Treatment of Vulvar Cancer
Best hospitals and doctors for vulvar cancer treatment abroad
Leading hospitals
Cost for treatment
One of the neoplasms women are most susceptible to in menopause, is vulvar cancer. Vulvar cancer includes different types of neoplasms localized on the outer surface of the female genitals.
Content
- Types
- Symptoms
- Metastasizing
- Diagnostics
- Treatment options
- Surgery
- Chemotherapy
- Radiation therapy
- Relapses
- Prognosis
- Best hospital for treatment abroad
- Cost of treatment for vulvar cancer
- Treatment abroad with Booking Health
Types
Based on the cell type, which vulvar cancer develops from, several diseases are distinguished. The therapeutic tactics of each pathology has its own peculiarities.
Malignant neoplasms are differentiated into two types, including vulvar squamous cell carcinoma and vulvar melanoma.
Symptoms
Now let's talk about how vulvar cancer manifests itself. Like most other cancers, vulvar cancer is asymptomatic at the initial stages, without causing severe health manifestations. Typically, women with vulvar cancer can experience certain health issues including:
- Irritation of the vulva
- Itching in the area
- Burning sensation
The listed symptoms are paroxysmal, and at night they increase markedly.
With vulvar cancer progression and the increase in the size of the neoplasm, the disturbance of the affected tissues trophism develops, and ulcerated areas begin to appear. The cover of the vulva swells, in some regions its integrity is violated. Pain and pathological discharge (serous or with impurities of blood or pus) arise. With deeper invasion, and especially with the localization of the tumor on the clitoris, the pain syndrome increases. Due to the destruction of a malignant formation, intense bleeding often develops, and the discharge acquires an odor.
Metastasizing
Vulvar cancer may spread through the lymphogenous pathway, affecting first the inguinal, and then the hypogastric and iliac lymph nodes. At the 3rd stage of the disease, the spread of the malignant process to the vagina, the lower region of the urethra, the anal area, and lymph nodes located on one body side can be observed. At the fourth stage, the bladder, the upper parts of the urethra, the rectum, and the lymph nodes located on both body sides are affected. At stage 4 of the diagnosis, the development of metastatic foci in distant organs, i.e. lungs, liver, and intestines, is diagnosed.
At the advanced stages, the patient experience:
- Intense pain
- Subfebrile temperature
- Fatigue, weakness
- Depression and mood changes
As a rule, multiple regional and distant metastases are detected at the advanced stages of the diagnosis. In this case, palliative chemotherapy or radiation is used, aimed at relieving painful symptoms, improving the condition, and prolonging the patient's life.
Diagnostics
Since the main method of primary diagnosis making is still a gynecological examination, it is necessary to visit a doctor regularly for the timely detection of dangerous pathology and the start of vulvar cancer treatment. During the examination, the doctor detects small nodules, ulcers, pigmented plaques in the external genital area, which are noticeably different in color from healthy areas.
For a detailed examination of suspicious areas, vulvoscopy is used. Also, microscopic and cytological laboratory analyses of tissues obtained from the surface of the neoplasm and the vagina are performed. To make the final diagnosis, a biopsy of the vulva is performed and material is harvested for subsequent histological analysis.
To determine the stage of the oncological process, the degree of metastatic affection of regional lymph nodes and distant organs, the patient undergoes the following examinations:
- Ultrasound scan of the abdominal and pelvic organs
- Chest X-ray
- If necessary, cystoscopy, rectoscopy, and anoscopy
Treatment options
Vulvar cancer treatment is one of the difficult spheres of gynecological oncology. In the vulvar cancer treatment options, pathogenetic approaches have not been elaborated yet. Vulvar cancer treatment is prescribed strictly individually; the integrated approach is used. Radiation therapy is prescribed in 10% of women; these are women with health contraindications for extended surgery. No more than 4% of patients with vulvar cancer may undergo chemotherapy when there are health contraindications to surgical treatment.
In general, vulvar cancer includes the following treatment options:
- Surgical removal of tissues (local excision of malignant cells and adjacent tissues, vulvectomy, removal of lymph nodes, etc.)
- Photodynamic treatment (destruction of atypical cells by focused light)
- Laser ablation (vaporization of malignant cells with a laser beam)
- Chemotherapy and radiation therapy
Surgery
Considering the course of pathology, peculiarities of the specific clinical case, doctors give preference to conducting organ-preserving surgery. Such interventions allow preserving the normal appearance of the organs, avoid disturbance of urination and defecation (which is of great importance since vulvar cancer may be located near structures responsible for the above).
Stage 1. How to treat vulvar cancer may depend on the degree of spread and invasiveness of the neoplasm. As a rule, a radical vulvectomy is performed (removal of the labia majora and small labia) in combination with unilateral lymphadenectomy.
Stage 2. Radical vulvectomy in combination with bilateral lymphadenectomy (inguinal and femoral lymph nodes are removed) is conducted. When oncopathology is detected in the clitoris area, the surgery of the inguinal and iliac lymph nodes is performed (in most cases, bilateral one).
