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:
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 treatmentDepending 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.
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