OnCo

Sign in to keep your watchlist

Your watched pages live in this browser. Sign in with an email link and OnCo keeps the same list on every device you use. Only your email address and your watchlist are stored.

Living with cancer·Standard of care

HPV-associated vulvar squamous cell carcinoma: the decisions you may face

Cancer page →Second-opinion finder →

4 treatment settings, 4 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Precursor (usual-type VIN)

3 options

Excision or laser ablation of visible lesions; imiquimod as a medical alternative; trials of artesunate ointment; HPV vaccination for prevention.

Guideline
NCCN Guidelines: Vulvar Cancer
The options, in plain words
Thermal ablation and cryotherapy for cervical precancerStandard of care

Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons.

  • Cheap, fast, no anaesthesia or electricity mains
  • Enables single-visit screen-and-treat
HPV & HBV vaccinationStandard of care

Vaccines that prevent the viral infections behind cervical, throat, anal, and liver cancers. The most effective anti-cancer intervention ever created.

  • Prevents cancer outright
  • Cheap at scale
Nonavalent HPV vaccineApprovedProphylactic vaccine (virus-like particles)

A vaccine against nine HPV types that prevents about 90% of cervical cancers, and now works with a single dose.

The evidence behind it
The main trade-offs on record
Thermal ablation and cryotherapy for cervical precancer
  • No histology
  • Not suitable for large or endocervical lesions
HPV & HBV vaccination
  • Coverage gaps, vaccine hesitancy
Questions to ask about this decision
  1. Between Thermal ablation and cryotherapy for cervical precancer, HPV & HBV vaccination and Nonavalent HPV vaccine, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in Phase II Study of Artesunate Ointment for the Treatment of Vulvar High Grade Squamous Intraepithelial Lesions (Vulvar HSIL, VIN2/3) and Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy Females, and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  5. Does your recommendation follow the current guideline (NCCN Guidelines: Vulvar Cancer), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  6. For my situation (precursor (usual-type vin)), which of the standard options do you recommend and why?
    Why: Guideline options include: Excision or laser ablation of visible lesions; imiquimod as a medical alternative; trials of artesunate ointment; HPV vaccination for prevention.
  7. Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  8. How do the results of Phase II Study of Artesunate Ointment for the Treatment of Vulvar High Grade Squamous Intraepithelial Lesions (Vulvar HSIL, VIN2/3) and Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy Females apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Early / localised

Early stage (tumour under four centimetres, clinically negative groins)

2 options

Wide local excision with sentinel node biopsy (GROINSS-V I); groin radiotherapy for sentinel node metastases of two millimetres or less and lymphadenectomy for larger ones (GROINSS-V II).

Guideline
NCCN Guidelines: Vulvar Cancer
The options, in plain words
Sentinel lymph node biopsyStandard of care

Removing just the first lymph node a tumour drains to, instead of all of them, to check for spread.

  • Avoids lymphoedema from full dissection
IMRT / IGRT (modern external beam)Standard of care

IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.

  • Conformal dose, fewer side effects
  • Hypofractionation saves visits
Also referenced:Lymphadenectomy (lymph node dissection)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Sentinel lymph node biopsy
  • False negatives in ~5-10%
IMRT / IGRT (modern external beam)
  • Low-dose bath to normal tissue
  • Motion management
Questions to ask about this decision
  1. Between Sentinel lymph node biopsy and IMRT / IGRT (modern external beam), which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Vulvar Cancer), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (early stage (tumour under four centimetres, clinically negative groins)), which of the standard options do you recommend and why?
    Why: Guideline options include: Wide local excision with sentinel node biopsy (GROINSS-V I); groin radiotherapy for sentinel node metastases of two millimetres or less and lymphadenectomy for larger ones (GROINSS-V II).

Add these to your appointment list, or take the full question set for this cancer.

Locally advanced

Locally advanced disease

2 options

Cisplatin-based chemoradiotherapy (GOG 205); surgery for residual disease; p16-positive tumours respond well.

Guideline
NCCN Guidelines: Vulvar Cancer
The options, in plain words
CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

IMRT / IGRT (modern external beam)Standard of care

IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.

  • Conformal dose, fewer side effects
  • Hypofractionation saves visits
Also referenced:Chemoradiation (chemoradiotherapy, CRT)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Cisplatinall recorded rates →
  • Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
IMRT / IGRT (modern external beam)
  • Low-dose bath to normal tissue
  • Motion management
Questions to ask about this decision
  1. Between Cisplatin and IMRT / IGRT (modern external beam), which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Vulvar Cancer), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (locally advanced disease), which of the standard options do you recommend and why?
    Why: Guideline options include: Cisplatin-based chemoradiotherapy (GOG 205); surgery for residual disease; p16-positive tumours respond well.
  6. Am I a candidate for Cisplatin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Recurrent or metastatic disease

4 optionsCompare side by side →

Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive or mismatch-repair-deficient tumours after chemotherapy; trials of pembrolizumab with lenvatinib and of cadonilimab.

Guideline
NCCN Guidelines: Vulvar Cancer
The options, in plain words
CarboplatinApprovedCytotoxic chemotherapy (platinum)

Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.

Paclitaxel / nab-paclitaxelApprovedCytotoxic chemotherapy (taxane)

A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.

BevacizumabApprovedMonoclonal antibody (anti-VEGF)

Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.

PembrolizumabApprovedMonoclonal antibody (anti-PD-1)

Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.

The evidence behind it
The main trade-offs on record
Carboplatinall recorded rates →
  • Dose by Calvert formula using GFR (see the calculators).
Pembrolizumaball recorded rates →
Side effectAny gradeGrade 3+
Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients8%-
Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients3.4%-
Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients1.7%-
Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients0.7%-
  • No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision
  1. Between Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab and the other options, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in Pembrolizumab Combination With Lenvatinib in Pts With Recurrent,Persistent,Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative Surge and AK104 for Recurrent or Metastatic Vulvar Cancer, and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?
    Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
  5. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  6. Does your recommendation follow the current guideline (NCCN Guidelines: Vulvar Cancer), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  7. For my situation (recurrent or metastatic disease), which of the standard options do you recommend and why?
    Why: Guideline options include: Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive or mismatch-repair-deficient tumours after chemotherapy; trials of pembrolizumab with lenvatinib and of cadonilimab.
  8. Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  9. How do the results of Pembrolizumab Combination With Lenvatinib in Pts With Recurrent,Persistent,Metastatic or Locally Advanced Vulvar Cancer Not Amenable to Curative Surge and AK104 for Recurrent or Metastatic Vulvar Cancer apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.