Vulval cancer is a rare form of cancer affecting the external female genitalia, and while treatment often begins with surgery, the specific approach depends on the cancer’s size, stage, and location. Early detection greatly improves treatment success, and advances in both standard care and emerging therapies are offering more options for managing this challenging condition.

Understanding Your Treatment Path for Vulval Cancer

When you receive a diagnosis of vulval cancer, understanding the treatment goals becomes crucial to navigating the journey ahead. The primary aim of treatment is to remove the cancer completely while preserving as much normal tissue and function as possible. This balancing act requires careful planning by your medical team, who will consider not just eliminating the disease, but also maintaining your quality of life and minimizing long-term complications.^[1]

Treatment decisions for vulval cancer are never one-size-fits-all. Your healthcare team will tailor the approach based on several important factors, including how large the cancer is, whether it has spread to nearby tissues or lymph nodes, what type of vulval cancer cells are involved, and your overall health status. The stage of your cancer—which describes how far it has progressed—plays a particularly important role in determining whether you will need surgery alone or a combination of treatments.^[2]

Most people with vulval cancer will start treatment within a few weeks of diagnosis. If surgery is the only treatment needed, the entire process including recovery typically takes about six to eight weeks. However, if radiation therapy or chemotherapy is added to your treatment plan, the timeline will be longer, and your doctor can provide more specific details about what to expect in your individual case.^[13]

Medical societies and cancer organizations have developed clinical guidelines that represent the current best practices for treating vulval cancer. These recommendations are based on years of research and clinical experience, helping ensure that patients receive care that has been proven effective. At the same time, researchers continue to explore new treatments through clinical trials, testing innovative approaches that may one day become standard options for future patients.^[2]

Standard Treatment Approaches

Surgery as the Primary Treatment

Surgery remains the cornerstone of vulval cancer treatment, especially when the cancer is detected at an early stage. The goal of surgical treatment is to remove all cancer cells while taking out as little healthy tissue as possible. The specific type of surgery you undergo depends on the size and location of the cancer on your vulva.^[11]

For smaller cancers, surgeons perform what’s called a wide local excision. This procedure involves removing the cancerous area along with a margin of healthy tissue surrounding it. The margin—typically a border of normal tissue around the tumor—is important because it helps ensure that no cancer cells are left behind. When the cancer is larger or more widespread, a partial vulvectomy may be necessary, which means removing a larger portion of the vulva. In rare cases, when the cancer is extensive, a radical vulvectomy is performed, removing the entire vulva including the labia and sometimes the clitoris.^[12]

Many patients also require examination and possible removal of lymph nodes in the groin area. Vulval cancer can spread to these lymph nodes, which are small structures that are part of your body’s drainage and immune system. Surgeons often check what’s called the sentinel lymph nodes—the first nodes where cancer cells would likely spread from the vulva. If cancer is found in these sentinel nodes, additional lymph nodes may need to be removed in a procedure called a groin lymphadenectomy. This can be done on one or both sides of the groin, depending on where the cancer is located.^[17]

The extent of surgery has significant implications for recovery. A simple excision can often be performed as an outpatient procedure, meaning you go home the same day. However, more extensive surgeries, particularly those involving lymph node removal, typically require a hospital stay of a few days. If lymph nodes are removed, you may be discharged with drainage tubes in place for several weeks. Your medical team will teach you how to care for these drains, or they will arrange for nursing care at your home.^[13]

For patients requiring removal of a large area of the vulva, reconstructive surgery may be an option. A specialist called a plastic surgeon can use skin and muscle from other parts of your body to create a new vulva, a procedure known as vulval reconstruction. This option should be discussed with your surgical team before the initial operation if a large portion of your vulva needs to be removed.^[6]

Radiation Therapy for Vulval Cancer

Radiation therapy, also known as radiotherapy, uses high-energy waves similar to X-rays to destroy cancer cells. This treatment works by damaging the genetic material inside cancer cells, preventing them from growing and dividing. Radiation therapy can be used at different points in your treatment journey depending on your specific situation.^[12]

Many patients receive radiation therapy after surgery, which is called adjuvant radiotherapy. The purpose of adjuvant treatment is to kill any remaining cancer cells that might not have been visible or removable during surgery, thereby reducing the chance of the cancer returning. Your doctors will typically recommend adjuvant radiotherapy if one or more lymph nodes in your groin contained cancer cells, if the cancer broke through the capsule that surrounds the lymph node, if cancer cells were found in the sentinel lymph node, or if the cancer was too close to the edge of the healthy tissue removed during surgery.^[17]

