Vulvar Cancer

Overview

Vulvar cancer is an uncommon cancer of the vulva, the external female genital area. Most are squamous cell carcinomas arising from the skin, with melanoma and other types occurring less often. It is more frequent in older women but can occur at any age, and pre-cancerous changes called vulvar intraepithelial neoplasia (VIN) can precede it.

Treatment centres on surgery to remove the cancer with a margin of healthy tissue and to assess the groin lymph nodes, sometimes with radiotherapy or chemotherapy depending on the stage. Care aims to control the cancer while preserving appearance, sensation and function where possible, coordinated by a specialist gynaecological cancer team.

This page is an educational overview only and is not medical advice. Diagnosis and treatment must be arranged with a qualified gynaecological oncology team, and no outcome can be guaranteed.

Who May Need This

Assessment may be needed by women with a persistent lump, ulcer or wart-like growth on the vulva, ongoing itching, burning or pain, changes in skin colour or thickening, bleeding unrelated to periods, or a sore that will not heal. These symptoms often have benign causes, but persistent changes should be checked.

Risk is higher with persistent HPV infection, certain chronic vulvar skin conditions (such as lichen sclerosus), a history of pre-cancerous changes or cervical or vaginal cancer, smoking, and older age. Only a specialist can determine whether symptoms are due to vulvar cancer, after examination and biopsy.

When It May Be Recommended

Treatment is recommended once a biopsy confirms vulvar cancer and its extent is assessed. Surgery to remove the cancer and assess the groin lymph nodes is generally recommended for most tumours. Radiotherapy, sometimes with chemotherapy, may be recommended for larger or more advanced cancers, before surgery or as the main treatment when surgery is not suitable.

The specific plan depends on the size, location and stage of the tumour and whether lymph nodes are involved, as well as the person's overall health and preferences. Because these decisions balance cancer control with function, they are made by a specialist multidisciplinary team.

Diagnosis and Evaluation

Evaluation includes examination of the vulva, often with magnified inspection, and a biopsy to confirm the cancer type. Assessment of the groin lymph nodes — by examination, ultrasound and sometimes fine-needle sampling — is important, and MRI, CT or PET may be used to assess larger tumours and check for spread.

Because vulvar cancer can be associated with cancer or pre-cancer elsewhere in the lower genital tract, the cervix and vagina may also be checked. Blood tests and an assessment of general health complete the work-up. All results are reviewed by the multidisciplinary team, and a second opinion may be valuable.

Treatment Options

Surgery ranges from wide local excision of the tumour with a margin to more extensive vulvar surgery, with reconstruction where needed. The groin lymph nodes are assessed, ideally with a sentinel lymph node biopsy (removing only the first draining node) in suitable cases to reduce side effects, or by removing the groin nodes when required.

Radiotherapy, often combined with chemotherapy, may be used before surgery to shrink a large tumour, after surgery to reduce recurrence, or as the main treatment when surgery is unsuitable. For pre-cancerous changes, local treatments are options. The best combination is individualised.

How It Is Performed

Surgery is performed under anaesthesia. The surgeon removes the cancer with a margin of healthy tissue, and, for the lymph nodes, either identifies and removes the sentinel node(s) using a tracer or removes the groin nodes when needed. Larger removals may involve reconstruction using nearby tissue to restore the area.

The removed tissue is examined to confirm the type, stage and whether margins are clear and nodes are involved, which guides any further treatment. Radiotherapy and chemotherapy, when used, are given as planned courses. Wound care is important because of the location, and specialist nursing support aids recovery.

Preparation

Preparation includes completing biopsy and imaging, assessing the groin nodes, and standard pre-operative tests. Your team reviews medicines, gives instructions on wound care and hygiene, and explains the planned surgery and its likely effects on appearance, sensation and sexual function so you can prepare and ask questions.

