new in vulvar cancer research and treatment?

Research is being done to find new ways to prevent and treat cancer of the vulva. There are some promising new developments.

Oncogenes and tumor suppressor genes: Scientists are learning more about how certain genes called oncogenes and tumor suppressor genes control cell growth and how changes in these genes cause normal vulvar cells to become cancerous. This information is already being used to develop new drugs that counteract the effects of these gene changes. The ultimate goal of this research is gene therapy. Gene therapy involves replacing the damaged genes in cancer cells with normal genes in order to stop the abnormal behavior of these cells.

HPV vaccines: Vaccines for preventing and treating vulvar and cervical cancer are being developed and tested.

Some of these vaccines are meant to prevent infection with certain types of HPV by boosting the body’s immunity to them. Two HPV vaccines, Gardasil and Cervarix, are available. Both vaccines are able to prevent infection with HPV types 16 and 18 and prevent pre-cancerous changes in the cervix. Studies have shown that Gardasil can also prevent anal, vulvar, and vaginal cancers caused by HPV types 6 and 11. Other preventive vaccines are also under study.

Some vaccines being studied are intended to help the immune systems of women with HPV infections destroy the virus and cure the infection before a cancer develops.

Other vaccines are meant to help women who already have a cancer or pre-cancer. These vaccines attempt to produce an immune reaction to the parts of the virus (E6 and E7 proteins) that specifically contribute to the abnormal growth of cancer cells. It is hoped that this immunity will kill the cancer cells or stop them from growing. A vaccine of this type was tested in women with grade 3 vulvar intraepithelial neoplasia (VIN3) that tested positive for HPV-16. Most women treated had their VIN lesions shrink, and in some the lesions even went away completely. More studies of this vaccine are planned.

Drug treatment: 

There have been case reports of using drugs known as targeted therapies to treat vulvar cancers. These drugs do not have the same kind of side effects as traditional chemo drugs do. So far, the drugs cetuximab and erlotinib have been tried and doctors have reported some success in a few patients. Sometimes cetuximab is combined with cisplatin chemotherapy for treatment. Further studies of these drugs are needed.

Combining surgery, radiation therapy, and chemotherapy: Clinical trials are underway to determine the best way to combine surgery, radiation therapy, and chemotherapy. For example, these trials will provide information about whether certain groups of patients benefit from radiation after surgery and whether patients with cancer that has spread to lymph nodes benefit from chemotherapy or pelvic radiation therapy.

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