Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Nell Suby

Nell Suby, MD

Gyn Oncology

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Sacramento Medical Center
Appt/Advice: 916-614-4055

See all office information »

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Vulvar cancer can begin as abnormal (precancer) cells, or as a growth or lump. It develops in the skin or tissues around the vaginal opening (vulva).

Vulvar cancer is often not painful until the tumor is large. A cancerous (malignant) vulvar tumor can:

  • Damage nearby organs, such as the anus or urethra.
  • Spread to nearby lymph glands. 

In later stages, cancer cells can enter the bloodstream and spread (metastasize) to other parts of the body. 

The treatments for vulvar cancer are:

  • Surgery
  • Radiation therapy
  • Chemotherapy 

We can almost always cure vulvar cancer, if we catch it early. Together, we’ll create your best treatment plan, based on the stage of your cancer.

Additional References:


Most vulvar cancers are surgically removed. We check the lymph nodes for cancer at the same time. Depending on the stage of the cancer, surgical options include:

Radical vulvectomy removes the whole vulva, including skin and fatty tissue.

Radical local excision removes the vulvar tumor area and a rim of normal skin. Part of the vulva remains.

Sentinel lymph node biopsy (for vulvar cancers within a specific size range). In this procedure we:

  • We identify and remove 1 or 2 lymph nodes (the sentinel node) where the cancer is most likely to spread.
  • A specialist checks the sentinel node tissue for cancer. The other groin lymph nodes are left in place, if the sentinel node is not cancerous. 

Inguinal (groin) lymph node dissection. In this procedure, we:

  • Remove the lymph nodes and have them checked for cancer spread.
  • Collect the remaining lymphatic fluid, using rubber tubing called a Jackson-Pratt drain.
  • Remove the drain after a few days when fluid levels go down.

Radiation Therapy and Chemotherapy

Radiation therapy. If cancer was found in your lymph nodes, we may recommend radiation therapy in your groin area. This helps reduce the chance that cancer will return.

Radiation therapy:

  • Uses high-energy waves, such as X-rays.
  • Aims a beam of radiation at the cancer and the surrounding tissues.
  • Is usually done several times a week for several weeks. 

Chemotherapy. This treatment uses medications to kill cancer cells. It’s also known as “chemo.”

  • Most women with vulvar cancer don’t need chemotherapy.
  • Sometimes it’s needed to slow the spread of cancer to organs such as the lungs or liver.
  • Chemotherapy is given by an injection into a woman’s vein (IV). It circulates through the bloodstream. 

Chemotherapy is sometimes given at the same time as radiation therapy. This is called chemoradiation and can make treatment more effective. If your vulvar tumor is large, you may be given chemoradiation before surgery.

Radiation Therapy and Chemotherapy Side Effects

Both chemotherapy and radiation therapy kill cancer cells but can also damage normal tissues. Side effects range from mild to serious. We can help you manage any side effects.

Either radiation or chemotherapy may cause side effects that include:

  • Tiredness.
  • Nausea and vomiting.
  • Menopause-like symptoms such as vaginal dryness, hot flashes, and night sweats.

Other possible radiation therapy side effects include:

  • Skin tenderness or redness.
  • Frequent urination or blood in urine.
  • Loss of pubic hair.
  • Diarrhea.
  • Loss of the ability to become pregnant (infertility).
  • End of menstruation. Periods return over time in some younger women.

Other possible chemotherapy side effects include:

  • Anemia (low level of red blood cells).
  • Increased risk of infection (low level of white blood cells).
  • Bruising and bleeding easily (low level of blood platelets).
  • Hair loss.
  • Numbness, tingling, or pain in hands and feet.
  • Reduced kidney function.
  • Hearing loss.

Clinical Trials

We may suggest that you join a clinical trial. Clinical trials are designed to study how to improve cancer treatment for patients. 

Some clinical trials research new treatments. Others compare new treatments to those already in use.

Additional References:

Follow-up Care

After treatment we’ll make a follow-up care plan. We want to watch you carefully, to quickly catch any sign of cancer returning and help you with any ongoing treatment side effects.

For the next few years, your follow-up visits will:

  • Occur every 6 months.
  • Be with your regular gynecologist, a doctor who specializes in women’s cancers, or another cancer specialist.
  • Include a physical exam and possibly blood tests and X-rays.
  • Give you time to talk with us about any side effects of treatment that bother you. We can help you manage this important part of your recovery.

Contact us immediately if you develop:

  • Vaginal bleeding.
  • A cough that doesn’t go away.
  • Pain in your belly or pelvis.
  • Unexplained weight loss.

What You Can Do

Taking care of yourself during and after your treatment is very important. Be sure to:

  • Choose healthy foods.
  • Stop smoking.
  • Be active every day, when you feel well enough.
  • Keep your follow-up appointments.
  • Join a support group to talk with people with similar experiences.
  • Talk with your partner or a therapist about any intimacy issues.
Additional References:

Getting Your Care at Kaiser Permanente

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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