If you are travelling for treatment, bring all imaging and biopsy results. Plan an in-country stay covering surgery and initial wound healing, which can take time given the location, arrange support, and organise continuing gynaecological oncology follow-up with your home team.

Benefits and Expected Goals

The goals of treatment are to remove the cancer completely, check and treat the lymph nodes, reduce the risk of recurrence, and preserve appearance and function as much as possible. For early cancers, surgery is often highly effective while limiting the extent of tissue removed.

Benefits depend on the stage, type and lymph node involvement, and cannot be guaranteed. Your team can explain the realistic goals for your situation, the likely effects on function, the support available, and the follow-up needed to detect any recurrence early.

Risks and Possible Complications

Surgery in this area, and additional treatments, carry risks that the team works to minimise.

• Wound-healing problems, infection and breakdown, which are more common in this region
• Leg swelling (lymphoedema) after removal of the groin lymph nodes
• Changes in appearance, sensation and sexual function
• Radiotherapy effects in the treated area and chemotherapy side effects
• The possibility of recurrence, needing ongoing follow-up

Sentinel node techniques and careful surgery help reduce some risks. Your team will explain those specific to your treatment. Report spreading redness, discharge, fever or wound breakdown promptly.

Recovery, Follow-up & Aftercare

Recovery includes wound healing, which can take time because of the location, with careful hygiene and, sometimes, specialist wound care. If groin nodes were removed, watching for and managing leg swelling is important. Support for sexual wellbeing and adjustment is available and encouraged.

Follow-up includes regular examinations and, where relevant, imaging to detect recurrence early, plus management of any lymphoedema or functional effects. If you were treated abroad, arrange this continuing follow-up with your home team and carry a full summary of your treatment and pathology results.

Medical Tourism Planning

Choose a JCI- or ISO-accredited hospital with an experienced gynaecological oncology service, sentinel lymph node and reconstructive capability, and access to radiation and medical oncology. Confirm the surgeon's experience and the plan, including likely effects on function, in writing.

Plan an in-country stay covering surgery and initial wound healing, request a written treatment plan and cost estimate, and arrange continuing follow-up, wound care and support with your home team. Carry your records and consider medical travel insurance.

Estimated Cost Factors

Cost depends on the extent of surgery (including any reconstruction and the type of lymph node assessment), whether radiotherapy or chemotherapy is needed, the length of hospital stay, imaging and pathology, and management of any wound or other complications.

Many destinations offer gynaecological cancer treatment at a fraction of typical US prices, but costs vary widely by case and cannot be judged from online figures. Always request a personalized written quote detailing what is included before deciding.

Choosing a Hospital or Specialist

Look for a hospital with recognised accreditation, an experienced gynaecological oncology team, sentinel lymph node and reconstructive expertise, specialist pathology, and access to radiation and medical oncology. Confirm that a multidisciplinary team guides decisions.

Ask about international patient services, interpreter support, and how follow-up, wound care and support for function would be coordinated with your home doctors. Written treatment and cost plans are signs of a quality programme.

Alternatives

Depending on the cancer, alternatives include the extent of surgery and lymph node assessment (for example sentinel node biopsy versus full node removal), and radiotherapy with or without chemotherapy instead of, before, or after surgery. For pre-cancerous changes, local treatments are options.

Each approach balances cancer control against effects on appearance and function. Clinical trials may offer newer treatments. Discuss all options with your gynaecological oncology team so the plan fits the cancer type, stage and your priorities.

Questions to Ask Your Doctor

• What type and stage of vulvar cancer do I have?
• How much tissue will be removed, and will I need reconstruction?
• Will you assess my lymph nodes with a sentinel node biopsy or full removal?
• Will I need radiotherapy or chemotherapy as well?
• How will treatment affect appearance, sensation and sexual function, and what support is available?
• What are the specific risks, including wound problems and leg swelling?
• What follow-up will I need, and if I travel, how will it be arranged at home?
• What is included in the written cost estimate?