Vulvar Cancer

Cleveland Clinic cancer providers are experts in delivering both an accurate diagnosis and treatment that keeps you at the center of your care every step of the way.

At your first visit, your provider will ask about your symptoms and take a detailed medical history. They’ll also want to know if your family has a history of cancer. They may do a pelvic and rectal exam.

Testing

Your provider will also do some tests to confirm your diagnosis, find the cause of your vulvar cancer and see how large it is or if it’s spread. These tests could include:

• Colposcopy to take a closer look at the tissue in your vulva, vagina and cervix. We’ll use a thin, lighted magnifying tool called a colposcope to do this.
• Biopsy to test cysts or lumps in your vulva, like ones your provider might find in a colposcopy.
• Cystoscopy to make sure cancer hasn’t spread to your bladder.
• Human papillomavirus (HPV) testing to understand whether the HPV virus caused the cancer.
• Genetic testing to find changes in your genes (DNA inside your cells) that may have led to vulvar cancer.
• CT scan (computerized tomography scan), PET scan (positron emission tomography scan) or MRI (magnetic resonance imaging) to see if the cancer has affected your urethra, bladder, anus or rectum.
• Proctoscopy to see if cancer has spread to your rectum.
• Tissue sample tests to see if the cancer cells have high levels of PD-L1, a protein involved in your body’s immune response to cancer.
• Sentinel lymph node biopsy to let us check if cancer has spread to nearby lymph nodes. Compared to other lymph node procedures, this biopsy has a lower risk of lymphedema, infections and wound complications, thanks to smaller incisions (cuts) and less time in the operating room (OR).

Second Opinions for Vulvar Cancer

Finding out you have vulvar cancer can feel overwhelming, and you may have lots of questions. It’s important you feel confident that you’re working with a team of healthcare providers you trust completely. That’s why we encourage second opinions.

Our expert cancer providers will take the time to help you better understand what’s going on and explain what your treatment options are. We also know that cancer doesn’t wait, so we always try to get your appointment with us scheduled as soon as possible. A second opinion can give you peace of mind knowing that you’re in the most capable and compassionate hands.

Meet Your Vulvar Cancer Team

At Cleveland Clinic, you’ll have a team of experienced, compassionate providers from different specialties working together to diagnose and treat your vulvar cancer. Your team could include:

• Gynecologic oncologists.
• Radiation oncologists.
• Urologists.
• Plastic surgeons.
• Gastroenterologists.
• Colorectal surgeons.
• Physical therapists.
• Pathologists.

How we treat your cancer will depend on what’s causing it, how advanced it is (its stage), your age, overall health and your specific needs. We’ll also consider whether you were just diagnosed with vulvar cancer or if it’s a cancer that’s come back (recurred).

There are several different kinds of surgery you might have. Please know that we always try to preserve your ability to have sex or intimacy while removing all the cancer.

Local excision

We’ll remove the cancer and some of the tissue surrounding it. We might also do a sentinel lymph node biopsy at the same time and take out nearby lymph nodes.

Vulvectomy

In this surgery, we’ll remove part or all of your vulva and maybe some lymph nodes. A plastic surgeon might do skin grafts to replace the skin removed during the vulvectomy. Your surgeons will work together to minimize your time in the operating room.

Radiation and chemotherapy

Your specialist may also recommend chemotherapy, or radiation before surgery, after surgery or instead of surgery to kill any remaining cancer cells.

Pelvic exenteration

If you have advanced vulvar cancer that hasn’t responded to other treatments, we might need to remove your lower colon, rectum, bladder, cervix, vagina, ovaries and nearby lymph nodes. This surgery is called pelvic exenteration. Your team of surgeons will create new openings in your body to allow pee (urine) and poop (stool) to move from your body into a collection bag.

Other treatments

Topical skin creams or biologic agents may help boost your immune system’s reaction to cancer.

Recovering from vulvar cancer surgery

Our goal for treating vulvar cancer is to remove all of the cancer cells through surgery, if possible. We’ll give you tips on good hygiene and wound care to help you recover as quickly as possible without complications.

Sometimes treatment might change how you look and move. It could also make it more challenging for you to have or enjoy sex/intimacy or go to the bathroom as usual. If any of these things happen, we’ll help you limit the uncomfortable effects treatment could have on your life with education, physical therapy and counseling.

Taking the Next Step

Having vulvar cancer is a life-changing curve ball you probably never imagined. And it can turn your world upside down. But finding healthcare providers who understand this rare cancer and have years of experience diagnosing and treating it is the first step toward getting your life back on track. Our experts are here to help. We’re ready to listen, understand and act quickly with care that focuses on your specific needs.