Cancer of the Vulva Vulva
Introduction
Cancer is predominantly a disease of older women. Squamous cell carcinoma is the commonest histological type, usually arising from premalignant lesions–vulva intraepithelial neoplasia (VIN). Risk factors contributing to development of VIN and later vulva cancer include HPV infection, infection with HIV, and cigarette smoking.
Management:
Treatment is individualized, taking into considerations of histological type, disease stage and patient factors
Primary treatment is surgery. Adequate surgery involves wide local excision of primary tumor together with groin lymphnode dissection.
Radiotherapy is indicated in the following conditions:
• As primary therapy for patient with small primary tumors particularly young patients in whom surgical resection would have significant psychological consequences.
• For patients with locally advanced disease where resection is not possible.
• After surgery to treat the pelvic and groin nodes.
• After surgery in patients with positive surgical margins.
Signs and Symptoms
Diagnostic criteria
• A lump or vulva mass
• Presence of leukoplakia and other dystrophic changes on the vulva
• Itching is a common manifestation and may become ulcerative (“non-healing ulcers”)
Investigation
• FBC, LFTs, Urea, creatinine, HIV test
• CXR, Ultrasonography or CT scan of abdomen and pelvis
• Colposcopy to determine presence of other lesions in the vagina and cervix
• Biopsy from the vulvar lesion to confirm the diagnosis
Staging: FIGO and TNM.
Treatment
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Pharmacological
- Chemotherapy is given as a radiotherapy sensitizer or on palliative intent.
Cisplatin 40 mg/m2 IV to max of 70 mg is given weekly during radiation therapy.
o If patient is HIV positive or has mild renal impairment consider 30 mg/m2 to max of 60 mg weekly.
o Available and preferred palliative chemotherapy drugs for metastatic, recurrent or persistent cancer after RT, given in single or combination regimen include: Cisplatin, paclitaxel, bevacizumab, carboplatin, docetaxel and gemcitabine.
• Do FBC, urea and creatinine before each cycle of chemotherapy
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Non-pharmacological
-
Prevention
Updated on,
5 Novemba 2020 09:15:33
References
STG 1