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Robison K, Kulkarni A, Dizon DS. Sexual Health in Women Affected by Gynecologic or Breast Cancer. Obstet Gynecol 2024; 143:499-514. [PMID: 38207333 DOI: 10.1097/aog.0000000000005506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/29/2023] [Indexed: 01/13/2024]
Abstract
Sexual health problems are prevalent among women affected by gynecologic or breast cancer. It is important to understand the effects cancer treatment can have on sexual health and to have the tools necessary to identify and treat sexual health problems. This Clinical Expert Series discusses practical methods for routinely screening for sexual dysfunction and reviews sexual health treatment options for women affected by cancer. We review the limitations of the current literature in addressing sexual health problems among sexually and gender minoritized communities. Finally, we discuss appropriate timing of referrals to sexual health experts, physical therapists, and sex therapists. Multiple resources available for both patients and clinicians are included.
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Affiliation(s)
- Katina Robison
- Tufts Medical Center, Boston, Massachusetts; Columbia University, New York, New York; and the Lifespan Cancer Institute and Legorreta Cancer Center, Brown University, Providence, Rhode Island
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Morrison J, Baldwin P, Hanna L, Andreou A, Buckley L, Durrant L, Edey K, Faruqi A, Fotopoulou C, Ganesan R, Hillaby K, Taylor A. British Gynaecological Cancer Society (BGCS) vulval cancer guidelines: An update on recommendations for practice 2023. Eur J Obstet Gynecol Reprod Biol 2024; 292:210-238. [PMID: 38043220 DOI: 10.1016/j.ejogrb.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
| | - Peter Baldwin
- Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Adrian Andreou
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Department of Gynae-Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, East Yorkshire HU16 5JQ, UK; Perci Health Ltd, 1 Vincent Square, London SW1P 2PN, UK. https://www.percihealth.com/
| | - Lisa Durrant
- Radiotherapy Department, Beacon Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Katharine Edey
- Centre for Women's Health Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
| | - Asma Faruqi
- Department of Cellular Pathology, The Royal London Hospital, Barts Health NHS Trust, London E1 2ES, UK
| | - Christina Fotopoulou
- Department of Cellular Pathology, The Royal London Hospital, Barts Health NHS Trust, London E1 2ES, UK; Gynaecologic Oncology, Imperial College London Faculty of Medicine, London SW7 2DD, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | - Kathryn Hillaby
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire, Hospitals NHS Foundation Trust, GL53 7AN, UK
| | - Alexandra Taylor
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
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Olesen ML, Seibaek L, Sekse RJT. Impaired sexual health among women treated for vulvar cancer: An integrated review. J Clin Nurs 2023; 32:6212-6228. [PMID: 37221928 DOI: 10.1111/jocn.16753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Although gynaecological cancer's negative effects on sexual function are well known, most studies on the subject have not included vulvar cancer patients or a multidimensional perspective on sexual health. Therefore, this review aimed to address this research gap and explored the impact of vulvar cancer on women's sexual health from a multidimensional perspective. METHODOLOGY An integrated review was conducted, as described by Whittemore and Knafl. The PubMed, CINAHL, PsycINFO and Embase databases were searched in March 2021 and updated in August 2022 and March 2023. The data were thematically analysed using NVivo, and the PRISMA-ScR and ENTREQ guidelines were followed. FINDINGS The following themes were identified in the 28 reviewed articles: impact of a changed female body, impact on women's sexual identity, consequences for women's sexual relationships and unmet needs and loneliness caused by taboos about sexual health. DISCUSSION Women's impaired sexual health after vulvar cancer points to a great need to understand and holistically investigate sexual health. In addition, healthcare professionals have an obligation to care for the sexual health issues of patients with vulvar cancer. However, most questionnaires used in the selected studies revealed a narrow understanding of sexual health and focused on sexuality as a genital activity. CONCLUSION The sexual health of women with vulvar cancer was tabooed and stigmatised for patients and healthcare professionals. Consequently, women received sparse sexual guidance, felt isolated and had unmet needs. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals need knowledge and training on how to break taboos and address the sexual needs of vulvar cancer patients. Systematic screenings for sexual health needs should be conducted using a multidimensional perspective. TRIAL AND PROTOCOL REGISTRATION The protocol was preregistered at the Open Science Framework (www.osf.io), registration DOI: https://doi.org/10.17605/OSF.IO/YDA2Q PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Affiliation(s)
- Mette Linnet Olesen
- Department of Gynecology, The Interdisciplinary Research Unit of Women's Children's and Families´ Health, Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Institute of Health and Nature, Ilisimatusarfik, University of Greenland, Nuuk, Greenland
- Affiliated to Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
- Research Centre for Patient Involvement (ResCenPi), Aarhus University, Aarhus, Denmark
| | - Ragnhild Johanne Tveit Sekse
