women s health issues
Vulvar Cancer
Treatment of Vulvar Cancer
Removal of all or part of the vulva Usually removal of nearby lymph nodes For more advanced cancers, surgery and radiation therapy, often with chemotherapy All or part of the vulva is surgically removed (a procedure called vulvectomy). Nearby lymph nodes are usually also removed. But sometimes doctors can instead do a What Is a Sentinel Lymph Node? dissection (removal of the first lymph node that would be affected by the cancer). Because basal cell carcinoma of the vulva does not tend to spread (metastasize) to distant sites, surgery usually involves removing only the cancer. The whole vulva is removed only if basal cell carcinoma is extensive. To identify sentinel lymph nodes, doctors inject a blue or green dye and/or a radioactive substance into the vulva around the tumor. These substances map the pathway from the vulva to the first lymph node (or nodes) in the pelvis. During surgery, doctors then check for lymph nodes that look blue or green or that give off a radioactive signal (detected by a handheld device). Doctors remove this lymph node and send it to a laboratory to be checked for cancer. If it is cancer-free, no other lymph nodes need to be removed (unless they look abnormal). For early-stage cancers, such treatment is usually all that is needed. Doctors may remove sentinel lymph nodes on one or both sides of the vulva, depending on the size of the tumor. If areas of cancer that measure less than 2 millimeters in size (called micrometastases) are detected in the sentinel lymph nodes, they are treated with radiation therapy. If the areas are larger (macrometastases), the lymph nodes in the groin are removed (lymphadenectomy). For more advanced vulvar cancers, radiation therapy, often with chemotherapy, are usually used before vulvectomy. Such treatment can shrink very large cancers, making them easier to remove. Sometimes the clitoris and other organs in the pelvis must be removed. For very advanced vulvar cancers, treatment may include surgery to remove all pelvic organs (called pelvic exenteration), radiation therapy, and/or chemotherapy. These organs include the reproductive organs (vagina, uterus, fallopian tubes, and ovaries), bladder, urethra, rectum, and anus. Which organs are removed and whether all are removed depend on many factors, such as the cancer's location, the woman's anatomy, and her goals after surgery. Permanent openings—for urine (urostomy) and for stool ( Understanding Colostomy )—are made in the abdomen so that these waste products can leave the body and be collected in bags. After the cancer is removed, surgery to reconstruct the vulva and other affected areas (such as the vagina) may be done. Such surgery can improve function and appearance. Doctors work closely with the woman to develop a treatment plan that is best suited to her and takes into account her age, sexual lifestyle, and any other medical problems. Sexual intercourse is usually possible after vulvectomy. 