In some cases, radiation therapy is given before surgery to shrink the tumor, making it easier to remove. This approach, called neoadjuvant treatment, can be particularly helpful when the cancer is large or located in a difficult area. For patients who cannot have surgery due to health reasons or because surgery would cause serious problems with nearby structures like the anus or urethra, radiation therapy may be used as the primary treatment instead of surgery.^[12]

Radiation therapy is typically given five days a week over several weeks. Each treatment session lasts only a few minutes, although you’ll spend more time in the department for preparation and positioning. The treatment itself is painless, similar to having an X-ray. However, the effects of radiation build up over time, and side effects may develop as treatment progresses. Common side effects include skin irritation and redness in the treated area, fatigue, and changes in bowel or bladder function. These effects usually improve gradually after treatment ends, though some may persist.^[12]

Chemotherapy in Vulval Cancer Treatment

Chemotherapy refers to drugs that kill rapidly dividing cells, including cancer cells. These medications travel through your bloodstream to reach cancer cells throughout your body, which is why chemotherapy is considered a systemic treatment—it affects your whole system rather than just one specific area.^[12]

In vulval cancer treatment, chemotherapy is most commonly given in combination with radiation therapy, a approach known as chemoradiotherapy. When these two treatments are combined, they can work together more effectively than either treatment alone. The chemotherapy makes the cancer cells more sensitive to radiation, improving the overall effectiveness. This combined approach might be recommended if you cannot have surgery for medical reasons or if the cancer is in a location where surgery would significantly affect important functions.^[17]

Chemotherapy may also be given before surgery or radiotherapy with the goal of shrinking the tumor. By reducing the size of the cancer, chemotherapy can sometimes make it possible to perform less extensive surgery than would otherwise be needed. Common chemotherapy drugs used for vulval cancer include agents like fluorouracil and cisplatin, though the specific drugs and combinations chosen will depend on your individual situation.^[17]

Because chemotherapy affects rapidly dividing cells throughout the body, it can cause side effects. Fast-growing cells in your bone marrow, digestive tract, and hair follicles are particularly affected. This means you might experience side effects such as increased risk of infection due to low blood cell counts, nausea and vomiting, mouth sores, diarrhea, fatigue, and hair loss. Not everyone experiences all these side effects, and their severity varies from person to person. Your healthcare team can provide medications and strategies to help manage these effects and make treatment more tolerable.^[12]

Emerging Therapies and Clinical Trial Research

While standard treatments for vulval cancer have been refined over many years, researchers continue to search for new and better ways to treat this disease. Clinical trials represent the primary way that new treatments are tested and eventually become available to patients. These studies follow strict protocols to ensure patient safety while evaluating whether new approaches are effective.^[2]

Clinical trials proceed through three main phases. Phase I trials are the first step, focusing primarily on safety. Researchers determine the appropriate dose of a new treatment and identify what side effects it causes. These trials typically involve a small number of participants. Phase II trials expand to a larger group of patients and focus on whether the treatment works—does it shrink tumors or improve outcomes? Finally, Phase III trials compare the new treatment directly against the current standard treatment to see if it offers advantages. These large studies often involve hundreds or even thousands of patients across multiple locations.^[2]

For vulval cancer specifically, much of the clinical trial research focuses on finding treatments for advanced disease or cancer that has returned after initial treatment. Because vulval cancer is relatively rare, clinical trials may not always be available at every cancer center, and some studies may enroll patients from multiple countries to gather enough participants.^[2]

Immunotherapy Approaches

One promising area of research involves immunotherapy, which works by helping your own immune system recognize and attack cancer cells. Some vulval cancers, particularly those associated with human papillomavirus (HPV) infection, have characteristics that make them potential targets for immune-based treatments. Researchers are investigating drugs called checkpoint inhibitors, which work by blocking proteins that prevent immune cells from attacking cancer. By removing these “brakes” on the immune system, these drugs can help immune cells more effectively target and destroy cancer cells.^[2]

Studies are examining whether checkpoint inhibitors that have shown success in other types of cancer might also benefit patients with vulval cancer. These drugs target proteins like PD-1, PD-L1, or CTLA-4, which are found on either cancer cells or immune cells. Early research suggests that patients whose tumors have certain characteristics, such as high levels of immune cell infiltration or specific genetic changes, may be more likely to respond to these treatments. However, these therapies are still being studied and are not yet part of standard care for vulval cancer.^[2]

