Treatments for stage 4 vulvar cancer

The following are treatment options for stage 4 vulvar cancer. Stage 4 vulvar cancer is usually treated with a combination of surgery, radiation therapy, chemotherapy and targeted therapy.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

You may be offered surgery for stage 4 vulvar cancer. The goal of the surgery is to remove the cancer as much as possible. It may also help control symptoms.

A complete radical vulvectomy removes the whole vulva (including the clitoris), the deeper tissues under the vulvar skin and nearby lymph nodes.

A pelvic exenteration is a major operation. It includes a vulvectomy and removing the lymph nodes in the groin. It also removes one or more organs in the pelvis, such as the vagina, uterus, bladder or rectum.

Surgery may also be done to remove blockages of the bowel or bladder.

Find out more about surgery for vulvar cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy for stage 4 vulvar cancer.

External radiation therapy may be used with or without chemotherapy to:

• treat advanced vulvar cancer when surgery can’t be done
• shrink a tumour before surgery (called neoadjuvant therapy)
• destroy cancer cells left behind after surgery to reduce the risk that the cancer will come back (recur) (called adjuvant therapy)
• relieve pain or control the symptoms of advanced vulvar cancer (called palliative therapy)

Find out more about radiation therapy for vulvar cancer.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy with radiation therapy for stage 4 vulvar cancer. Chemotherapy may also be used alone to relieve pain or control the symptoms of advanced vulvar cancer (called palliative chemotherapy).

Find out more about chemotherapy for vulvar cancer.

Radiation therapy and chemotherapy may be given during the same time period to treat vulvar cancer. This is called chemoradiation. You may be offered chemoradiation if you cannot have surgery due to health problems.

The most common types of chemotherapy drugs used in chemotherapy and chemoradiation include:

• cisplatin and paclitaxel
• carboplatin and paclitaxel

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer.

You may be offered targeted therapy for stage 4 vulvar cancer. Sometimes a targeted therapy drug is combined with a chemotherapy drug.

Targeted therapy drugs that may be offered include:

• bevacizumab (Avastin and biosimilars)
• erlotinib (Tarceva)

Targeted therapy drugs used for vulvar cancer may not be covered by all provincial and territorial health plans. Your healthcare team will talk to you about your options if they think you may benefit from these drugs.

Find out more about targeted therapy for vulvar cancer.

Talk to your doctor about clinical trials open to people with vulvar cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.