What Is Vulva Cancer?

Vulvar cancer is a malignant tumor of the vulva and is not uncommon, accounting for about 5% of malignant tumors of the female reproductive tract. Among them, primary squamous cell carcinoma is the main type, and secondary malignant tumors are rare. It occurs most often in the labia majora, followed by the labia minora, vaginal vestibule, and clitoris. Local nodules or lumps first appear, and they gradually increase in size, necrosis, ulceration, and infection, with increased secretions and itching and pain. The mass can be papillary or cauliflower-like, and can rapidly expand, involving the anus, rectum, and bladder.

Basic Information

English name: carcinoma of vulva
Visiting department: Obstetrics and Gynecology, Oncology
Multiple groups: Postmenopausal women

Common locations: Labia majora
Common causes: Unknown, has some relationship with human papilloma virus infection
Common symptoms: Vulvar nodules, often accompanied by pain and itching

Causes of vulvar cancer

The cause of vulvar cancer is unknown. At present, human papilloma virus (HPV) is considered to be the main cause of its occurrence, but HPV-negative vulvar cancer is related to vulvar leukoplakia, vulvar atrophy, genital warts, and other sexually transmitted diseases such as syphilis and lymphogranuloma.

Clinical manifestations of vulvar cancer

The main symptoms are vulvar nodules, often accompanied by pain and itching. Most patients first have long-term vulvar pruritus. After many years, pimples, vulvar nodules, or small ulcers appear locally. They do not heal for a long time, and some patients have vulvar white spots. When the tumor is near or invades the urethra, frequent urination, dysuria, burning urination, and dysuria may occur. In the advanced stage, there are ulcers or irregular papillary or cauliflower-like masses, and the lesions often have purulent secretions. The lesions can also enlarge the anus, rectum, and bladder, and one or both groin can feel hard and fixed inactive enlarged lymph nodes.

Vulvar cancer test

Histopathological examination, Doppler ultrasound, CT examination, etc.

Vulvar cancer diagnosis

Vulvar cancer is mainly based on clinical symptoms and biopsy. Vulvar lesions should be observed in detail. If persistent ulcers, papillary warts, or white lesions are not obvious after treatment, biopsies should be taken. Except for very early benign lesions, which are difficult to confirm, general diagnosis is not difficult. Biopsy is the only reliable method of identification. Taking a biopsy at the non-bleaching area after toluidine blue staining can obtain a more accurate diagnostic result. Multiple, multiple biopsies are required to make a final diagnosis.

Vulvar cancer treatment

Vulvar squamous cell carcinoma is sensitive to radiation, but because the normal tissues of the vulva are poorly tolerated by radiation, the radiation dose of vulvar cancer is limited. Except for a few early and small cases, only radiotherapy is feasible, and the rest of vulvar cancer is only adjuvant. Melanoma is not sensitive to radiotherapy and should be relatively contraindicated.

Indications for radiation therapy

(1) The primary tumor is huge and deeply infiltrated. Patients with squamous cell carcinoma that are close to or involve the urethra, vagina, and anus, and have difficulty in surgical resection. Preoperative radiotherapy can shrink the tumor to increase the resection rate and preserve the function of adjacent organs.

(2) Patients whose surgical margin is too close to the tumor and cannot be easily removed.

(3) Elderly patients or those who are not suitable for surgery for other reasons.

(4) Young patients with small primary cancer near the clitoris, who require the clitoris to be retained.

(5) Advanced vulvar cancer is treated with comprehensive radiotherapy and surgery to replace trauma, and patients are unwilling to undergo pelvic resection.

(6) Vulvar cancer that recurs after surgery and is difficult to resect.

2. Surgical treatment of vulvar cancer

In general, surgical resection can be used to treat this disease. The surgical methods and scope of surgery include the following:

(1) Simple vulvar resection includes part of the clitoris, bilateral posterior perineum combined with the labia majora, and the margin is the outer edge of the labia majora. It has a depth of 2 cm of subcutaneous fat and retains the perineum and vagina.

(2) Radical resection of the vulva is performed from the upper genital to the lower vagina to the perineum. The incision of the skin on both sides of the labia majora is 3 cm away from the tumor, and the internal incision includes the removal of the 1 cm vaginal wall. Adductor myofascial fascia on both sides, pubic fascia (upper) on base, skin thickness <0.8cm.

(3) The radical resection of the local vulva includes the normal skin and subcutaneous adipose tissue 3cm away from the outer periphery of the cancerous foci, and the urethra or anus should not be damaged under the principle of removing at least 1cm normal tissue from the inner periphery. Partial vulvectomy can be unilateral vulvectomy, anterior vulvectomy or posterior vulvectomy. However, partial vulvar resection must ensure complete resection of the local cancerous lesions, and the depth of resection and the outer peripheral distance of the cancerous lesions are the same as radical resections.

(4) Inguinal lymph node dissection is performed from the anterior superior iliac spine 3cm, through the inguinal ligament midpoint abdominal artery pulsation point, to the vertical vertical incision of the femoral triangular tip, the thickness of the skin is 0.5cm, and the resection range is the external superior anterior superior iliac spine and suture. The articular surface, medial pubic tubercle, and adductor muscle surface were used to open the femoral tube, and the soft tissue lymph nodes on the surface of the femoral vein and medial adductor muscle were removed, including the Cloguet lymph node in the femoral tube, and the saphenous vein was ligated high.

(5) If pelvic peritoneal lymph node dissection is not required for pelvic organ resection, the operation should be performed extraperitoneally, and the scope of resection is the same as that of radical curettage of cervical cancer.

(6) Partial urethral resection followed by extensive vulvar resection of the specimen from the pubic symphysis, dissection of the pubic arch downwards, treatment of the clitoris foot, urethra free 2 cm from the pubic arch, and removal of part of the urethra under metal urethral support.

(7) Total urethral resection of bladder muscle flap urethroplasty.

(8) Anterior pelvic organ resection of the vulva involving the triangular area of the bladder, a total cystectomy, often at the same time a full palace plus anterior vaginal wall resection, urinary diversion.

(9) Posterior pelvic organ resection of vulvar cancer involves the anal canal, rectum or vaginal rectum, and abdominal and perineal resection of the rectum or part of the posterior vaginal wall. Sigmoid ostomy. Sometimes it is necessary to perform a total uterine and posterior vaginal resection.

3. Biotherapy

Surgery and radiotherapy and chemotherapy have the disadvantage of not being able to cure vulvar cancer. Surgery can only remove local lesions, which is easy to metastasize and recur. Radiotherapy and chemotherapy have large toxic and side effects, which can cause patients to have symptoms such as nausea and vomiting, resulting in damage to human immune function and severe contusion. Anti-cancer confidence.

In view of the disadvantages of surgical chemoradiotherapy, clinical bioimmunotherapy after vulvar cancer surgery can improve the functional status of the body and prevent metastasis and recurrence. Combined with radiotherapy and chemotherapy, it can improve the overall efficacy and reduce toxic and side effects, which is conducive to the early recovery of surgical injuries. . For patients with advanced vulvar cancer who are not suitable for surgery and chemoradiation, biological immunotherapy can be used as the main treatment method. By increasing the number of immune cells in the body, it can often achieve the purpose of reducing symptoms, improving quality of life, and prolonging life.