Targeted Therapy Research

Targeted therapies are drugs designed to attack specific molecular features of cancer cells. Unlike chemotherapy, which affects all rapidly dividing cells, targeted therapies aim to interfere with particular molecules or pathways that cancer cells need to grow and survive. For vulval cancer, researchers are investigating whether drugs targeting specific genetic mutations or growth factor receptors might be effective.^[2]

Some vulval cancers have mutations or changes in genes that control cell growth. For instance, some tumors have alterations in genes like PIK3CA or have increased activity of certain growth factor receptors. Clinical trials are testing whether drugs designed to block these specific pathways can slow cancer growth or shrink tumors. This research is still in early stages, but it represents an important direction for developing more personalized treatment approaches based on the specific characteristics of each patient’s cancer.^[2]

Refining Radiation Techniques

Advances in radiation therapy technology are also being studied for vulval cancer treatment. Modern techniques like intensity-modulated radiation therapy (IMRT) allow doctors to deliver radiation more precisely to the tumor while minimizing exposure to surrounding healthy tissues. This precision can potentially reduce side effects while maintaining or improving treatment effectiveness. Clinical trials are evaluating whether these newer radiation approaches provide better outcomes and fewer complications compared to traditional radiation methods.^[11]

Novel Chemotherapy Combinations

Researchers continue to explore different combinations of chemotherapy drugs and ways to combine chemotherapy with other treatments. Some trials are testing whether adding newer chemotherapy agents to standard regimens improves outcomes. Others are examining the optimal timing and sequencing of chemotherapy with surgery or radiation. The goal is to find combinations that are more effective at controlling the cancer while causing fewer or more manageable side effects.^[17]

Participating in Clinical Trials

If you’re interested in participating in a clinical trial, discuss this option with your oncology team. They can help determine whether there are trials that might be appropriate for your specific situation and whether you meet the eligibility criteria. Trials may be available at major cancer centers in various locations, including the United States, Europe, and other regions. Eligibility typically depends on factors like the stage and type of your cancer, what treatments you’ve already received, and your overall health status.^[10]

Participating in a clinical trial can provide access to new treatments that aren’t yet widely available. Additionally, patients in clinical trials receive very close monitoring and care from specialized research teams. However, it’s important to understand that experimental treatments may not work better than standard options, and they may have unexpected side effects. Your healthcare team can help you weigh the potential benefits and risks of trial participation in your personal situation.^[10]

Most Common Treatment Methods

• Surgical Treatment
  • Wide local excision for small, localized cancers, removing the tumor with a margin of healthy tissue
  • Partial vulvectomy when a larger portion of the vulva needs to be removed
  • Radical vulvectomy for extensive disease, removing the entire vulva
  • Sentinel lymph node biopsy to check for cancer spread to nearby lymph nodes
  • Groin lymphadenectomy to remove lymph nodes if cancer has spread
  • Vulval reconstruction using skin and muscle from other body areas to rebuild the vulva after extensive surgery
• Radiation Therapy
  • Adjuvant radiotherapy after surgery to reduce the risk of cancer recurrence
  • Neoadjuvant radiotherapy before surgery to shrink larger tumors
  • Primary radiotherapy as an alternative to surgery when surgery isn’t possible
  • Palliative radiotherapy to manage symptoms in advanced disease
  • Intensity-modulated radiation therapy (IMRT) for more precise targeting in research settings
• Chemotherapy
  • Chemoradiotherapy combining chemotherapy drugs with radiation to enhance effectiveness
  • Neoadjuvant chemotherapy before surgery to shrink tumors
  • Adjuvant chemotherapy after surgery to help prevent recurrence
  • Fluorouracil and cisplatin as commonly used chemotherapy agents
  • Palliative chemotherapy to control symptoms when cancer has spread
• Immunotherapy (In Clinical Trials)
  • Checkpoint inhibitors targeting PD-1, PD-L1, or CTLA-4 proteins
  • Immune-based treatments particularly for HPV-associated vulval cancers
  • Therapies designed to help the immune system recognize and attack cancer cells
• Targeted Therapy (In Clinical Trials)
  • Drugs targeting specific genetic mutations in cancer cells
  • Growth factor receptor inhibitors for cancers with specific molecular features
  • Pathway-specific drugs designed for personalized treatment approaches

