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Vulvar Cancer

The vulva is the skin and fatty tissue that make up the outer parts of the feVulvarCancermale anatomy. This is made up of the outer lips (labia majora) which is where you have pubic hair, and the inner lips (labia minora). At the top of the inner lips lies the clitoris. Most vulvar cancers begin in the skin cells that make up the vulva. In younger women, there has been some connection with chronic HPV (human papilloma virus) infection and developing cancer. In older women, the cause is not always known but may be related to chronic skin irritation in the area. Along with different types of cancer of the vulva, benign tumour growths may also be found on the vulva.

The most common treatment for vulvar cancer is surgery; however, if the tumour is too large or too close to other structures such as the urethra (the opening that allows you to urinate) or the anus (the opening that allows for a bowel movement), surgery in these areas may permanently affect their function. In these cases, in order to minimize trauma to these structures, radiation may be used to shrink the tumour first. In these cases, you will usually still go to the operating room first to have a lymph node sampling of one or both groins to determine if any cancer cells have escaped and travelled to these areas. This information is important to help plan the radiation not only for the tumour itself but to the groins as well if cancer is found in these areas.

Vulvar cancer is not as common as other gynecological cancers.

Vulvar cancer is treated by a team of experts at the cancer centre who often use different types of treatment depending on the stage and location of the disease. These include surgery, chemotherapy and radiation.

Your family doctor or gynecologist will make a referral for you if a vulvar cancer is suspected. The cancer centre will then set up an appointment for you. You may see a Gynecologic Oncologist (a specialist in gynecological surgery and chemotherapy), a Medical Oncologist (a specialist in chemotherapy) or a Radiation Oncologist (a specialist in radiation therapy).
Sometimes, based on the information that they have, you may need to see more than one specialist. The oncologist(s) you see will review your case and will go over the best treatment plan for your situation. This appointment may be overwhelming, so it is best to bring someone with you for support.

Surgery

The most common treatment for vulvar cancer is surgery. Your surgery will most likely be one of the following procedures:

Wide local excision
Modified Radical Vulvectomy with Lymphadenectomy
Exenteration

Other Treatment Options

Radiation Therapy
External Beam Radiation Therapy (EBRT)
Chemotherapy or Intravenous (IV) chemotherapy
Clinical Trials

Vulvar cancer is typically treated with external beam radiation.

Radiation or chemotherapy may be used to treat vulvar cancer. It is used when cancer cells have been found in the lymph nodes of the groin or if surgery cannot safely remove all of the tumour with clear margins.

Because the tissues in the vulvar region are so fragile and tender, there is a possibility of developing a significant skin reaction in the tissues in that area, which may require a break during radiation treatment. Your radiation team will review with you the best ways of keeping the skin in this area healthy during radiation. As well, sometimes the radiation is planned in phases, where the primary treatment is given, and then a boost, or concentrated treatment, is planned to target specific areas.

Sometimes radiation is given to shrink the tumour size first, allowing for possible surgery later. Your health care team will review with you the best options in managing your specific circumstance.

The chemotherapy used to treat vulvar cancer when given with radiation does not cause hair loss, but may affect blood counts and cause some nausea and vomiting. These are usually well controlled with medication, however if you find that they are not working to ease your symptoms, please consult your oncologist.

Resources

Canadian Cancer Society
1-888-939-3333
www.cancer.ca

Call or go online to look for:

• Vulvar Cancer: Understanding your diagnosis
• Eating well when you have cancer
• Chemotherapy and other drug therapies: A guide for people with cancer
• Radiation Therapy: A guide for people with cancer
• When someone you know has cancer: How you can help

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