Vulvar Cancer

Treatment

Vulvar intraepithelial neoplasia (VIN), a precancerous condition of vulvar tissue, is treated by local surgical removal (excision) or laser treatment. Until recently, the standard treatment for invasive vulvar cancers was complete removal of the vulva and nearby groin lymph nodes. However, experience has shown that cancers confined to small areas can often be safely treated with localized surgery.

Surgery

Surgical treatment for vulvar cancer consists generally of two parts: the removal of diseased tissue and the removal of lymph nodes. Often with vulvar cancer, several areas are affected, and large amounts of tissue may be removed. When the cancer has invaded to a depth greater than 1 mm, the cancer may have spread to the lymph nodes in the groin. These nodes are removed surgically and biopsied to determine how much the cancer has spread.

External radiation is occasionally used as a supplement to surgery when metastatic disease is found. Radiation is often an option for patients whose lymph nodes have been invaded by cancer or who have primary tumors that cannot be entirely removed without jeopardizing the patient's safety. When a patient's condition requires a colostomy or urinary diversion, external radiation can sometimes be substituted for surgical removal. In this situation, radiation is often combined with chemotherapy.

Physicians at Mayo Clinic consider each patient's age, as well as psychological and sexual issues, when recommending a treatment plan. Reconstructive surgery to minimize the effects of extensive surgery may be possible.

Reconstructive Surgery

At Mayo Clinic, a gynecologic oncologist and a plastic surgeon work together to restore as much anatomy and function as possible. This teamwork is especially important for vulvar cancer cases in which surgical reconstruction is necessary to the treatment plan. Mayo Clinic provides a full range of gynecologic reconstructive surgery procedures, including:

• Reconstruction of the vulva
• Rebuilding of the vagina after radical cancer treatment
• Use of skin grafts after radiation therapy or radical surgery for recurrent cancer in the vulva and groin
• Rebuilding of vital organs, such as a urinary bladder, vagina or pelvic floor, that were removed to treat advanced cancer or were badly damaged after radiation therapy. In the case of bladder reconstruction, for example, it is often possible to create a pouch that holds the urine internally, eliminating the need for an external collection bag.
• Reconstruction of the pelvic floor to correct pelvic prolapse and urinary or rectal incontinence

Physicians at Mayo spend whatever time is necessary to discuss patients' concerns and expectations and to review the treatment and reconstruction plan. Reconstructive surgery techniques at Mayo Clinic can produce cosmetically pleasing and functional results that improve a woman's quality of life.