Invasive carcinoma of the vulva: changing trends in surgical management

Article Abstract:

Invasive cancer of the vulva (the external female genitalia) is rare, accounting for less than half of 1 percent of cancer deaths among women. As longevity increases, however, the rate will rise, and this will be especially apparent in geographical regions such as Florida that have a high proportion of elderly people. Improvements in survival have been made, and to learn more about optimal treatment approaches, the 34-year history of treating invasive carcinoma of the vulva by one clinician at several medical institutions is reviewed. Four hundred and fifteen patients (median age, 67) underwent primary surgery for invasive carcinoma of the vulva; a description is provided of the preoperative investigation protocol and the surgical approach. Results showed that patients at highest risk were white, nulliparous (had borne no children), and weighed over 154 pounds. Most patients' initial complaint was of severe itching. The surgical approach selected was based on the stage of disease. Seventeen (4 percent) of the patients died within 28 days of surgery, 10 of whom died of pulmonary embolism (blood clot in the pulmonary artery, which carries blood from the heart to the lung). Breakdown of the groin wound occurred in slightly more than half the patients; this complication is not difficult to treat. Sixty-seven percent of the 203 patients for whom data could be gathered survived at least five years, with greater survival if cancer was diagnosed at an early stage and if groin lymph nodes were negative for metastases (cancer spread); this group had an 85 percent survival rate. Nineteen of 57 patients who were followed to detect recurrence did suffer a recurrence. A comparison of various surgical approaches to cancer of the vulva is presented. Recurrence remains the most serious problem after surgical treatment, and earlier diagnosis can do much to improve survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Cancer, Vulvar cancer, Operations, Surgical, Vulvectomy

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Laser vaporization of grade 3 vaginal intraepithelial neoplasia

Article Abstract:

Vaginal intraepithelial neoplasia (VIN), abnormal tissue growth in the epithelial layer of the vagina, is treated in a number of different ways. These include excision of the neoplastic tissue, partial or total removal of the vagina, radiation therapy, and laser vaporization of the tumor. No one treatment has proven superior over the others in treating these types of tumors. This study examined the effectiveness of laser vaporization in treating grade 3 VIN. The medical records of 26 patients who had grade 3 VIN and who were treated either primarily or secondarily with laser vaporization were reviewed. Twenty of the 26 patients had previously undergone a hysterectomy. The VIN was located in the upper third of the vagina in 15 patients, in the upper half in another three patients, in the anterior mid-vagina in one patient, and at multiple sites in seven patients. VIN recurred in 11 (42 percent) of the patients, on average within 22 weeks of the treatment. All 11 of these patients had a hysterectomy previously and in 10 of these 11 patients, the VIN was located around vaginal cuff scar tissue. Three of the 11 patients also had invasive cancer. In 14 other patients, no recurrence was seen at follow-up that took place on average 117 weeks after treatment. These results suggest that laser vaporization is not an effective treatment for grade 3 VIN diagnosed in a region of vaginal cuff scar tissue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Lasers in surgery, Laser surgery, Vaginal diseases, Epithelial tumors

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The management of diaphragmatic lesions in ovarian carcinoma

Article Abstract:

Ovarian cancer is usually treated by removal of all diseased tissue possible, but a special problem is presented by malignancy that has invaded the diaphragm (the muscle that separates the abdominal cavity from the chest cavity housing the lungs). During the surgical removal of such tissue, care must be taken to avoid puncturing the pleural cavity, the space between the two layers of tissue covering the lung. Puncturing this cavity leads to pneumothorax, a condition in which air rushes into the pleural cavity and the lung collapses. A surgical technique is described that allows removal of diaphragmatic tumors that have grown into the pleural cavity. Its application to two cases is described; both women subsequently underwent chemotherapy with cisplatin. In one case, the patient remained free of disease for 17 months (until the report was written). The other patient developed a recurrence of cancer 13 months after surgery. The anatomy of the diaphragm is reviewed, and the potential complications of this surgical procedure are discussed. It can be performed by a gynecologist and does not require the skills of a thoracic surgeon. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Ovarian cancer, Diaphragm, Diaphragm (Anatomy), Thoracic cancer

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