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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Vulvar cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the vulva?
STAGE EXPLANATION
Stages of cancer of the vulva
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the vulva is treated
Treatment by stage
STAGE 0 VULVAR CANCER
STAGE I VULVAR CANCER
STAGE II VULVAR CANCER
STAGE III VULVAR CANCER
STAGE IV VULVAR CANCER
RECURRENT VULVAR CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the vulva?

Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a woman's vagina. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal.

Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40. Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. A doctor should be seen if there is bleeding or discharge not related to menstruation (periods), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough.

If there are symptoms, a doctor may do certain tests to see if there is cancer, usually beginning by looking at the vulva and feeling for any lumps. The 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. A patient will be given some medicine to numb the area when the biopsy is done. Some pressure may be felt, but usually with no pain. This test is often done in a doctor's office.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vulva or has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of cancer of the vulva

Once cancer of the vulva is diagnosed, more tests will be done to find out if the cancer has spread from the vulva to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vulva:


Stage 0 or carcinoma in situ

Stage 0 cancer of the vulva is a very early cancer. The cancer is found in the vulva only and is only in the surface of the skin.


Stage I

Cancer is found only in the vulva and/or the space between the opening of the rectum and the vagina (perineum). The tumor is 2 centimeters (about 1 inch) or less in size.


Stage II

Cancer is found in the vulva and/or the space between the opening of the rectum and the vagina (perineum), and the tumor is larger than 2 centimeters (larger than 1 inch).


Stage III

Cancer is found in the vulva and/or perineum and has spread to nearby tissues such as the lower part of the urethra (the tube through which urine passes), the vagina, the anus (the opening of the rectum), and/or has spread to nearby lymph nodes. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)


Stage IV

Cancer has spread beyond the urethra, vagina, and anus into the lining of the bladder (the sac that holds urine) and the bowel (intestine); or, it may have spread to the lymph nodes in the pelvis or to other parts of the body.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vulva or another place.


TREATMENT OPTION OVERVIEW


How cancer of the vulva is treated

There are treatments for all patients with cancer of the vulva. Three kinds of treatment are used:

Surgery is the most common treatment of cancer of the vulva. A doctor may take out the cancer using one of the following operations:

A patient may need to have skin from another part of the body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. 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). Radiation may be used alone or before or after surgery.

Chemotherapy uses 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 of cancer of the vulva depends on the stage of the disease, the type of disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. 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 ongoing in most parts of the country for stages III and IV of cancer of the vulva. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 VULVAR CANCER

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

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

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

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

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, 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.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the vulva, call the National Cancer Institute's Cancer Information Service at 1-800-4-Cancer (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following general booklets on questions related to cancer may also be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
What You Need To Know About Cancer

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 08/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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