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Home :: Vulvar Cancer

Vulvar Cancer

The vulva is the skin and fatty tissue between the upper thighs of women, from the area of the anus to about an inch below the pubic hairline. Cancer of the vulva most often affects the two skin folds (or lips) around the vagina, known as the labia.

Vulvar cancer is not very common. However, it is very serious because it can affect a woman's sexual functioning. It can make sex painful and difficult. This makes some women feel sad and worthless. If found early, vulvar cancer has a high cure rate and the treatment options involve less surgery.

Cancer of the vulva accounts for approximately 4 % of all gynecologic malignancies. It can occur at any age, even in infants, but its peak incidence is in the mid-60s. The most common vulvar cancer is squamous cell carcinoma. Early diagnosis increases the chance of effective treatment and survival. Lymph node dissection demonstrates a 5-year survival rate in 85% of patients if it reveals no positive nodes; otherwise, the survival rate falls to less than 75%.

Causes of Vulvar Cancer

Although the cause of Vulvar Cancer is unknown, several factors seem to predispose women to this disease:

  • leukoplakia (white epithelial hyperplasia) - in about 25% of patients
  • chronic vulvar granulomatous disease
  • chronic pruritus of the vulva with friction, swelling, and dryness
  • pigmented moles that are constantly irritated by clothing or perineal pads
  • irradiation of the skin such as nonspecific treatment for pelvic cancer
  • sexually transmitted diseases, such as herpes simplex and condyloma acuminatum caused by human papilloma virus (HPV)
  • obesity
  • hypertension
  • diabetes

Signs and symptoms of Vulvar Cancer

In 50% of patients, cancer of the vulva begins with vulvar pruritus, bleeding, or a small vulvar mass (which may start as a small ulcer on the surface that, eventually, becomes infected and painful). These symptoms call for immediate diagnostic evaluation. Less common indications include a mass in the groin or abnormal urination or defecation.

Diagnosis of Vulvar Cancer

Pruritus, bleeding, small vulvar mass. or a Papanicolaou smear that reveals abnormal cells strongly suggests vulvar cancer. Finn diagnosis requires histologic examination. Abnormal tissues for biopsy are identified by colposcopic examination to pinpoint Vulvar lesions or abnormal skin changes and by staining with toluidine blue dye, which, after rinsing with dilute acetic acid, is retained by diseased tissues.

Other diagnostic measures include complete blood count, X-ray, electrocardiogram, and thorough physical (including pelvic) examination. Occasionally. a CT scan may pinpoint lymph node involvement

Vulvar Cancer treatment

Depending on the stage of the disease, cancer of the vulva usually calls for radical or simple vulvectomy (or laser therapy for some small lesions). Radical vulvectomy requires bilateral dissection of superficial and deep inguinallymph nodes. Depending on the extent of metastasis, resection may include the urethra, vagina, and bowel, leaving an open perineal wound until healing - about 2 to 3 months. Plastic surgery, including mucocutaneous graft to reconstruct pelvic structures, may be done later.

Small, confined lesions with no lymph node involvement may require a simple vulvectomy or hemivulvecto my (without pelvic node dissection), Personal considerations (young age of patient, active sexual life) may also mandate such conservative management. However, a simple vulvectomy requires careful postoperative surveillance because it leaves the patient at higher risk for developing a new lesion.

If extensive metastasis, advanced age, or fragile health rules out surgery, irradiation of the primary lesion offers palliative treatment.

Special considerations and Prevention

Patient teaching, preoperative and postoperative care, and psychological support can help prevent complications and speed recovery.

Before surgery:

  • Supplement and reinforce what the physician has told the patient about the surgery and postoperative procedures, such as the use of an indwelling urinary catheter, preventive respiratory care, and exercises to prevent venous stasis. Encourage the patient to ask questions, and answer them honestly.

After surgery:

  • Provide scrupulous routine gynecologic care and special care to reduce pressure at the operative site, reduce tension on suture lines, and promote healing through better air circulation.
  • Place the patient on an air mattress or convoluted foam mattress, and use a cradle to support the top covers.
  • Periodically reposition the patient with pillows. Make sure her bed has a half-frame trapeze bar to help her move.
  • For several days after surgery, the patient will be maintained on I. V. fluids or a clear liquid diet. As ordered, give her an antidiarrheal drug three times daily to reduce the discomfort and possible infection caused by defecation. Later, as ordered, give stool softeners and a low-residue diet to combat constipation.
  • Teach the patient how to clean the surgical tube thoroughly.
  • Check the operative site regularly for bleeding, foul-smelling discharge, or other signs of infection. The wound area will look lumpy, bruised, and battered, making it difficult to detect occult bleeding. This situation calls for a physician or a primary nurse who can more easily detect subtle changes in appearance.
  • Within 5 to 10 days after surgery, as ordered, help the patient to walk. Encourage and assist her in coughing and range-of-motion exercises.
  • To prevent urine contamination, the patient will have an indwelling urinary catheter in place for about 2 weeks. Record fluid intake and output, and provide standard catheter care.
  • Counsel the patient and her partner about resumption of sexual activity. Explain that sensation in the vulva will eventually return after the nerve endings heal, and they'll probably be able to have sexual intercourse 6 to 8 weeks following surgery. Explain that they may want to try different sexual techniques, especially if surgery has removed the clitoris. Help the patient adjust to the drastic change in her body image.

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