user: What are the treatments for Vulvar Cancer ?

assistant: Key Points
                    - There are different types of treatment for patients with vulvar cancer.    - Four types of standard treatment are used:         - Surgery     - Radiation therapy     - Chemotherapy     - Biologic therapy        - New types of treatment are being tested in clinical trials.     - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.
                
                
                    There are different types of treatment for patients with vulvar cancer.
                    Different types of treatments are available for patients with vulvar cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
                
                
                    Four types of standard treatment are used:
                    Surgery     Surgery is the most common treatment for vulvar cancer. The goal of surgery is to remove all the cancer without any loss of the woman's sexual function. One of the following types of surgery may be done:            -  Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.     -  Wide local excision: A surgical procedure to remove the cancer and some of the normal tissue around the cancer.     -  Radical local excision: A surgical procedure to remove the cancer and a large amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.      - Ultrasound surgical aspiration (USA): A surgical procedure to break the tumor up into small pieces using very fine vibrations. The small pieces of tumor are washed away and removed by suction. This procedure causes less damage to nearby tissue.     - Vulvectomy: A surgical procedure to remove part or all of the vulva:                  -  Skinning vulvectomy: The top layer of vulvar skin where the cancer is found is removed. Skin grafts from other parts of the body may be needed to cover the area where the skin was removed.       -  Modified radical vulvectomy: Surgery to remove part of the vulva. Nearby lymph nodes may also be removed.       -  Radical vulvectomy: Surgery to remove the entire vulva. Nearby lymph nodes are also removed.                -  Pelvic exenteration: A surgical procedure to remove the lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.           Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.       Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat vulvar cancer, and external radiation therapy may also be used as palliative therapy to relieve symptoms and improve quality of life.       Chemotherapy    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, a body cavity such as the abdomen, or onto the skin, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.     Topical chemotherapy for vulvar cancer may be applied to the skin in a cream or lotion.     See Drugs Approved to Treat Vulvar Cancer for more information.       Biologic therapy     Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.      Imiquimod is a biologic therapy that may be used to treat vulvar lesions and is applied to the skin in a cream.
                
                
                    New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.
                
                
                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
                
                
                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
                
                
                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.   It is important to have regular follow-up exams to check for recurrent vulvar cancer.
                
                 
            							Treatment Options by Stage
                    Vulvar Intraepithelial Neoplasia (VIN): Treatment of vulvar intraepithelial neoplasia (VIN) may include the following:         - Removal of single lesions or wide local excision.    -  Laser surgery.    - Ultrasound surgical aspiration.    -  Skinning vulvectomy with or without a skin graft.    -  Biologic therapy with topical imiquimod.
                    - Stage I Vulvar Cancer: Treatment of stage I vulvar cancer may include the following:         -  Wide local excision for lesions that are less than 1 millimeter deep..    -  Radical local excision and removal of nearby lymph nodes.    - Radical local excision and sentinel lymph node biopsy. If cancer is found in the sentinel lymph node, nearby lymph nodes are also removed.    -  Radiation therapy for patients who cannot have surgery.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage I vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    - Stage II Vulvar Cancer: Treatment of stage II vulvar cancer may include the following:         -  Radical local excision and removal of nearby lymph nodes.    -  Modified radical vulvectomy or radical vulvectomy for large tumors. Nearby lymph nodes may be removed. Radiation therapy may be given after surgery.    - Radical local excision and sentinel lymph node biopsy. If cancer is found in the sentinel lymph node, nearby lymph nodes are also removed.    - Radiation therapy for patients who cannot have surgery.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage II vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    - Stage III Vulvar Cancer: Treatment of stage III vulvar cancer may include the following:         -  Modified radical vulvectomy or radical vulvectomy. Nearby lymph nodes may be removed. Radiation therapy may be given after surgery.    - Radiation therapy or chemotherapy and radiation therapy followed by surgery.    - Radiation therapy with or without chemotherapy for patients who cannot have surgery.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage III vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    - Stage IV Vulvar Cancer: Treatment of stage IVA vulvar cancer may include the following:         -  Radical vulvectomy and pelvic exenteration.    - Radical vulvectomy followed by radiation therapy.    - Radiation therapy or chemotherapy and radiation therapy followed by surgery.    - Radiation therapy with or without chemotherapy for patients who cannot have surgery.        There is no standard treatment for stage IVB vulvar cancer. Treatment may include a clinical trial of a new treatment.   Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage IVB vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    
                
                  
								            Treatment Options for Recurrent Vulvar Cancer
								            Treatment of recurrent vulvar cancer may include the following:  - Wide local excision with or without radiation therapy to treat cancer that has come back in the same area.
								  -  Radical vulvectomy and pelvic exenteration to treat cancer that has come back in the same area.
								  -  Chemotherapy and radiation therapy with or without surgery.
								  -  Radiation therapy followed by surgery or chemotherapy.
								  -  Radiation therapy as palliative treatment to relieve symptoms and improve quality of life.
								  -  A clinical trial of a new treatment. 
								Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.