Treatment - Vulva Cancer - Cancer Council Victoria

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Wednesday 30 November, 2011

On this page: Surgery ι Lymph nodes ι Recovery after surgery ι Ann's story ι Radiotherapy ι Chemotherapy ι Palliative treatment ι Information reviewed by

Cancer of the vulva usually takes many years to develop but, like other types of cancer, it is easier to treat and cure at an early stage. Treatment may involve surgery, radiotherapy and chemotherapy. You may have one of these treatments or a combination.

Surgery

Surgery is the main treatment for cancer of the vulva. The type of operation you have depends on the stage of the cancer.

Wide local excision - In this operation, the surgeon removes the cancerous part of your vulva and about a 1cm border of healthy tissue around the cancer (called the margin).
Radical local excision - The surgeon cuts out the cancer and a larger area of normal tissue all around the cancer. The groin lymph nodes may also be removed (known as lymph node dissection).
Partial vulvectomy - The affected part of the vulva is removed. The surgeon may also take out some healthy tissue around the cancerous tissue (a wide local excision). This may mean that a significant portion of the vulva is removed.
Radical vulvectomy - The surgeon removes the entire vulva, including the clitoris. Usually, surrounding lymph nodes are also removed.
Pelvic exenteration - This operation is done if the cancer has spread beyond the vulva. The surgeon takes out the affected organs, such as the lower bowel, bladder, uterus or vagina.

The surgeon will aim to remove all of the cancer while preserving as much normal tissue as possible. However, it is important that a margin of healthy tissue around the cancer is removed to reduce the risk of the cancer coming back (recurring) in this area. Usually only a small amount of healthy skin is removed and it is possible to stitch the remaining skin together.

If it is necessary to remove a large area of skin, you may need a skin graft or skin flap. To do this, the surgeon may take a thin piece of skin from another part of your body (usually your thigh or abdomen) and stitch it on to the operation site. It may be possible to move flaps of skin in the vulvar area to cover the wound. The graft or flap will be done as part of the same operation.

Lymph nodes

The lymph nodes (also called lymph glands) in the groin are usually the first place to which vulvar cancer spreads. Lymph nodes are part of the lymphatic system and are found mainly in the groin, neck and armpits.

Lymph node surgery is usually not needed if the cancer is less than 1 mm deep. Women with deeper cancers will probably have nodes from one or both sides of the groin removed.

If the cancer is small, the surgeon may perform a sentinel lymph node biopsy. You will have an anaesthetic and an injection of radioactive dye.

This dye will identify the lymph node most likely to be the first to have cancer spread to it. The surgeon can remove this node and analyse it to decide whether further treatment is necessary. Your doctor will talk to you about the risks of having this type of biopsy.

Removing lymph nodes can cause your legs to swell (lymphoedema).

Recovery after surgery

Your recovery time after the operation will depend on the type of surgery you have. If a small amount of skin is removed, the wound will probably heal quickly. If your lymph nodes are removed or your surgery is more extensive, recovery will take longer.

Pain-killers

You will have medication to reduce any pain. Some women have an injection into a space around their spinal cord, called an epidural. This numbs the body from the waist down.

Catheter

A tube called a catheter will drain urine and keep your wound clean and dry. This will be removed within a few days.

Wound care

If you have stitches, they will usually dissolve as the wound heals. If not, they will be removed within a couple weeks of surgery. It is important to try to keep your wound clean. Some women have a dressing that is changed regularly. You will have frequent washes to the surgical site. Try to keep your vulva as dry as possible. If your vulva is numb, be careful patting it dry because you won't realise how much pressure you are using. Some women prefer to use a hair dryer on a low heat setting to dry the area.

Exercise and movement

You should start gently moving around as soon as possible after your operation. If you have skin grafts or flaps you may need bed rest for a few days. Women with stitches should try to keep their knees together when getting out of bed so the stitches do not tear. The nurse or physiotherapist can help you do regular leg and breathing exercises.

When you return home, you will need to take it easy. You may not be able to lift anything heavy or drive for 6-8 weeks.

Using the toilet

You may find that going to the toilet is different. The urine stream may spray in different directions or drip down one leg. For suggestions on managing this problem.

The emotional impact of having cancer and surgery is significant. You may wonder how it could affect your sexuality. See our sexuality and cancer section.

Ann's story

"I went to my GP with an itch on my vulva in 2004. No specialists knew what it was - they diagnosed heat rash, candida and thrush, just to name a few.

"In 2009 I saw a documentary about the research being done on dogs and their ability to smell cancer. Soon after, my dog sniffed and licked my trousers. I strongly believe my dog found the cancer.

"I was sent to the gynaecological dermatologist and insisted on a biopsy. I was then referred to a surgeon. Ten days later, I had a partial vulvectomy. I was in hospital for six days then home for six days when the lymph wound opened up.

"My surgeon lent me a machine to suck out the fluid and heal the wound, but it took six months of using it to close up the wound. I had to go to the physiotherapist afterwards.

"I've thrown my energies into spreading the word about vulval cancer. I tell women: if you have a persistent itch down there, get a biopsy!"

