Treatment depends on the type of cancer, its stage, its location, whether lymph nodes are involved, and the patient’s overall health and preferences.
A gynecologic oncologist can explain the available approaches and help the patient understand the expected benefits, risks, and potential effects on daily life.
Surgery
Surgery is a primary treatment for many vulvar cancers.
Depending on the tumor, surgery may involve removing the cancer with a margin of surrounding healthy tissue. This is often called a wide local excision.
For more extensive disease, a partial or radical vulvectomy may be necessary. A vulvectomy removes some or all the vulvar tissue, depending on the procedure.
Nearby lymph nodes in the groin may also need evaluation or removal. In selected patients with early-stage disease, a sentinel lymph node procedure can help determine whether cancer has spread while limiting the extent of lymph node surgery.
Surgery can be highly effective, but possible complications include pain, bleeding, infection, wound-healing difficulties, scarring, changes in sensation, and altered vulvar anatomy.
Removal of lymph nodes may cause lymphedema, which is swelling that develops when lymphatic fluid cannot drain normally. It may affect the legs, groin, or genital area.
The extent of these effects varies. Some women undergo relatively limited surgery and experience few lasting changes, while others face more significant physical and emotional adjustments.
Radiation Therapy
Radiation therapy uses high-energy radiation to damage cancer cells and prevent them from growing.
It may be recommended when cancer has spread to nearby lymph nodes, when the risk of recurrence is elevated, when surgery would be particularly extensive, or when cancer cannot be completely removed surgically.
Radiation may also be combined with chemotherapy to make cancer cells more sensitive to treatment.
Possible side effects include:
- Redness, tenderness, or irritation of the vulvar skin.
- Burning or pain during urination.
- Fatigue.
- Skin breakdown or moist, painful areas during treatment.
- Swelling and discomfort.
- Vaginal or vulvar tissue changes, including dryness, scarring, or reduced elasticity.
- Bowel or bladder irritation, depending on the radiation field.
- Longer-term changes in sexual comfort or sensation.
Some side effects improve after treatment ends, while others may persist or develop later. The severity depends on the treatment area, dose, individual health, and whether other treatments are given.
Chemotherapy
Chemotherapy uses medications that damage or kill cancer cells. It may be given alongside radiation for locally advanced disease or used for recurrent or metastatic cancer.
Medications may include cisplatin, carboplatin, paclitaxel, or other drugs chosen according to the circumstances.
Side effects may include fatigue, nausea, appetite changes, hair loss, low blood counts, increased infection risk, and nerve damage. Chemotherapy may also affect sexual desire, energy, hormonal function, and emotional well-being.
The specific regimen depends on the extent of the cancer and the patient’s health and treatment goals.
Immunotherapy and Targeted Treatments
Immunotherapy helps the immune system recognize and attack cancer cells. Certain immunotherapy drugs may be considered for advanced or recurrent vulvar cancer, particularly in selected patients based on tumor biomarkers, previous treatments, and eligibility criteria.
Examples may include pembrolizumab or other immune checkpoint inhibitors in appropriate circumstances. These treatments are not suitable for every patient, and their effectiveness varies.
For some patients, molecular testing may reveal biomarkers that help guide treatment choices or identify clinical trial opportunities.
Because vulvar cancer is relatively uncommon, treatment evidence for advanced disease is more limited than it is for several more common cancers. Clinical trials may offer access to newer therapies or combinations when standard options are limited.
Patients should ask their oncology team whether immunotherapy, biomarker testing, or a clinical trial may be appropriate for their cancer.
Treatment for Precancerous Vulvar Changes
Not every abnormal vulvar lesion is invasive cancer. Some lesions represent VIN, a precancerous condition.
Depending on the type, extent, and location of the lesion, treatment may include surgical excision, laser treatment, or topical imiquimod for selected HPV-associated lesions.
These treatments are not interchangeable, and topical therapy should only be used under medical supervision after an appropriate diagnosis. Suspected invasive cancer generally requires biopsy and a different treatment approach.
Regular follow-up is important because precancerous changes can persist, recur, or progress in some patients.
Recurrence Rates: Can Vulvar Cancer Come Back?
One of the most difficult parts of a cancer diagnosis is the possibility that the disease may return after treatment. Vulvar cancer can recur, even when the original tumor has been successfully removed.