- VID Specialized University, Faculty of Health Sciences, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Vivod G, Bosnjak M, Kovacevic N, Sersa G, Merlo S, Cemazar M. Safety and Feasibility of Vulvar Cancer Treatment with Electrochemotherapy. Cancers (Basel) 2023; 15:3079. [PMID: 37370690 DOI: 10.3390/cancers15123079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Electrochemotherapy is a local ablative therapy used for the treatment of various superficial and deep-seated tumors. Electrochemotherapy involves the application of electric pulses locally to tumors to destabilize cell membranes and facilitate the entry of cytotoxic drugs, thereby enhancing their cytotoxicity locally. The aim of our study is to investigate the safety and feasibility of electrochemotherapy in patients with vulvar cancer recurrence used for nonpalliative purposes. Ten patients with single local vulvar cancer recurrence were treated with intravenous bleomycin, followed by a local application of electric pulses (electrochemotherapy) to the tumor. Adverse events were determined using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The feasibility of treating vulvar cancer with electrochemotherapy was determined by an appropriate selection of electrodes based on the size and location of the tumor with safety margins included. Electrochemotherapy was feasible in all patients. No electrochemotherapy-related or other serious adverse events occurred. Our data suggest that electrochemotherapy is a feasible and safe technique for the treatment of vulvar cancer recurrence for nonpalliative purposes. Based on our results, electrochemotherapy might be a viable therapeutic tool for patients who would otherwise undergo surgery involving a mutilation of the external genitalia.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, 6000 Izola, Slovenia
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Perrone AM, Corrado G, Coada CA, Garganese G, Fragomeni SM, Tagliaferri L, Di Costanzo S, De Crescenzo E, Morganti AG, Ferioli M, De Terlizzi F, Scambia G, De Iaco P. Electrochemotherapy with intravenous bleomycin for heavily pre-treated vulvar cancer patients. Int J Gynecol Cancer 2023; 33:473-481. [PMID: 36787933 DOI: 10.1136/ijgc-2022-004127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE The management of vulvar cancer recurrences is complicated by patients' advanced age and comorbidities. Bleomycin-based electrochemotherapy is a potential treatment option in this setting. However, no data on long-term outcomes are available. Therefore, a multicenter observational study was designed to evaluate the 5-year results in these patients. METHODS Data about patients and tumor characteristics, electrochemotherapy cycles, clinical response, and follow-up were recorded. Treatment procedures were performed according to the European Standard Operating Procedures of Electrochemotherapy (ESOPE) guidelines. Response was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. RESULTS Fifty-one patients (mean age 82.31±7.28 years) with squamous cell vulvar cancer underwent electrochemotherapy (median number of sessions 1; range 1-4). 20 patients had complete response and 32% of these were disease-free after 2 years (median progression-free survival 16.8 months). In 13 patients with partial response the median progression-free survival was 15.36 months, while patients with stable or progressive disease showed tumor relapse after 6.95 and 3.26 months, respectively (p<0.001). Median overall survival was 18.77, 13.07, 6.73, and 11.13 months in patients with complete response, partial response, stable disease, and progressive disease, respectively (p=0.001). CONCLUSION Long-term follow-up of vulvar cancer patients showed reasonable tumor control after electrochemotherapy and improved progression-free survival and overall survival in responder subjects compared with non-responders. Further studies aimed at improving local response after electrochemotherapy are warranted. Thus, this approach represents a potential alternative for these patients.
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Affiliation(s)
- Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Corrado
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Maria Fragomeni
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stella Di Costanzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Italy
| | - Eugenia De Crescenzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Martina Ferioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Vulvar Paget's disease: outcomes of 51 patients treated with imiquimod cream. Maturitas 2022; 163:23-27. [DOI: 10.1016/j.maturitas.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
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O'Neill D, Evans M, Nunns D, El-Ghobashy A. Vulval extra-mammary Paget's disease: the master of disguise revealed. Br J Hosp Med (Lond) 2022; 83:1-12. [DOI: 10.12968/hmed.2021.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Extra-mammary Paget's disease is a rare cancer affecting the anogenital region and can present with a myriad of symptoms. In women, the diagnosis of Paget's disease can be challenging as it mimics several other vulval conditions. It is important to promptly recognise this disease because of its potential association with synchronous tumours, such as colorectal adenocarcinoma. The mainstay of treatment is with immunomodulating therapies or surgery, but unfortunately the risk of recurrence is high and appears to be independent of treatment choice and tissue margin status. There is growing evidence to move away from traditional surgical excision to using topical therapy, such as imiquimod, as surgery can often be extensive and disfiguring with a prolonged recovery time. There is considerable psychosexual and physical morbidity associated with Paget's disease, largely owing to multiple surgical recurrences. As recurrences can occur several years after the initial presentation, long-term follow up of patients is recommended.
