Treating stage 4 vulvar cancer is challenging due to its advanced nature, necessitating a multimodal approach. This stage involves metastatic spread to distant organs, necessitating aggressive and combined therapies for optimal management. Surgical intervention remains a key component, often involving radical vulvectomy coupled with lymphadenectomy to excise the primary tumor and involved lymph nodes. However, the extent of metastasis sometimes renders extensive surgery impractical, thus necessitating alternative treatments. Radiation therapy plays a pivotal role, employed either post-surgically to eliminate residual malignant cells or as a primary treatment when surgery is not viable. Technologies like intensity-modulated radiation therapy (IMRT) enable precise targeting of cancer cells while sparing surrounding healthy tissues, thereby reducing potential side effects. Chemotherapy is indispensable, especially for addressing distant metastasis. Standard chemotherapeutic agents include cisplatin, 5-fluorouracil, and paclitaxel. Concurrent chemoradiotherapy has shown promise in enhancing treatment efficacy and is often recommended. Innovative treatments like targeted therapies and immunotherapies are gaining traction. These modalities focus on specific cancer cell pathways and immune checkpoints, respectively. Though still under investigation, they offer hope for more effective management of vulvar cancer. Agents like pembrolizumab and bevacizumab are being tested in clinical trials with initial encouraging outcomes.Palliative care is equally critical, involving comprehensive pain management, nutritional support, and psychological counseling to improve the patient's quality of life. Integrating palliative care early in the treatment plan helps address symptoms and provides holistic support. Given the poor prognosis, individualized treatment plans and participation in clinical trials are crucial. Research continues to focus on improving therapeutic strategies to enhance survival and quality of life for patients with stage 4 vulvar cancer.

The cost of treating vulvar cancer in India varies significantly depending on the stage and specific treatment modalities. For early stages, surgical intervention can range from INR 1,00,000 to 4,00,000. Radiotherapy, including advanced methods like IMRT, can cost between INR 2,50,000 to 5,00,000. Chemotherapy expenses, including drug costs and hospital charges, typically lie between INR 50,000 to 2,00,000 per cycle. Targeted therapies and immunotherapies are more expensive, often exceeding INR 10,00,000 for a complete course. Palliative care, involving pain management and supportive therapies, can add an additional INR 50,000 to 1,50,000 monthly, depending on the patient's needs and care setting.