Radiotherapy

Radiotherapy uses high-energy x-rays to destroy or kill cancer cells. Whether you have radiotherapy or not will depend on the stage of the cancer, its size, whether it has spread to the lymph nodes and, if so, how many nodes are affected. You can have radiotherapy:

before surgery to shrink the cancer and make it easier to remove (neo-adjuvant treatment)
after surgery to get rid of any remaining cancer cells and reduce the risk of the cancer coming back (adjuvant treatment)
instead of surgery
to control symptoms of advanced cancer.

External radiotherapy

External radiotherapy is the most common type of radiotherapy for cancer of the vulva. You will lie on a treatment table and a machine will direct radiotherapy at the cancer. Treatment is normally given as a series of 10-15 minute daily treatments. The number of radiotherapy sessions you have will depend on the type and size of the cancer, but the entire course of treatment will usually last a few weeks.

Radiotherapy to the vulva and groin is painless, but it can cause side effects. The side effects you experience depend on the radiotherapy dose and the length of your treatment.

External radiotherapy will not make you radioactive. It is safe for you to be
with other people, including children, after your treatment.

You may have some of the following side effects:

Skin redness, soreness and swelling - The vulva is sensitive to radiation and the skin may become sore and swollen. Use lukewarm water to wash your vulva and avoid using perfumes, lotions or talcum powder. Your radiation therapist or nurse will advise you on skin care and swelling.
Hair loss - You may lose your pubic hair. For some women, this can be permanent.
Lymphoedema - Radiation to the groin can increase the risk of swelling in the legs.
Narrowing of the vagina - Radiotherapy can cause your vagina to shorten and narrow, which may make sex uncomfortable or difficult.
Cystitis - This is inflammation to the bladder lining. Cystitis can make you feel like you want to pass urine frequently or give you a burning sensation when you pass urine.
Diarrhoea - Radiotherapy can irritate the bowel and cause you to have loose stools. If this is a problem, let your doctor know.

Internal radiotherapy

Internal radiotherapy (brachytherapy) is a way of delivering radiotherapy directly to the tumour from the inside of your body. This is a less common treatment for vulvar cancer.

You will be given a general anaesthetic, and thin radioactive needles or wires will be inserted into your body on or near the cancerous tissue.

Treatment will make you slightly radioactive, so you will be cared for in a single room in hospital for a few days until the wires or needles are removed. Although it will be safe for your family and friends to visit you for short periods, children and pregnant women won't be allowed to visit to avoid the chance of them being exposed to radiation.

These safety measures and visiting restrictions might make you feel isolated, frightened and depressed at a time when you might want people around you. Talking to your medical team, seeing a counsellor or writing in a journal may help you.

While the needles are in place, the tissue around them will become swollen. This usually settles by the time the needles are taken out.

The treated area will feel sore after the needles or wires have been removed. The pain should ease over a couple weeks. Your doctor can prescribe pain-killers to help relieve the discomfort.

For more information, call Cancer Council Helpline 13 11 20 for a free booklet about radiotherapy.

Chemotherapy

Chemotherapy uses anti-cancer drugs to kill or slow the growth of cancer cells. Treatment is often given:

during the course of radiotherapy, to make treatment more effective
to control cancer that has spread to other parts of the body
as palliative treatment, to relieve the symptoms of the cancer.

Drugs are sometimes given as tablets or, more commonly, by injection into a vein (intravenously). You will have several treatment sessions, followed by a break. Treatment can often be given to you during visits to a hospital or clinic as an outpatient, but sometimes you may spend a few days in hospital.

Side effects

Most people have some side effects from chemotherapy. However, these can usually be controlled with medication.

Common problems include feeling sick (nausea), tiredness and a reduced resistance to infections. Chemotherapy for vulvar cancer may also increase any skin soreness caused by radiotherapy.

There are many different types of chemotherapy drugs and the side effects vary. Some people find that they are able to lead a fairly normal life during their treatment, while others become very tired and need to take things more slowly. Do as much as you feel like and try not to overdo it.

For more information, call the Helpline for a free booklet about chemotherapy and its side effects.

Palliative treatment

Palliative treatment helps to improve people's quality of life by reducing symptoms of cancer without trying to cure the disease. It is particularly important for people with advanced cancer.

However, it is not just for end-of-life care and it can be used at different stages of cancer.

Often treatment is concerned with pain relief and stopping the spread of cancer, but it also involves the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.

For more information, call Cancer Council Helpline 13 11 20 for free information about palliative care and advanced cancer.

This information was reviewed by:

Dr Greg Robertson, Gynaecological Oncologist, Royal Hospital for Women and St George Hospital; Jonathan Carter, Prof of Gynaecological Oncology, The University of Sydney and Head of Sydney Gynaecological Oncology Group, Sydney Cancer Centre; Belinda Fern, Consumer; Alicia Hiron, Consumer; Jayne Maidens, Clinical Nurse Consultant, Gynaecological Oncology Department, Royal North Shore Hospital; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, John Hunter Hospital; Fiona Pearce, Cancer Council NSW Helpline; Ann Tocker, Cancer Voices.