Stage 3. After assessing the operability of the patient, a radical vulvectomy is performed, as well as bilateral surgery for the inguinal, femoral, and iliac lymph nodes in combination with adjuvant (postoperative) external radiation therapy.
Stage 4. At this stage, surgery for vulvar cancer treatment is possible only in separate cases, with moderate involvement of neighboring organs in the malignant process. If surgery is possible, it is supplemented by pelvic exenteration. The latter surgery is traumatic and is performed only when the oncological disease spreads to the pelvic organs. In case of unresectability, the patient with vulvar cancer may receive a course of preoperative radiation and chemotherapy first.
Separately, lymphadenectomy has to be considered. Relatively recently, the intervention to excise regional lymph nodes was mandatory. The vulvar cancer treatment today has changed. It’s now proved that there’s the so-called main lymphatic group, which is the first to be involved into the malignant process. And if it turns out that it is not affected by the metastases, this means that all other lymph nodes are also healthy, and surgery for the whole adjacent lymph nodes complex is simply unnecessary.
Chemotherapy
For the vulvar cancer treatment, no universal chemotherapy regimens were developed. Chemotherapy is used:
- Prior to surgery – this type of cancer treatment is aimed at reducing the size of the neoplasm to transform the disease from an inoperable type to an operable one.
- After surgery – the goal is to treat the malignant cells preserved in the body after the operation, to prevent relapse. It is recommended to carry out 6 courses or continue chemotherapy until the disease regresses.
Radiation therapy
Radiation therapy for vulvar cancer treatment is prescribed:
- Before surgical treatment
- After surgery kn order to prevent relapse
- As the only method to treat vulvar cancer, when regional lymph nodes are affected
- In combination with chemotherapy or separately in presence of health contraindications to surgical treatment
- At the early stages, laser, radiofrequency or electrical ablation of the vulva is also used
Relapses
Recurrence after vulvar cancer treatment occurs on average in 24-30% of cases after primary surgery with or without radiation therapy.
About 80% of vulvar cancer recurrences occur within the first two years after the completion of the initial cancer treatment, mostly during the first 12 months.
This is why women after vulvar cancer treatment should undergo follow-up examination in order to detect early and potentially curable relapse. Besides, patients are advised to self-monitor the condition of the vulva in order to detect any changes early.
Relatively small prevalence of this oncology type, combined with a low recurrence rate, makes it difficult to conduct randomized clinical trials and develop optimal therapeutic strategy and treatment options.
Prognosis
How quickly vulvar cancer may develop and how long can a patient live with this disease?
The answers to these questions depend on many factors, first of all, on the timeliness of the diagnosis making and the success of the cancer treatment. The aggressiveness of the neoplasm differs depending on its localization. Clitoris cancer is considered the most aggressive. Malignant lesions of the labia minora have the most favorable prognosis, and the danger of a tumor on the labia majora occupies an intermediate position.
Best hospital for treatment abroad
Choosing hospitals for treatment abroad is extremely important, but by no means should be a difficult part of the process. Judged solely by statistical indicators of success in vulvar cancer treatment abroad, hospitals in Germany, Switzerland, and Israel are some of the best. Other destinations for treatment options (without devaluing the quality of cancer treatment) might be hospitals in Turkey and South Korea, that are in high demand among medical tourists.
Well-equipped and reputable hospitals should be the choice suitable for such treatment. A prerequisite for the success of treatment abroad is qualified specialists of the hospitals.
We suggest paying attention to the following hospitals:
- University Hospital Rechts der Isar Munich, Germany
- University Hospital Tuebingen, Germany
- Leverkusen Clinic, Germany
- University Hospital Ulm, Germany
- University Hospital Carl Gustav Carus Dresden, Germany
- University Hospital Heidelberg, Germany
You are welcome to check out the profiles of hospitals on the Booking Health website.
Cost of treatment for vulvar cancer
Several preparatory measures need to be conducted before starting the treatment in foreign hospitals. Without necessary documentation and medical reports, it will be impossible to correctly assess the services hospitals will need to provide.
The price policy is another issue that may differ significantly in two hospitals of the same country. But if we deduce the average cost of treatment options then the numbers are as follows.
The cost of treatment of vulvar cancer with partial vulvectomy starts at 10,208 EUR.
The cost of treatment of vulvar cancer with surgical vulvectomy starts at 10,211 EUR.
The cost of treatment of vulvar cancer with radical vulvectomy and lymphadenectomy starts at 19,080 EUR.
The minimal price for diagnostics of vulvar cancer is 1,749 EUR.
You may find prices for other treatment options on the Booking Health website.
Treatment abroad with Booking Health
Booking Health is the company providing services of medical tourism.
We strive to make treatment abroad as affordable as possible. Booking Health medical advisors will find the best options for treatment abroad for you.
With vulvar cancer, it’s necessary to be confident in the professionalism of clinicians. With Booking Health, you are free of worry. We select for you only highly qualified doctors and only comfortable conditions for staying abroad.
If you’d like to know more about mentioned services, please leave a request on the Booking Health website.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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