Radical vulvectomy and groin nodes dissection for vulvar cancer - jaf abu - gynae solution

Radical vulvectomy and groin nodes dissection for vulvar cancer

This procedures removes part of the vulva, including the deep tissue. In a complete radical vulvectomy, the entire vulva and deep tissues, including the clitoris, are removed.

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At Gynae Solution, we will use plain language to explain what you have, what the treatment options are and what your prognosis is in terms you can understand.

Understanding Radical vulvectomy and groin nodes dissection for vulvar cancer

This is an operation to remove part or the whole of the vulva area might be necessary in very severe cases of cancer of the vulva.

This procedure will also normally involve removing the lymph nodes (glands) from the groins. When the patient presents with early stage disease, it may be possible to just remove only the site of cancer along with a small amount of normal tissue around the cancer to make sure all of the cancer have been completely removed. This procedure is referred to as Wide Local Excision (WLE).

In such situations, it may not also be necessary to remove all of the groin nodes. All that may be needed is an operative procedure called Sentinel Lymph Nodes Removal. This is a very popular procedure in breast cancer patients and is also now the standard of care in women with early stage vulvar cancer. This procedure only aims to remove 1 or 2 sentinel lymph nodes from the groin rather the whole of the glands. This reduces potential risks and side effects such as lymphoedema (swollen lower limbs), groin lympho-cyst (collection of fluid in the groin area), lower limb venous thrombosis (clots formation in your lower limbs) and also reduces the risk of wound breakdowns.

This is why it is always advisable to regularly perform self-examination of your vulvar area. Using a small mirror to inspect your vulva from time to time while lying on your back is all that is required. If you notice any unusual skin changes, itching, ulceration or swelling, you will need to see your gynaecologist. It is usually advisable not to remove any vulvar lesion in it’s entirety, until it has been seen and examined by a consultant gynaecological oncologist.

An incisional biopsy (a small biopsy from the lesion) rather than an excisional biopsy (removing the lesion in it’s entirety) is usually advised. This will make it less complicated for the gynae oncologist to manage if it was diagnosed as cancer. It allows him/her to actually see the cancer and make sure it is completely removed at the time of surgery. It also makes it easier to do the sentinel lymph node procedure.

When the cancer has been removed, identifying the sentinel lymph nodes becomes more difficult and the procedure is more likely to fail. This is because, you will need to be able to see the site of tumour to know exactly where to inject a special dye that would then help you to identify the sentinel lymph nodes in the groin areas.

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It's important to find a consultant who will listen to your concerns to help explain and answer any questions you might have.

What is a sentinel lymph node?

A sentinel lymph node is the first lymph node to which cancer cells are most likely to spread from the primary site of cancer. Sometimes, there can be more than one sentinel lymph node, and very rarely, more than 2.

A negative sentinel lymph node result suggests that cancer has not yet spread to nearby lymph nodes or other organs. Therefore, there will be no need to remove the other lymph nodes and most importantly, no need for further treatment with chemotherapy or radiotherapy.

A positive sentinel lymph node result indicates that cancer is present in the removed lymph node and that it may have spread to other nearby lymph nodes and, possibly, other organs. This information is important for 2 reasons: firstly, helps to  determine the stage of the cancer (extent of the disease within the body) and secondly, assists in developing an appropriate treatment strategy which could be in the form of a more extensive surgery or the addition of further treatment (chemotherapy/radiotherapy) or both.

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