Squamous cell carcinoma of the vulva is a rare but serious cancer that requires careful treatment planning. While surgery remains the main approach, many patients also benefit from radiation therapy or chemotherapy depending on the stage and spread of the disease, and researchers continue to explore new ways to improve outcomes and reduce the impact of treatment on daily life.
Understanding Treatment Goals and Approaches
The treatment of squamous cell carcinoma of the vulva aims to remove or destroy cancer cells while preserving as much normal tissue and function as possible. The type of treatment depends on several important factors, including how large the cancer is, where exactly it is located on the vulva, whether it has spread to nearby lymph nodes or other parts of the body, and the patient’s overall health and personal preferences.[1][2]
Squamous cell carcinoma is the most common type of vulvar cancer, accounting for about 90% of all vulvar cancers. It develops in the flat cells that make up the outer surface of the skin.[2][4] This cancer usually grows slowly over several years, which means that if caught early, treatment can be very effective. The earlier the cancer is diagnosed, the less extensive the surgery typically needs to be.[1]
Medical societies and cancer organizations have developed standard treatment guidelines based on years of research and clinical experience. These recommendations help doctors choose the most appropriate treatment for each patient’s situation.[8][11] At the same time, researchers are actively testing new therapies in clinical trials to find treatments that work better, cause fewer side effects, or help patients whose cancer has not responded to standard treatments.
Treatment planning is not a one-size-fits-all process. Each patient’s care team considers the stage of the cancer, the location and size of the tumor, whether lymph nodes are involved, and the patient’s age and health status. The goal is always to achieve the best possible outcome while maintaining quality of life and, when possible, preserving sexual function and the appearance of the vulva.[10][14]
Standard Treatment Options
Surgery as the Primary Treatment
Surgery is the main treatment for squamous cell carcinoma of the vulva, especially when the cancer is found early.[8][10][14] The type of surgery depends on the size and location of the tumor. For very early-stage cancers, the surgeon may remove only the cancer itself along with a margin of healthy tissue around it. This is called wide local excision and allows most of the vulva to remain intact.[11]
The goal of surgery is to remove all cancer cells while taking out as little healthy tissue as possible. Surgeons aim for clear margins, meaning that when the removed tissue is examined under a microscope, there should be no cancer cells at the edges. For early-stage tumors, particularly those classified as stage T1a, removing the lesion with at least 1 centimeter of surrounding healthy tissue may be sufficient, with survival rates at five years around 100% and at ten years around 94.7%.[3]
For larger or more invasive cancers, more extensive surgery may be necessary. This can involve removing part of the vulva, including one or both labia (the inner or outer lips). In some cases, a radical vulvectomy is needed, which means removing the entire vulva, potentially including the clitoris.[4][14] The surgeon works to reconstruct the area using remaining skin, and sometimes a plastic surgeon helps by using tissue from other parts of the body to rebuild the vulva and maintain its appearance and function.[14]
In many cases, especially when the cancer is larger or has invaded deeper into tissue, doctors also need to check the lymph nodes in the groin. Lymph nodes are small bean-shaped structures that are part of the body’s drainage and immune system. Cancer cells can travel through lymph vessels to these nodes.[11] Removing and examining lymph nodes helps doctors understand whether the cancer has spread and determine what additional treatment might be needed.
Recovery from surgery varies depending on how much tissue was removed. Patients typically receive support from their care team throughout the healing process. Some women may experience changes in sexual function, urination, or the appearance of the area. Surgeons and specialized nurses work with patients to address these concerns and help them adjust to any changes.[14]
Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. It may be used at different points in treatment for squamous cell vulvar cancer.[10][14][19] Sometimes radiation is given before surgery to shrink the tumor, making it easier to remove or reducing the amount of tissue that needs to be taken out. This approach is particularly helpful when the cancer is located near important structures like the clitoris, urethra, or anus, where extensive surgery could significantly affect function.[9]
Radiation therapy may also be used after surgery to help prevent the cancer from coming back. This is called adjuvant radiation therapy. Doctors recommend it when there is a higher risk of recurrence, such as when cancer cells were found close to the edges of the removed tissue, when lymph nodes were involved, or when the tumor had certain high-risk features.[10][19]
For some patients, radiation therapy may be the main treatment instead of surgery. This might be the case for people who cannot have surgery due to other health conditions, for those who wish to avoid the physical and emotional impact of extensive vulvar surgery, or when the cancer is in a location where surgery would be particularly difficult.[14][19]
Radiation therapy is typically given in daily sessions over several weeks. Each session lasts only a few minutes, and the treatment itself is painless, though it can cause side effects. Common side effects include skin irritation in the treated area, fatigue, and discomfort when urinating or having bowel movements. These effects usually improve after treatment ends, though some women may experience long-term changes in the skin and tissues of the vulva and vagina.[9]
Chemotherapy
Chemotherapy involves using medicines to kill cancer cells throughout the body. For vulvar cancer, chemotherapy is often given together with radiation therapy, a combination known as chemoradiation.[10][14][19] The chemotherapy drugs make the cancer cells more sensitive to radiation, which can make the treatment more effective.
