Vulva cancer. Treatment
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Significant advances have occurred in the management of squamous cell carcinoma of the vulva with the advent of conservation for unifocal lesions and limitation of pelvic lymphadenectomy. Now, full groin dissection can be avoided in some patients with stage IA vulvar carcinoma. In stage IB, contralateral groin dissection in patients with lesions smaller than 2 cm and negative ipsilateral nodes has been eliminated. Also, separate groin incisions are now used, which may reduce prolonged postoperative wound healing. The use of preoperative radiation therapy has reduced the need for exenteration in patients with advanced disease. The use of postoperative radiation to decrease the incidence of recurrence and to improve survival has been proven to be effective in a randomized trial in patients with two or more positive groin nodes. Cheap viagra super active.
Every effort should be made to reduce morbidity while retaining curative potential. Abandonment of en bloc resection with the butterfly incision, which has a significant wound separation of at least 50%, can reduce the morbidity of regional node dissection. The outcome after triple incisions is essentially equal to that of a single incision in early-stage disease.
The primary morbidities of radical vulvectomy and bilateral groin dissection are lymphedema and groin wound breakdown. Few intraoperative deaths occur, but there is a postoperative mortality rate of 5% because of the geriatric population affected. Radical vulvectomy is often complicated by problems associated with insufficient closure of a large skin defect contributing to postoperative necrosis of the suture line over the mons pubis and the inguinal areas. The gluteus maximus myocutaneous flap has been used to cover these defects. The perineal artery axial flap is useful in reconstruction of moderate defects of the perineum. Perhaps the most useful flap is a rhomboid transposition flap used to repair the perineal defect after surgery for carcinoma of the vulva.
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Age alone should not be a deterrent to surgical management of gynecologic malignant disease. Morbidity and mortality cannot be predicted from age, past history, type of operation, or preoperative laboratory studies. With careful perioperative management and attention to the unique problems of the elderly, acceptable surgical outcomes should be achieved.
Radiation therapy with megavoltage equipment using electron beam has been applied as primary treatment of extensive carcinoma of the vulva. In selected cases, radiation therapy may be given preoperatively to reduce disease and define surgical margins. Cheap hgh online at canadian pharmacy mall.