Surgery is the primary treatment for most vulvar cancers, with the specific approach depending on how large the tumor is and whether it has spread to nearby lymph nodes. For early-stage disease, treatment often involves removing the tumor with a margin of healthy tissue, while more advanced cases may require a combination of radiation, chemotherapy, and more extensive surgery. Understanding what each treatment involves and what recovery looks like can help you prepare for the path ahead.
How Stage Determines the Treatment Plan
Vulvar cancer is staged based on tumor size and how deeply it has grown into the surrounding tissue. Stage IA means the tumor is 2 cm or smaller and has invaded no more than 1 mm deep. Stage IB means the tumor is either larger than 2 cm or has invaded more than 1 mm. This distinction matters because it directly shapes how aggressively the cancer needs to be treated, particularly whether the lymph nodes in the groin need to be evaluated.
About 90% of vulvar cancers are squamous cell carcinomas, and nearly all treatment guidelines are built around this type. Rarer forms, such as vulvar melanoma or Paget’s disease, follow different treatment principles and are typically managed by specialists with experience in those specific cancers.
Surgery for Early-Stage Vulvar Cancer
Wide local excision is the current standard for early-stage vulvar cancer, replacing the older approach of removing the entire vulva (radical vulvectomy). The goal is to remove the tumor along with a surrounding border of healthy tissue. Surgeons typically aim for a 2 cm margin around the tumor during the procedure to ensure that at least 8 mm of cancer-free tissue remains when examined under a microscope. If the pathology report shows that the margins are clear, the chance of the cancer returning at that site drops significantly.
This tissue-sparing approach preserves more of the vulvar anatomy, which has meaningful benefits for physical comfort, sexual function, and body image. Radical vulvectomy is now reserved for cases where the tumor is too large or positioned in a way that makes a smaller excision impractical.
Lymph Node Evaluation
For tumors that have invaded more than 1 mm deep (Stage IB and above), checking the groin lymph nodes is a critical part of treatment. Whether cancer has reached these nodes is one of the strongest predictors of long-term outcome.
For smaller, single tumors under 4 cm, a sentinel lymph node biopsy is often used. This technique identifies and removes only the first few lymph nodes where cancer would spread, rather than removing all of the groin nodes. If the sentinel nodes are cancer-free, a full lymph node dissection can be avoided, which dramatically reduces the risk of complications. When the sentinel nodes do contain cancer, or when the tumor is 4 cm or larger, a more complete removal of the groin lymph nodes is typically necessary.
Radiation and Chemoradiation
Radiation therapy plays several roles in vulvar cancer treatment. After surgery, radiation to the groin or pelvis is often recommended if cancer was found in the lymph nodes. It can also be used before surgery to shrink a large tumor and make it operable, or as the main treatment when surgery isn’t feasible.
When radiation is used as the primary or presurgical treatment, it is usually combined with chemotherapy to make the radiation more effective. This combination, called chemoradiation, typically pairs radiation with a platinum-based drug given weekly during the course of treatment. In studies of advanced vulvar cancer treated with chemoradiation before surgery, 63% to 92% of patients had tumors that became operable afterward.
Chemoradiation is the preferred approach for tumors that cannot be surgically removed without extremely disfiguring procedures, such as removing the bladder or rectum. By shrinking the tumor first, it can sometimes allow for a less radical operation.
Treatment for Advanced or Recurrent Disease
There is no single standard chemotherapy regimen for vulvar cancer that has spread to distant sites or come back after initial treatment. Chemotherapy options are largely borrowed from protocols used for other squamous cell cancers, such as cervical and anal cancer.
Immunotherapy has emerged as an option for advanced vulvar squamous cell carcinoma that has progressed after prior treatment. In the KEYNOTE-158 study, pembrolizumab (an immune checkpoint inhibitor) produced an overall response rate of about 11% in previously treated patients. While that number sounds modest, for some patients the responses can be durable. Interestingly, the study found responses in both patients whose tumors tested positive and negative for the PD-L1 biomarker, though the small number of PD-L1-negative patients makes that finding preliminary.
Reconstruction After Vulvar Surgery
When a significant amount of tissue is removed, reconstructive surgery can restore both appearance and function. The most common technique uses fasciocutaneous flaps, where nearby skin and underlying tissue are shifted to close the surgical site. V-Y advancement flaps, which use tissue from the inner thigh or surrounding area, are the most frequently performed reconstruction. For larger defects, muscle-based flaps using tissue from the abdomen or thigh may be needed.
The type of reconstruction depends on the size and location of the wound, your overall health, and what will give the best functional result. Goals include comfortable sitting, urination without difficulty, and preserved sexual function when possible. Reconstructive planning ideally happens before the cancer surgery itself, so the surgical team can coordinate both steps.
Lymphedema After Treatment
Swelling in one or both legs is one of the most common and persistent side effects of vulvar cancer treatment, particularly after groin lymph node removal. The overall prevalence of lymphedema following gynecologic cancer surgery ranges from 7% to 35%, but in vulvar cancer specifically, rates can reach as high as 80% depending on the extent of lymph node dissection.
Sentinel lymph node biopsy, when appropriate, significantly reduces this risk compared to full lymph node removal. For those who do develop lymphedema, the main management strategies include regular exercise, manual lymphatic drainage (a specialized massage technique), and compression garments. Maintaining a healthy weight also helps prevent worsening. Lymphedema can develop weeks, months, or even years after treatment, so staying alert to new or persistent leg swelling is important for the long term.
Survival Rates by Stage
Five-year survival varies considerably depending on when vulvar cancer is caught. For stage 1 disease, about 80% of patients survive five years or more. That number drops to around 50% for stage 2 and approximately 40% for stage 3. Reliable five-year statistics for stage 4 are limited due to the small number of cases diagnosed at that point.
These figures, based on patients diagnosed between 2013 and 2017, reflect outcomes before newer treatments like immunotherapy became available. They also represent averages across many patients with varying health profiles, so individual outcomes can differ substantially. The strongest factor influencing survival is whether cancer has reached the lymph nodes, which is why accurate lymph node evaluation is such a central part of treatment planning.