Vulvar cancer

Treatment

Surgery

Vulvar surgery
Radical total vulvectomy: treatment aimed at removing the entire vulva (labia majora and minora, clitoris), the superficial muscles of the vulva and the cellulofatty tissues down to the deep pelvic plane and fascias.

Partial vulvectomy, lateral (or hemivulvectomy), anterior or posterior, for localized forms (stage I).

Enlarged resections (with surgery on the urinary or digestive systems) in the event of extension to neighboring organs.

The particularity of this surgery is that it is often complicated by disunity of scars, long healing, secondary infections due to the proximity of stools and urine, and sometimes the fragility of the patient.

Reconstructive surgery
Since excision surgery can sometimes be mutilating, reconstruction is possible using skin flap transfers or skin and muscle transfers from the abdomen or thigh.

Node surgery
It is often recommended to perform excision of the inguinal lymph nodes (inguinal lymphadenectomy). However, there is an alternative, scientifically validated: the sentinel lymph node technique (link to the specific chapter).

The sentinel lymph node technique.
This is a practice whose principle is to know the lymph node status of the disease by taking the first relays of the inguinal lymph node chain, thus avoiding total lymph node dissection and its complications.
This requires detecting the first lymph nodes.

This detection is twofold:
-isotopic: a radioactive product is injected into the tumor the day before the nuclear medicine intervention, tracking images are taken the next day before the intervention, and the surgeon locates them in the operating room during the intervention at the using snapshots and a detection probe.
- colorimetric: once the patient is asleep, the surgeon injects a dye into the tumor. The latter will then migrate to the lymph nodes which will be easily identified by their bluish coloring.

The duration of hospitalization varies from a few days to 2 weeks depending on the case and in the absence of complications. Most often drains and a urinary catheter will be left in place and local care will be carried out several times a day by the nursing team.
A home nurse is most often necessary, as well as follow-up visits to check healing and adapt nursing care.
A second intervention is sometimes necessary in view of the microscopic results generally available after 3 weeks

Medical treatments

In some cases, after discussion in a multidisciplinary consultation meeting, it may be proposed to perform radiotherapy or chemotherapy.

Need to adapt the treatment according to the patient

Treatments, in particular surgical treatments, can be particularly dilapidating and heavy, especially in elderly or very elderly women, and we are sometimes required to perform surgical procedures for the sole purpose of comfort.

Vulvar cancer, which is rare, requires all the more care in a specialized environment which takes care of many women with this tumour. A multidisciplinary team that can involve specialized surgeons, radiotherapists, medical oncologists, nurses specialized in wound healing, geriatric oncologists, pathologists, and dermatologists.