Types of Vulvar Cancer Medications

Vulvar cancer is rare and surgery is the first-line treatment. General chemotherapy and radiation regimens may be involved in treatment. HPV infection is a major risk factor for cancer of the vulva, so vaccination against human papilloma virus is the best way to prevent this cancer.

Vulvar cancer medications are designed to treat certain stages of vulvar cancer. Surgery is the primary treatment for vulvar cancer, and medications are used in the precancerous stage, or in advanced stages when the cancer has spread to other parts, or recurred after treatment.

Medications for vulvar cancer include vaccines for prevention, topical applications in early stages, and chemotherapy in advanced stages. There are no standard treatment protocols for vulvar cancer, because it is a rare type of cancer. 

Vaccines are given to prevent human papillomavirus (HPV) infection, which is a major risk for vulvar cancer. Topical applications include fluorouracil, a chemotherapy drug, and imiquimod, a cream that enhances the immune system’s ability to fight the tumor growth.

Systemic chemotherapy is almost always administered along with radiation, known as chemoradiation, mainly to reduce the size of the tumor, prior to surgery. Chemotherapy medications such as cisplatin or paclitaxel may be used as systemic treatment for advanced vulvar cancer.

Vulvar cancer is the uncontrolled growth of abnormal cells in the vulva. Cancer cells grow into a mass of tissue known as a tumor, and form lumps or lesions. A tumor is termed to be benign if it grows but does not spread, and malignant or metastatic if it spreads to other parts of the body.

The external parts of a woman’s genitals are together known as vulva, which consists of:

• Vaginal opening: The opening of the vaginal passage
• Urethral opening: The opening of the urinary passage
• Mons pubis: The fleshy mound over the pubic bone
• Labia majora: Fleshy outer skin folds that resemble lips, on either side of the vaginal and urethral openings
• Labia minora: Thinner skin folds that are inside the labia majora
• Clitoris: The sensitive knob of tissue where the folds of labia minora meet above the vaginal opening
• Perineum: The patch of skin between the vulva and anus

Vulvar cancer most commonly develops on the labia, but may affect any part of the vulva, the Bartholin glands located on either side of the vaginal opening, which produce lubricating fluid, or the sweat glands under the vulvar skin tissue.

Types of vulvar cancer

The vulva is essentially skin and fatty tissue, and consequently, vulvar cancers are primarily types of skin-related cancers. The types of vulvar cancer include the following:

• Squamous cell carcinoma (SCC): Squamous cell carcinoma, which often develops on the edges of the labia, accounts for approximately 90% of vulvar cancers. Squamous cells are a type of flat cells found on the skin and lining of the body’s organs. Subtypes of SCC include:
  • SCC from thickened (keratinized) vulvar skin that develops in older women, typically over the age of 70.
• Basaloid SCC, an aggressive type that develops in younger women with human papillomavirus (HPV) infection.
• Verrucous carcinoma, a rare type that grows into a large wart.
• Adenocarcinoma: Adenocarcinomas start in gland cells. Vulvar adenocarcinoma can develop in the Bartholin glands, or the sweat glands in the vulvar skin, which is known as Paget’s disease.
• Melanoma: Melanoma is a cancer of the skin cells that produce pigments which give skin its color. Melanoma typically occurs in skin that is exposed to the sun, and vulvar melanoma is rare.
• Sarcoma: Sarcoma is a cancer that develops in the connective tissue, bones and muscles. Vulvar sarcoma is uncommon but can occur in women or girls of any age.
• Basal cell carcinoma: Basal cell carcinoma is the most common type of skin cancer but occurs rarely in the vulvar region.

The stages of vulvar cancer include the following:

• Vulvar intraepithelial neoplasia (VIN): VIN is the pre-cancerous slow-growing stage in which cells become abnormal and can develop into vulvar cancer if left untreated.
• Stage I: Tumor growth is only on the vulva.
• Stage II: The cancer has spread to parts of the vagina, anus and/or the urethra.
• Stage III: The cancer has spread to nearby lymph nodes in addition to parts of the vagina, anus and urethra.
• Stage IV: The cancer has spread to nearby lymph nodes, and nearby and/or distant organs.

