Vulvar Treatment Options at Penn

Different treatments are available for those with vulvar cancer. Some treatments are called standard. This means they are the currently used treatments. Some treatments are being tested in clinical trials. A treatment clinical trial is a study meant to help improve current treatments or obtain information on new treatments.

When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. You may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment, while others are available during or after treatment.

Treatment options vary depending on your situation including the stage of the cancer and other factors that may be present.

Talk with your team about the approach that is best for you.

Standard treatment for vulvar cancer:

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Surgery

Surgery is the most common treatment for cancer of the vulva. The goal of surgery is to remove all the cancer without any loss of the woman's sexual function. One of the following types of surgery may be done:

• Wide local excision: A surgical procedure to remove the cancer and some of the normal tissue around the cancer.
• Radical local excision: A surgical procedure to remove the cancer and a large amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.
• Vulvectomy: A surgical procedure to remove part or all of the vulva:
• Skinning vulvectomy: The top layer of vulvar skin where the cancer is found is removed. Skin grafts from other parts of the body may be needed to cover the area.
• Simple vulvectomy: The entire vulva is removed.
• Modified radical vulvectomy: The vulva containing cancer and some of the normal tissue around it is removed.
• Radical vulvectomy: The entire vulva, including the clitoris, and nearby tissue is removed. Nearby lymph nodes may also be removed.
• Pelvic exenteration: A surgical procedure to remove the lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Adjuvant Therapy: Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells.

• External radiation (or external beam radiation) comes from a machine outside the body. The machine directs high-energy rays at the cancer and some normal surrounding tissue. It is the most often used radiation treatment. The machine used to deliver the high-energy rays is called a linear accelerator.

• Three-dimensional (3-D) conformal radiation treatment is a type of external beam radiation. It uses computers to allow doctors to more precisely target a tumor with radiation beams (using width, height, and depth).

• Intensity-modulated radiation treatment (IMRT). IMRT is a type of 3-D conformal radiation treatment that uses radiation beams (usually x-rays) of
  various intensities to give different doses of radiation, at the same time, to small areas of tissue. This allows the delivery of higher doses of radiation to the tumor and lower doses to nearby healthy tissue.

• Internal radiation treatment, or brachytherapy, is given by placing an implant into or near the tumor. The implant is a small container that holds the
  radioactive source or material. Internal radiation treatment allows your doctor to give a higher total dose of radiation to a smaller area and in a shorter time than with external radiation treatment.

• Photodynamic therapy (PDT) combines a drug called a photosensitizer or photosensitizing agent with a specific type of light to kill cancer cells.
  Photosensitizers are drugs that when exposed to a specific wavelength of light, produce a form of oxygen that kills nearby cells. PDT can also work by shrinking or destroy tumors by damaging blood vessels in the tumor. This
  prevents the cancer from receiving nutrients. Also, PDT may activate the
  immune system to attack the tumor cells.

• Stereotactic radiosurgery is a a type of external radiation therapy that uses special equipment to position the patient and precisely give a single large dose of radiation to a tumor. It is used to treat brain tumors and other brain disorders that cannot be treated by regular surgery. It is also being studied in the treatment of other types of cancer. Also called radiation surgery, radiosurgery, and stereotaxic radiosurgery.

• Proton Therapy is the most precise form of radiation treatment for cancer possible, while minimizing damage to healthy tissue and surrounding organs.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Topical chemotherapy for vulvar cancer may be applied to the skin in a cream or lotion.

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