Cancer of the Vulva - Treatment
Contents:
All stages of cancer of the vulva can be treated; all are not curable.
Treatment of cancer of the vulva depends on the stage of the disease, the
type of disease and the patient's age and overall medical condition. The
three main types of treatment used are surgery (minor and major), radiation
therapy and chemotherapy.
An outline of the treatments generally administered at each stage is:
 | Stage 0 |
Treatment is by local
excision for relatively small lesions
up to a few centimetres in dimension. If the lesions are multifocal
and/or widespread, then it may be better to treat these by a skinning
vulvectomy. This involves literally skinning the abnormal area of the
vulva and possibly covering the defect with a split
skin graft. This will be done in a hospital under anaesthetic.
| Stage I |
The primary approach is a wide local excision of the lesion. This may
involve removal of one side of the vulva, called a hemivulvectomy.
It is important to get at least 1 centimetre of normal tissue from around
the cancer, to ensure that none remains. If the cancer comes close to the
midline of the vulva, then it may be wise to treat the cancer by a whole
excision of the vulva, called a radical
vulvectomy.
If the cancer invades to a depth of more than 1 millimetre, then the lymph
nodes should be removed from the groin.
Whether this should be done for one or both groins depends on the size and
site (location) of the cancer.
| Stage II |
This would generally be treated by a radical vulvectomy, involving the
removal of the whole vulva and removal of the lymph nodes in both groins.
If cancer is found in the groin lymph nodes, then further treatment with radiation
therapy to the pelvis
may be advised.
| Stage III |
This may be treated by radical vulvectomy involving the removal of the
whole vulva and removal of the lymph nodes in both groins. However, the
feasibility of this approach will depend very much on the degree to which
the urethra,
vagina or anus
are affected.
At times, and in order to minimise the surgery, initial treatment may
be by radiation therapy and chemotherapy
to reduce the size of the tumour, followed by surgical removal.
| Stage IV |
In this group of patients, the treatment needs be individualised to
suit the situation. It may involve a combination of surgery, radiation
therapy and chemotherapy.
| Recurrent |
This will depend very much on the site (location) of the recurrence. It
may involve surgical removal of the recurrence followed by radiotherapy,
or radiation therapy by itself or with chemotherapy. These choices have to
be made on an individual case-by-case basis.
It is important that patients have proper follow-up after treatment for
cancer of the vulva. Follow-up examination involves taking a brief history
covering the time since the last visit. A physical examination is then
undertaken with careful checking of the vulva and groins. The usual
follow-up protocol is to be seen:
| every 3 months for the first 2 years |
| every six months from 2 to 5 years |
| yearly thereafter. |
|
