Therapy is based on the stage and type of cancer and the patient’s age and overall health. Staging for vaginal cancer and vulvar cancer is critical, and ranges from early-stage disease to stage IV cancer, which means the cancer cells have already spread to nearby organs or distant sites in the body.
All patients' cases are discussed at Wilmot's multidisciplinary tumor board — a conference that is attended by all different specialties required for your care.
Three main treatments are commonly used for vaginal and vulvar cancers: surgery, radiation, and chemotherapy. Laser surgery and topical treatments (creams) can be used for pre-cancers.
This is the most common treatment for both vaginal and vulvar cancer. The goal is to remove the cancer while balancing the importance of sexual function and quality of life. Wilmot oncologists can offer a number of surgical options at Highland Hospital, the hub for our gynecologic cancer team. Highland was the first hospital in the Finger Lakes region to have new technology that provides virtually scarless surgery. Our surgeons also use the daVinci robotic surgical system, which offers precision and enhanced 3D, high-definition views of the tumor and surrounding operative field.
Depending on the stage of disease, surgical options for vaginal and vulvar cancer include:
Wide local excision: A doctor removes the cancer and some of the normal tissue around it. Often the surgeon will also evaluate nearby lymph nodes for cancer.
Vaginectomy: The surgeon removes all or part of the vagina.
Vulvectomy and radical vulvectomy: The surgeon removes all or part of the vulva. Sometimes only the top layer of cancerous skin needs to be removed, but other times the entire vulva and other deep tissues must be removed.
Inguinal lymph node dissections: All vulvar cancer patients require an evaluation of the lymph node located in the groin to determine if the cancer has spread. This was traditionally done with a complete lymph node dissection, which involved removing 10 to 20 lymph nodes from a patient during surgery. Complications can include infection, wound breakdown, and chronic lymphedema (swelling of the legs and feet). However, an evaluation of the lymph nodes by a pathologist is critical because the information helps to determine if further treatment with radiation and/or chemotherapy is necessary.
Sentinel lymph node dissection: This is a newer method that allows the surgeon to remove one to three lymph nodes from the groin instead of the removal of 10 to 20 lymph nodes as described previously. Sentinel node technology uses a radioactive tracer and a dye that allows the surgeon to identify the first lymph node in a chain of lymph nodes, where the cancer is likely to migrate first. This method is more sensitive at detecting cancer cells in the lymph nodes, and also reduced the risk of complications. The Gynecologic Oncology division at the Wilmot Cancer Institute is the only program in the region and one of the few in the country that offers this technology to patients with vulvar cancer. Richard Moore, M.D., chief of Gynecologic Oncology at Wilmot, is one of the nation’s leading researchers in this area and has published multiple articles on sentinel node dissections for vulvar cancer.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. This is a common treatment for vaginal cancer, and is also used for vulvar cancers. Brachytherapy is another type of radiation therapy that can be used to treat vaginal cancer: Doctors use a special device to place a radioactive material into the body directly near the cancer in the vagina.
Chemotherapy uses drugs or combinations of drugs—given intravenously or as pills—to destroy cancer cells. It can be given in combination with radiation therapy; as part of the initial treatment; or if cancer returns.
Many standard cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects the same way.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.
Wilmot's Cancer Control & Survivorship Program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.