Vulvar Cancer

Treatment :

Clinical staging The International Federation of Gynecology and Obstetrics (FIGO) has adopted a surgical staging system for vulvar cancer. The stage of cancer is determined after surgery. The previous clinical staging system for vulvar cancer is no longer used. Vulvar cancer is categorized into five stages (0, I, II, III, and IV) which may be further subdivided (A and B) based on the depth or spread of cancerous tissue. The FIGO stages for vulvar cancer are: Stage 0. Vulvar intraepithelial neoplasia. Stage I. Cancer is confined to the vulva and perineum. The lesion is less than 2 cm (about 0.8 in) in size. Stage II. Cancer is confined to the vulva and perineum. The lesion is larger than 2 cm (larger than 0.8 in) in size. Stage III. Cancer has spread to the vagina, urethra, anus, and/or the lymph nodes in the groin (inguinofemoral). Stage IV. Cancer has spread to the bladder, bowel, pelvic bone, pelvic lymph nodes, and/or other parts of the body. Treatments Treatment for vulvar cancer will depend on its stage and the patient's general state of health. Surgery is the mainstay of treatment for most cases of vulvar cancer. SURGERY. The primary treatment for stage I and stage II vulvar cancer is surgery to remove the cancerous lesion and possibly the inguinofemoral lymph nodes. Removal of the lesion may be done by laser, to burn off a minimal amount of tissue, or by scalpel (local excision), to remove more of the tissue. The choice will depend on the severity of the cancer. If a large area of the vulva is removed, it is called a vulvectomy. Radical vulvectomy removes the entire vulva. A vulvectomy may require skin grafts from other areas of the body to cover the wound and make an artificial vulva. Because of the significant morbidity and the psychosexual consequences of radical vulvectomy, there is a trend toward minimizing the extent of cancer excision. The specific inguinofemoral lymph node that would receive lymph fluid from the cancerous lesion, known as the sentinel node, may be exposed for examination (lymph node dissection) or removed (lymphadenectomy), especially in cases in which the cancerous lesion has invaded to a depth of more than 1 mm. Surgery may also be followed by chemotherapy and/or radiation therapy to kill additional cancer cells. Surgical treatment of stage III and stage IV vulvar cancer is much more complex. Extensive surgery would be necessary to completely remove the cancerous tissue. Surgery would involve excision of pelvic organs (pelvic exenteration), radical vulvectomy, and lymphadenectomy. Because this extensive surgery comes with a substantial risk of complications, it may be possible to treat advanced vulvar cancer with minimal surgery by using radiation therapy and/or chemotherapy as additional treatment (adjuvant therapy). An intraoperative technique that is used to identify the sentinel node in breast cancer and melanoma is being applied to vulvar cancer. This technique, called lymphoscintigraphy, is performed during surgical treatment of vulvar cancer and allows the surgeon to immediately identify the sentinel node. A radioactive compound (technetium 99m sulfur colloid) is injected into the cancerous lesion approximately two hours prior to surgery. This injection causes little discomfort, so local anesthesia is not required. During surgery, a radioactivity detector is used to locate the sentinel node and any other nodes to which cancer has spread. Though still in the experimental stage, vulvar lymphoscintigraphy shows promise in reducing morbidity and hospital length of stay. The most common complication of vulvectomy is the development of a tumor-like collection of clear liquid (wound seroma). Other surgical complications include urinary tract infection, wound infection, temporary nerve injury, fluid accumulation (edema) in the legs, urinary incontinence, falling or sinking of the genitals (genital prolapse), and blood clots (thrombus). RADIATION THERAPY. Radiation therapy uses high-energy radiation from x rays and gamma rays to kill the cancer cells. The skin in the treated area may become red and dry and may take as long as a year to return to normal. Fatigue, upset stomach, diarrhea, and nausea are also common complaints of women having radiation therapy. Radiation therapy in the pelvic area may cause the vagina to become narrow as scar tissue forms. This phenomenon, known as vaginal stenosis, makes intercourse painful. CHEMOTHERAPY. Chemotherapy uses anticancer drugs to kill the cancer cells. The drugs are given by mouth (orally) or intravenously. They enter the bloodstream and can travel to all parts of the body to kill cancer cells. Generally, a combination of drugs is given because it is more effective than a single drug in treating cancer. The side effects of chemotherapy are significant and include stomach upset, vomiting, appetite loss, hair loss, mouth or vaginal sores, fatigue, menstrual cycle changes, and premature menopause. There is also an increased chance of infections. Alternative treatment Although alternative and complementary therapies are used by many cancer patients, very few controlled studies on the effectiveness of such therapies exist. Mind-body techniques such as prayer, biofeedback, visualization, meditation, and yoga have not shown any effect in reducing cancer but can reduce stress and lessen some of the side effects of cancer treatments. Clinical studies of hydrazine sulfate found that it had no effect on cancer and even worsened the health and well-being of the study subjects. One clinical study of the drug amygdalin (Laetrile) found that it had no effect on cancer. Laetrile can be toxic and has caused death. Shark cartilage, although highly touted as an effective cancer treatment, is an improbable therapy that has not been the subject of clinical study. The American Cancer Society has found that the "metabolic diets" pose serious risk to the patient. The effectiveness of the macrobiotic, Gerson, and Kelley diets and the Manner metabolic therapy has not been scientifically proven. The FDA was unable to substantiate the anticancer claims made about the popular Cancell treatment. There is no evidence for the effectiveness of most over-the-counter herbal cancer remedies. However, some herbals have shown an anticancer effect. As shown in clinical studies, Polysaccharide krestin, from the mushroom Coriolus versicolor, has significant effectiveness against cancer. In a small study, the green alga Chlorella pyrenoidosa has been shown to have anticancer activity. In a few small studies, evening primrose oil has shown some benefit in the treatment of cancer.