Recurrent Vulvar Cancer
Recurrent vulvar cancer means that the cancer has returned after treatment. This happens in approximately 24% of cases after initial treatment with surgery, with or without radiation.
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What Is Recurrent Vulvar Cancer?
Recurrent vulvar cancer means that the cancer has come back after it has been treated[1][2]. This is also known as recurrence, which refers to the return of cancer cells in the body after a period when they could not be detected.
Recurrent vulvar cancer occurs in an average of 24% of cases after primary treatment with surgery, with or without radiation[3]. The vulva is the outer part of the female genitals, which includes the inner and outer lips of the vagina, the clitoris, the opening of the vagina, and the area in front of the pubic bones[4].
Because primary vulvar cancers are relatively few, combined with the low proportion of recurrences, it has been difficult to perform large randomized studies to document the most appropriate treatment approaches[5]. Most reports are small retrospective studies and anecdotal reviews.
Treatment Options
Recurrent vulvar cancer is usually treated with a combination of surgery, radiation therapy, chemotherapy, and targeted therapy[6]. Traditionally, the most accepted treatment of vulvar cancer has been and continues to be surgery[7]. Recently, radiation and chemotherapy have been combined with very encouraging results.
Surgery
Surgery is an important treatment option for recurrent vulvar cancer. The type of surgery depends on the depth, size, and location of the tumor[8].
A complete radical vulvectomy removes the whole vulva, including the clitoris, the deeper tissues under the vulvar skin, and nearby lymph nodes[9]. This is a major surgical procedure performed when cancer has returned in a larger area.
A pelvic exenteration is a major operation that includes a vulvectomy and removal of the lymph nodes in the groin[10]. It also removes one or more organs in the pelvis, such as the vagina, uterus, bladder, or rectum. This surgery is usually used to treat cancer that has come back in the pelvis only, which is called local recurrence.
Radiation Therapy
Radiation therapy uses high-energy rays or particles to destroy cancer cells[11]. External radiation therapy may be used with or without chemotherapy to shrink a tumor before surgery, which is called neoadjuvant therapy. Radiation can also be used to relieve pain or control symptoms of recurrent vulvar cancer, known as palliative therapy.
Brachytherapy is a type of internal radiation therapy that places a sealed container of radiation directly into or near the tumor[12]. It is sometimes used with external radiation therapy to deliver a high dose of radiation directly to the tumor, making treatments work better.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. For recurrent vulvar cancer, chemotherapy may be offered with radiation therapy[13]. Chemotherapy may also be used alone to relieve pain or control symptoms of advanced vulvar cancer, which is called palliative chemotherapy.
Chemoradiation
Radiation therapy and chemotherapy may be given during the same time period to treat vulvar cancer[14]. This approach is called chemoradiation. It may be offered if you cannot have surgery due to health problems.
The most common types of chemotherapy drugs used include cisplatin and paclitaxel, or carboplatin and paclitaxel[15].
Targeted Therapy
Targeted therapy uses drugs to target specific molecules, such as proteins, on cancer cells or inside them to stop the growth and spread of cancer[16]. Sometimes a targeted therapy drug is combined with a chemotherapy drug.
Targeted therapy drugs that may be offered for recurrent vulvar cancer include bevacizumab (Avastin and biosimilars) and erlotinib (Tarceva)[17].
Factors That Affect Treatment Decisions
Treatment for recurrent vulvar cancer depends on several important factors[18]:
- The location of the recurrence
- How far the cancer has spread
- Whether cancer is found in the lymph nodes
- Whether you had radiation therapy for vulvar cancer before
Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan[19].