Treatment of vulvar cancer abroad

Vulvar cancer is a malignant tumor of the external part of female genital organs. This cancer is on the fourth place in gynecologic oncology after endometrial cancer.


Disease is mainly diagnosed in the elderly over 65 years old and is rarely met in women of reproductive age.


Causes of vulvar cancer

Risk factors of vulvar cancer are:

  • Age of 60-70 years old
  • Late onset of menstruation (15-17 years old)
  • Early onset of the menopause (before the age of 40)
  • Papillomavirus infection
  • Smoking
  • AIDS


Tumor is often occurs as a consequence of precancerous conditions and vulvar illnesses including:

  • Kraurosis
  • Leukoplakia
  • Dysplasia
  • Atrophic vulvitis
  • Sclerotic lichen
  • Papillomatosis
  • Erythroplasty
  • Bowen's disease
  • Paget's disease


vulvar cancer symptoms


Symptoms of vulvar cancer

Clinical course of vulvar cancer may differ, but the most common signs are:

  • Itching in the genital area is the very first symptom that occurs in 65% of patients
  • Pain in the genitals
  • Discharge from the genital tract - clear or bloody
  • As the tumor grows, the discharge can become purulent


The next group of symptoms develops as a result of regional metastasis of vulvar cancer into neighboring anatomical structures:

  • Pubic edema
  • Edema of one or both lower limbs
  • Urinary incontinence or urinary retention


Intoxication syndrome can be also observed. It is manifested by fever, weakness, quick fatigue.


Following vulvar cancer symptoms are detected during diagnostics:

  • Thickening of the skin in the area of the pathological process location
  • Palpable malformation
  • Presence of ulcers on the lining


vulvar cancer diagnostics


Diagnostics of vulvar cancer

Vulvar cancer is a generalized name for tumors of different localization that can occur in:

  • Clitoris (the most dangerous form of cancer)
  • Small labia (the most favorable type of tumor)
  • Large labia (the most common form of vulvar cancer making 60% of all primary tumor localization cases)
  • Bartholin glands (the rarest type of cancer, which is only 1% of the total number)


"Vulvar cancer" term is used in diagnostics because all the anatomical structures of the external reproductive organs are close to each other. Tumor may sprout into the neighboring tissues making it impossible to define its primary location.


Diagnosis is established after the cytological test of a smear from the reproductive organs. Also biopsy (tissue sample test) is done.


Visualization techniques are done to evaluate the level of pathological process prevalence. These help to determine tumor size and detect possible metastases:

  • Ultrasound
  • CT
  • MRI
  • PET


German hospitals provide all high-tech diagnostic techniques for the vulvar cancer which allows doctor to obtain maximum information about the disease and chose the best treatment scheme possible.


Some women are ordered diagnostic laparoscopy if they have advanced stages of cancer. Video endoscopy equipment is introduced into the small pelvis cavity, and the image of the organs “from the inside” is viewed on the monitor. Laparoscopy is an invasive method of research, but at the same time it is one of the most accurate ways to determine the prevalence of vulvar cancer, to detect metastases and to plan the scope of a surgical operation.


vulvar cancer treatment abroad


Treatment of the vulvar cancer abroad

Surgery is a key way to treat this type of cancer. Its scope is determined by the tumor location, its prevalence and size.


If a tumor is at the first stage, surgeon will perform one of the next operations:

  • Simple vulvectomy is a removal of the vulvar structures affected by the tumor process, retreating 0.5 cm from the edge of pathologically altered tissues
  • Radical excision of the vulva is used for microinvasive treatment (germination in the tissues no more than 5 mm) and involves a significant removal of the surrounding healthy tissues
  • Bilateral or unilateral (on one side) lymphadenectomy (removal of the lymph nodes) is performed,if indicated


Bilaterial lymphadenectomy is mandatory starting from the second stage of cancer. Also, radiation therapy is used postoperatively for the following indications:

  • Presence of two or more micro metastases into inguinal lymph nodes (according to post-operative histological examination)
  • Presence of at least one macro metastasis (more than 1 cm in diameter)
  • Extracapsular tumor growth


Radiation therapy or chemotherapy is possible before the operation to improve tumor resection. Results of treatment are analyzed by a surgeon. Oncology surgeon decides on the possibility of the intervention.


Volume of operation can be significant at the third stage. Sometimes they remove a bladder, rectum fragment or other organs where a tumor has already affected. Doctors apply intraoperative intra-cavity gamma-therapy (irradiation) to improve treatment effectiveness.


vulvar cancer innovative treatments


Innovative treatments of vulvar cancer

Doctors are trying to minimize the amount of surgical treatment of stage 1 vulvar cancer, and even completely reject it in recent years. It is possible to perform laser ablation, photodynamic therapy, or combinationof those two instead of vulvectomy.


Such therapy is better tolerated by a patient, has low risk of complications and ensures quick recovery. Meanwhile, effect is the same as after the surgery.


Clinical trials are conductedto study some medicines that are planned to be included into the pharmacotherapy scheme of vulvar cancer treatment. These drugs allow increasing patients’ life expectancy.


Today, such target therapy medicines that are in clinical trials:

  • Erlotinib
  • Cetuximab, including in combination with Ciplatin


New approaches in the comprehensive treatment of the patients with locally advanced vulvar cancer are being developed. This involves simultaneous use of surgery, chemotherapy and radiation therapy. 


vulvar cancer prognosis


Prognosis for vulvar cancer

General 5-year-survival of patients depending on the pathological process prevalence is:

  • Vulvar cancer without metastases – 86%
  • Vulvar cancer with regional metastases - 54%
  • Vulvar cancer with distant metastases - 16%


Prognosis depends not only on the disease stage, but also on the primary location of a tumor. The most favorable prognosis is for those having vulvar cancer restricted by the small labia area. The worst prognosis is peculiar for those having clitoral cancer, because it quickly gives distant metastases in hematogenous (through the blood) way, bypassing the lymphatic system.



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