Vulvar cancer may have any of the following characteristics depending on the type:

• Raised bumps, masses or a wart-like growth
• Patch of skin that turns pink or red, different from the rest of the vulva
• Thickened patch of skin or scaly skin on the vulva
• Open sore or lesion that doesn’t heal
• Moles that grow and change in color and/or shape

Vulvar intraepithelial neoplasia most often does not produce any symptoms. In addition to changes in the appearance of the vulva, symptoms of vulvar cancer include:

• Persistent itching
• Pain, burning or soreness
• Bleeding or discharge unrelated to menstrual periods
• Burning sensation during urination
• Pain during sexual intercourse

The risk factors for vulvar cancer include the following:

• Advanced age
• Human papillomavirus (HPV) infection
• Human immunodeficiency virus (HIV) infection
• Family history of melanoma
• Vulvar intraepithelial neoplasia
• Vaginal or cervical cancer
• Lichen sclerosus, a condition which causes patches of thin, itchy vulva skin
• Smoking, especially if one also has HPV infection

Treatment for vulvar cancer varies depending on its type and stage. No specific treatment has been developed for vulvar cancer because of its rarity, but it is possible to enroll in clinical trials for new types of treatment that are being evaluated. Treatment options include the following:

Surgery

Surgical procedures to treat vulvar cancer include:

• Laser surgery: Use of laser beams to destroy abnormal cells, primarily in vulvar intraepithelial neoplasia.
• Ultrasound surgical aspiration: Use of ultrasound to break up the tumor and remove it by suctioning. 
• Excision: Removal of the cancerous vulvar tissue with a margin of healthy tissue.
• Vulvectomy: Vulvectomy is the surgical removal of vulvar tissue. Vulvectomy of a large area may require skin grafts and vulvar reconstruction. Vulvectomy may be any of the following types:
  • Skinning vulvectomy: Only the top layer of vulvar skin affected by cancer is removed.
  • Simple vulvectomy: Entire vulvar skin and some tissue under the skin may be removed, which includes labia and sometimes clitoris.
  • Partial radical vulvectomy: Most of the vulva and the deep tissue under the vulva are removed.
  • Complete radical vulvectomy: The entire vulva, deep tissue and nearby lymph nodes may be removed.
• Pelvic exenteration: Surgery to remove nearby organs such as vagina, cervix, rectum, lower colon or bladder, depending on the extent of cancer spread in the pelvic region.

Radiation therapy

Radiation therapy is the use of high-energy X-rays to destroy the cancer cells. Radiation may be used before a surgical procedure to reduce the size of the tumor, or after a surgery to destroy any remaining cancer cells.

Medications

Medications are administered to prevent vulvar cancer and to treat the disease in pre-cancerous and advanced stages. Medications may be in the form of topical applications, oral formulations or injections.

Three types of medications are used in the treatment of vulvar cancer:

• Preventive vaccines
• Topical applications
• Systemic medications

Medications for vulvar cancer may prevent abnormal cells from developing into cancer, directly kill cancer cells or stimulate the immune system to kill the cancer cells.

Preventive vaccines

Vaccines help prevent HPV infections, which carry a high risk for vulvar cancer. The FDA has approved two vaccines to prevent vulvar cancer:

• Recombinant HPV quadrivalent vaccine (Gardasil)
• Recombinant HPV nonavalent vaccine (Gardasil 9)

Topical applications

Topical applications are creams and lotions applied directly on the vulvar skin, and may cause irritation and peeling. Topical applications are used only for VIN and not for invasive vulvar cancer. Two types of ointments are used topically:

• Fluorouracil: A chemotherapy ointment which kills abnormal cells.
• Imiquimod: An immunotherapy drug which stimulates immune activity against the abnormal cells.

Systemic medications

Chemotherapy is the only kind of systemic medication used to treat vulvar cancer. Chemotherapy drugs are primarily used in the later stages of vulvar cancer. The only FDA-approved chemotherapy drug for palliative care in advanced vulvar cancer is:

• Bleomycin sulfate

Common chemotherapy drugs used off-label to treat advanced vulvar cancer include:

• Cisplatin
• Carboplatin
• Vinorelbine tartrate
• Paclitaxel
• Erlotinib hydrochloride

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.