Managing Life After Treatment

Completing treatment for vulval cancer doesn’t mean your journey with the disease ends—it simply enters a new phase. Life after treatment involves physical recovery, emotional adjustment, and ongoing monitoring to watch for any signs that the cancer might return. Many aspects of your wellbeing may be affected, and understanding these challenges can help you prepare and find the support you need.^[19]

Physical Recovery and Long-term Effects

Recovery from vulval cancer treatment varies greatly depending on what treatments you received. If you had surgery, the physical healing process depends on how extensive the operation was. Healing from a wide local excision might take several weeks, while recovery from more extensive surgery or lymph node removal can take several months. During this time, you’ll need to care for surgical wounds, manage pain, and gradually return to normal activities.^[22]

Some physical effects of treatment can persist long after the initial healing period. Lymphedema, which is swelling caused by a buildup of lymph fluid, can develop in the legs if lymph nodes were removed from the groin or pelvis. This swelling may appear months or even years after surgery. While lymphedema cannot always be prevented, there are ways to manage it, including wearing compression stockings, elevating the affected leg, doing special exercises, and working with a physiotherapist who specializes in lymphedema management.^[22]

Changes in urination patterns can occur after vulval surgery, particularly if the surgery affected the area near the urethra. Some women find that the direction of their urine stream changes or that there’s more spray. Practical adjustments, like sitting farther back on the toilet, can help manage these changes. In some cases, urinary incontinence—difficulty controlling urination—may develop, though this is not common with vulval cancer treatment specifically.^[22]

Sexual function and intimacy often change after vulval cancer treatment. Surgery can alter the structure and sensation of the vulva, making sex uncomfortable or painful. Radiation therapy can cause vaginal dryness and narrowing due to scarring. These physical changes can be distressing, but there are many ways to address them. Vaginal moisturizers and lubricants can help with dryness, while vaginal dilators used regularly can help prevent or treat narrowing. Working with a healthcare professional who specializes in sexual health after cancer can provide personalized strategies and support.^[22]

Emotional and Psychological Impacts

The emotional journey with vulval cancer can be just as challenging as the physical one. Many women feel embarrassed or uncomfortable discussing cancer in such an intimate area, which can lead to feelings of isolation. You might experience a range of emotions including fear about the cancer returning, anxiety about changes to your body, grief over losses in function or sensation, and uncertainty about the future.^[18]

Body image and self-esteem are often affected by vulval cancer and its treatment. Even though changes to the vulva are not visible to others, they can profoundly impact how you feel about yourself. Some women worry about how their partner will react or fear rejection. These feelings are completely normal and valid. Speaking with a counselor or psychologist, particularly one experienced in cancer care or sexual health, can provide valuable support in working through these emotions.^[22]

Talking to others about your experience can be helpful, though you might find it difficult at first. Some family members and friends may feel uncomfortable or unsure how to respond, which can make you feel even more isolated. It’s okay to tell people what kind of support you need—whether that’s someone to talk to, practical help with daily tasks, or simply companionship. Support groups, where you can connect with other women who have been through similar experiences, can be particularly valuable. These might be in-person groups or online forums where you can share and learn from others who truly understand what you’re going through.^[18]

Follow-up Care and Monitoring

After completing treatment, you’ll have regular follow-up appointments with your healthcare team to monitor for any signs of cancer recurrence. These visits typically occur more frequently at first—perhaps every few months—and then gradually become less frequent if everything remains stable. During these appointments, your doctor will examine the vulval area and may check the lymph nodes in your groin. Additional tests or imaging studies might be ordered if there’s any concern.^[19]

Between appointments, it’s important to be aware of any new symptoms or changes and to report them to your doctor rather than waiting for your next scheduled visit. Signs that should prompt you to contact your healthcare team include new lumps or sores on the vulva, persistent itching or pain, unusual bleeding, or new swelling in the legs. While these symptoms don’t necessarily mean the cancer has returned, they should always be evaluated promptly.^[1]

Your follow-up care should also address any ongoing side effects from treatment and help you maintain the best possible quality of life. Don’t hesitate to bring up concerns about pain, sexual function, emotional distress, or any other issues affecting your wellbeing. Your healthcare team can offer treatments, referrals to specialists, or other resources to help manage these challenges.^[19]