Like radiation, chemotherapy can be used before surgery to shrink the tumor, making it easier to remove or reducing the extent of surgery needed. It may also be used after surgery if there is concern that cancer cells might remain or if the cancer has spread to lymph nodes.[10][14]
When vulvar cancer has spread to other parts of the body, chemotherapy may be used to slow the growth of the cancer, relieve symptoms, and improve quality of life. In advanced cases, the goal of chemotherapy shifts from curing the cancer to controlling it and managing symptoms for as long as possible.[14][19]
Chemotherapy drugs are usually given through a vein in cycles, with periods of treatment followed by rest periods to allow the body to recover. The specific drugs used and the duration of treatment depend on many factors. Side effects of chemotherapy can include nausea, fatigue, hair loss, increased risk of infection, and mouth sores. Not all patients experience all side effects, and many can be managed with supportive medications.[10]
Treatment in Clinical Trials
While surgery, radiation, and chemotherapy remain the standard treatments for squamous cell vulvar cancer, researchers are actively investigating new approaches that might improve outcomes and reduce side effects. Clinical trials are research studies in which patients receive experimental treatments under careful medical supervision. These trials help doctors learn whether new treatments are safe and effective.[9]
Understanding the Biology of Vulvar Cancer
One important area of research focuses on understanding how vulvar cancer develops. Scientists have identified two main pathways that lead to squamous cell vulvar cancer.[2] About 30% to 40% of vulvar cancers are associated with infection by high-risk types of human papillomavirus (HPV), the same virus that causes cervical cancer. In these cases, viral proteins interfere with important genes that normally prevent cells from growing out of control.[2][9]
The remaining cases, which occur more often in older women, develop through a different pathway not related to HPV. These cancers often arise in women who have had chronic inflammatory skin conditions of the vulva, such as lichen sclerosus.[2][9] Understanding these different pathways is important because they may require different treatment approaches.
Targeted Therapies and Immunotherapy
Researchers are studying targeted therapies, which are drugs designed to attack specific features of cancer cells while causing less harm to normal cells than traditional chemotherapy. These therapies work by blocking specific molecules or pathways that cancer cells need to grow and survive.[9] For example, some targeted drugs block growth factor receptors on the surface of cancer cells, preventing signals that tell the cells to divide and multiply.
Immunotherapy is another promising area of research. These treatments work by helping the patient’s own immune system recognize and attack cancer cells. Some types of immunotherapy, called checkpoint inhibitors, remove the “brakes” that cancer cells put on immune cells, allowing the immune system to fight the cancer more effectively. Because HPV-associated vulvar cancers have viral proteins that the immune system might recognize, immunotherapy may be particularly helpful for these cases.[9]
Clinical trials are investigating various immunotherapy drugs that have shown success in other cancers. The research is still in relatively early stages for vulvar cancer, but results from other HPV-related cancers suggest potential benefits. These studies typically enroll patients with advanced disease that has not responded to standard treatments or has come back after initial treatment.[9]
Chemoradiation as an Alternative to Surgery
For approximately 30% of women who present with advanced disease, treatment can be very challenging. Some tumors are too large to remove surgically without causing severe functional problems or requiring a permanent stoma (an opening for waste elimination). In these cases, researchers are investigating whether chemoradiation alone can be as effective as surgery.[9][21]
Clinical trials are comparing different combinations and doses of chemotherapy and radiation to find the most effective approaches with the fewest side effects. The goal is to find ways to cure the cancer or control it long-term while avoiding the physical and psychological impact of extensive vulvar surgery. Some studies are also looking at whether less extensive surgery after chemoradiation might be sufficient, reducing complications while still treating the cancer effectively.[9][21]
Phase and Location of Clinical Trials
Clinical trials go through several phases. Phase I trials focus mainly on safety, testing new treatments in small groups of patients to find the right dose and identify side effects. Phase II trials examine whether the treatment works against the cancer and continue to monitor safety. Phase III trials compare the new treatment with current standard treatments in larger groups of patients to see which approach is better.[9]
Clinical trials for vulvar cancer are conducted at specialized cancer centers around the world, including locations in the United States, Europe, and other regions. Because vulvar cancer is relatively rare, not all cancer centers offer trials specifically for this disease. Patients interested in clinical trials should talk with their doctors about available options and whether they might be eligible.[9]
Eligibility for Clinical Trials
Each clinical trial has specific criteria that determine who can participate. These might include the stage of cancer, whether the patient has received previous treatment, the presence of certain molecular features in the tumor, and the patient’s overall health. Some trials specifically enroll patients with advanced or recurrent disease, while others may include patients at earlier stages. Doctors can help patients find appropriate trials and determine whether they meet the eligibility requirements.[9]
Most Common Treatment Methods
- Surgery
- Wide local excision: Removes the cancer and surrounding healthy tissue with a margin of at least 1 centimeter, used for early-stage tumors.[3][11]
- Partial vulvectomy: Removes part of the vulva, including affected labia or other structures.[14]
- Radical vulvectomy: Removes the entire vulva, including labia and sometimes the clitoris, used for larger or more invasive cancers.[4][14]
- Lymph node removal: Takes out lymph nodes from the groin area to check for cancer spread and determine prognosis.[11][14]
- Reconstructive surgery: Uses skin or muscle from other parts of the body to rebuild the vulva after cancer removal.[14]
- Radiation Therapy
- Preoperative radiation: Given before surgery to shrink tumors and make them easier to remove.[10][19]
- Postoperative (adjuvant) radiation: Used after surgery to kill any remaining cancer cells and prevent recurrence.[10][14]
- Primary radiation therapy: Used as the main treatment when surgery is not possible or desired.[14][19]
- Palliative radiation: Helps control symptoms when cancer has spread to other parts of the body.[14]
- Chemotherapy
- Concurrent chemoradiation: Chemotherapy given together with radiation therapy to enhance treatment effectiveness.[10][14][19]
- Neoadjuvant chemotherapy: Given before surgery to shrink tumors, often combined with radiation.[10][14]
- Adjuvant chemotherapy: Used after surgery when cancer has spread to lymph nodes or has other high-risk features.[10]
- Palliative chemotherapy: Helps control advanced cancer and relieve symptoms when cure is not possible.[14][19]
- Targeted Therapies (in clinical trials)
- Immunotherapy (in clinical trials)
