Although cancer of the vulva is very rare, its side-effects require very special management and sensitivity. Women, who develop cancer of the vulva, usually complain of an itch, discomfort, bleeding or an ulcer.
If a malignancy is suspected in the skin of the area, then a] small biopsy is taken, usually under local anesthetic, to confirm the diagnosis. In most cases this will be the common ‘squamous’ cancer but occasionally it will be a melanoma – which is usually pigmented – or rarely a ‘basal cell cancer or ‘rodent ulcer’ which has a more slow moving course and can be easily treated by simple removal. Vulva cancer is usually treated with surgery. If it is very advanced and involving such important organs as the bladder or anus, often a combination of chemotherapy and radiation is given.
Because these cancers can be very invasive and because they are often found in more than one site or can occur nearby, then a ‘radical vulvectomy’ is usually undertaken, together with removal of the lymph nodes in the groins. The ‘radical’ refers to the width and the depth of excision, which usually involves 2 cm on either side. This may include removal of the labia majora and minora and clitoris that are the external parts you see and can feel quite easily. If the tumour is close to the midline, then both right and left groin glands are removed, but if one-sided then the lymph glands on that side are usually only removed. If the results are positive then the other side is treated as well. This surgery can often have a huge impact on the woman’s ability to enjoy a ‘normal’ sex life again, and requires considerate understanding from the woman’s partner. Sexual counseling is advised to discuss how one can regain a pleasurable intimate life again.
If more than one lymph gland is found to contain cancer then radiation to the groin and pelvis is undertaken. This can result in lymphoedoema (swelling in the lymph area) in the pubis, groin and legs where sitting down for long periods of time can be extremely uncomfortable as the pubis swells and becomes engorged.
If cancer of the vulva recurs, it usually does so locally or in the groin. Local recurrence is treated surgically or occasionally by radiation if it has not been given previously. Groin recurrences are very difficult to treat because usually radiation has been given before and surgery with the introduction of new tissue using plastic surgical techniques is often necessary. When the cancer recurs in an area that has undergone previous irradiation and cannot be cut out, then this provides a very difficult problem for the patient and her physician. Pain relief is important and may require not only narcotics, but in some cases the addition of a spinal block to deaden the nerves in the area. Sometimes morphine has to be given through an implantable pump into the spinal canal to help with this.
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DETECTING CANCER OF THE VULVA
Posted: February 10th, 2011 under Cancer.
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