Recurrence may develop in the vulvar area, in nearby lymph nodes, or, less commonly, at distant sites.
The likelihood of recurrence depends on several factors, including the original stage, lymph node involvement, tumor characteristics, surgical margins, and the treatments received.
How Common Is Recurrence?
There is no single recurrence percentage that applies to every patient with vulvar cancer. Studies report different rates because they include different stages, tumor types, treatments, and follow-up periods.
Local recurrence is a particular concern with vulvar cancer, and it can occur even after apparently successful initial treatment. Some recurrences develop relatively early, while others may appear years later.
Factors associated with an increased risk include:
- Cancer involving the groin lymph nodes.
- Tumor cells remaining at or near the surgical margins.
- More advanced disease at diagnosis.
- Certain aggressive tumor characteristics.
- Persistent HPV-related precancerous changes or underlying vulvar skin disease.
Importantly, a recurrence does not automatically mean the cancer has spread throughout the body. Some recurrences are limited to the vulva and can be treated again with surgery, radiation, or a combination of approaches.
The National Cancer Institute identifies surgery, radiation, and chemoradiation among the possible treatments for recurrent vulvar cancer. The appropriate approach depends on where the cancer returns, its extent, and the treatments previously received.
Follow-Up After Treatment
Follow-up care is essential because recurrence may be detected through examination or when a patient notices a new symptom.
Care commonly includes regular appointments to examine the vulva and groin lymph nodes, discuss symptoms, and evaluate new or persistent changes. Imaging and other investigations may be ordered when symptoms or examination findings warrant them.
Follow-up schedules vary according to individual risk and local guidelines. Some guidelines recommend visits every three to four months during the first two years, followed by less frequent visits during subsequent years. Long-term monitoring may be appropriate for people with ongoing risk factors or persistent vulvar skin conditions.
Patients should contact their healthcare team if they develop a new lump, persistent itching, a nonhealing sore, unexplained bleeding, or another concerning change between scheduled appointments.
It is also important to remember that not every new symptom represents recurrence. Many vulvar skin conditions are benign, and an examination can help determine the cause.
Body Image and Emotional Changes After Vulvar Cancer
The physical effects of vulvar cancer can be particularly personal because the disease and its treatment involve an area closely connected to identity, privacy, sexuality, and bodily autonomy.
Even when treatment is successful, women may need time to adjust to changes in appearance, sensation, comfort, and confidence.
Changes in Body Image
Surgery may alter the shape or appearance of the labia, clitoris, or surrounding tissues. Scars may be visible to the patient or a partner, and some women may experience changes in skin texture or symmetry.
Women who undergo more extensive surgery may feel grief, embarrassment, anger, or a sense of loss. They may worry that their bodies look unfamiliar or that a partner will respond negatively.
Some may avoid mirrors, changing clothes in front of others, or situations that involve nudity.
These feelings are understandable. The vulva is a private and intimate part of the body, and changes can carry emotional meaning beyond physical effects alone.
Helpful approaches may include:
- Allowing yourself time to adjust without demanding immediate acceptance.
- Asking your healthcare team to explain what physical changes to expect.
- Seeking counseling with a professional experienced in cancer survivorship and body image.
- Connecting with other survivors when sharing experiences feels helpful.
- Exploring clothing, skincare, and other comfort measures that help you feel more at ease.
- Remember that your worth, femininity, and ability to experience intimacy are not defined by the appearance of your vulva.
You do not have to feel positive about every change to begin rebuilding confidence.
Changes in Sensation and Physical Comfort
Depending on the tumor’s location and the treatment received, women may experience numbness, tingling, tenderness, heightened sensitivity, or reduced sensation.
Some may notice discomfort when sitting for long periods, wearing tight clothing, exercising, or engaging in activities that place pressure on the vulvar area.
Scarring and tissue changes may contribute to pulling sensations, discomfort, or pain. Radiation may cause additional changes in skin and tissue elasticity.
These symptoms can interfere with daily activities as well as intimacy.
Treatment options depend on the cause. Wound care, appropriate pain management, pelvic floor physical therapy, rehabilitation, and evaluation by a clinician specializing in vulvar disorders may help.
Women should not assume that persistent pain is something they simply must accept. New or worsening pain should be evaluated to identify its cause and determine whether additional treatment is needed.
Citations.
Empowering Intimacy
Foundation for Women’s Cancer
ACS
Mayo Clinic