Vulvar Cancer

• Laser surgery burns off the layer of abnormal cells. It is used for treating vulvar intraepithelial neoplasia, but not invasive cancer.

• Excision (sometimes called wide local excision) removes the cancer and a small portion of surrounding normal cells.

• Vulvectomy may involve removing part or all of the vulva and its underlying tissue. A simple vulvectomy removes only the vulva. A partial, radical vulvectomy involves the removal of a portion of the vulva and the underlying tissue. A complete vulvectomy removes the entire vulva and the tissue underneath it, including the clitoris. The effects on sexual function depend upon how much of the vulva is removed.

• Pelvic exenteration is an extensive surgery that includes vulvectomy, the removal of the pelvic lymph nodes, and removal of one or more of the following: vagina, rectum, lower colon, bladder, uterus and cervix.

Radiation can be given before or after surgery. If cancer has spread to the lymph glands, external-beam radiation therapy may be directed at the lymph nodes after surgery. This type of therapy carefully targets a beam of radiation at the cancer. If tumor cells are found at the edges of the tissue that was removed, radiation therapy directed at these areas may be recommended after surgery. If the cancer affects a large area, radiation may be used before the surgery to reduce its size.

The use of chemotherapy (anticancer drugs) for vulvar cancer still is being investigated. Research is being done on a new method of treatment for severe cases, in which the cancer has spread to other tissues, organs and lymph nodes nearby. In this treatment, chemotherapy drugs are given intravenously (into a vein) along with radiation therapy before surgery.