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Affiliation(s)
- Danielle O'Neill
- Department of Gynaecology Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Matthew Evans
- Department of Pathology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - David Nunns
- Department of Gynaecology Oncology, Nottingham University Hospitals Trust, Nottingham, UK
| | - Alaa El-Ghobashy
- Department of Gynaecology Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Complications and risk factors in vulvar cancer surgery – A population-based study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1400-1406. [DOI: 10.1016/j.ejso.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 02/04/2023]
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Ouh YT, Kang D, Kim H, Lee JK, Hong JH. Prevalence and Treatment of Vulvar Cancer From 2014-2018: A Nationwide Population-Based Study in Korea. J Korean Med Sci 2022; 37:e25. [PMID: 35075824 PMCID: PMC8787801 DOI: 10.3346/jkms.2022.37.e25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vulvar cancer is one of the rare gynecologic malignancies. Despite the recent increasing trend of vulvar cancer in western countries due to the increased infection of human papillomavirus, there has been no study for population-based incidence of vulvar cancer in Korea. We aimed to investigate the prevalence and treatment of vulvar cancer in South Korea between 2014 and 2018. METHODS Data from patients diagnosed and treated with vulvar cancer between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (National In-Patient Sample) in South Korea. RESULTS A total of 4,636,542 women were identified through the HIRA-NIS database from 2014 to 2018, of which 259 patients were diagnosed and treated for vulvar cancer. The mean age diagnosed with vulvar cancer was 62.82 (± 14.30) years in 2014, 64.19 (± 16.79) years in 2015, and 67.40 (± 14.41) years in 2016. In terms of treatment modalities, the most frequent treatment was surgery only without chemotherapy or radiation therapy. In the age-specific prevalence analysis, vulvar cancer was the most prevalent among those over 70 years old. According to multiple regression analysis, patients' age was significantly associated with the prevalence of vulvar cancer. Vulvar cancer was more prevalent in women with low socioeconomic status (SES) compared to those with high SES in 2018 (OR, 4.242; P < 0.001). CONCLUSION Considering the high prevalence of vulvar cancer in the elderly, it is necessary to establish a new strategy for early screening and treatment.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, Korea
| | - Hoseob Kim
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Seoul, Korea.
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10
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Zeitoun J, Calvary M, Bonneau C, Rouzier R. Impact of Vulvar Cancer Surgery on Quality of Sex Life: A Review of Literature. J Low Genit Tract Dis 2022; 26:38-42. [PMID: 34798652 DOI: 10.1097/lgt.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Vulvar cancer is a gynecological cancer for which posttreatment morbidity must be known to propose the appropriate medical strategy. The objectives of this article were to review and to summarize the available studies evaluating the impact of vulvar surgery on the quality of sex life. MATERIALS AND METHODS We searched MEDLINE abstracts (source PubMed) and included all studies published between 1990 and 2020 that evaluated the impact of vulvar surgery on the patients' sex life. Articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We evaluated the quality of the studies using the "study quality assessment tools" established by the National Heart Lung and Blood Institute and the health-related quality-of-life score. Summary statistics were used to report the results of the studies selected. RESULTS A total of 41 articles were screened, and 15 studies were included in this review. Two questionnaires, that is, European Organization for Research and Treatment of Cancer QLC C30 and Female Sexual Function Index, were used in 60% of the studies. The quality of the studies was heterogeneous. None of them had a high level of evidence. Eleven of the 16 studies reported an impairment of quality of sex life, mainly related to the size of the initial lesion and the type of surgery performed. Preoperative sexual status, that is, active sex life, age, and morbidity seemed to be important factors. CONCLUSIONS None of the studies had a high level of evidence, and their methodological quality was heterogeneous. More powerful studies using validated questionnaires are necessary. Because this is essential surgery, patients should be informed that if it impacts their sexual life, management strategies will be part of their postoperative care.
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Affiliation(s)
- Jeremie Zeitoun
- département d'oncologie chirurgicale, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Marjolaine Calvary
- département d'oncologie chirurgicale, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Claire Bonneau
- département d'oncologie chirurgicale, Institut Curie, PSL Research University, Saint-Cloud, France
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Malandrone F, Bevilacqua F, Merola M, Gallio N, Ostacoli L, Carletto S, Benedetto C. The Impact of Vulvar Cancer on Psychosocial and Sexual Functioning: A Literature Review. Cancers (Basel) 2021; 14:cancers14010063. [PMID: 35008225 PMCID: PMC8750175 DOI: 10.3390/cancers14010063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The diagnostic and therapeutic pathway of vulvar cancer impacts severely on the psychosocial and psychosexual equilibrium of women affected by it. The current literature shows the presence of depressive and anxious symptoms in association with physical, psychological and behavioural alterations in sexuality as well as deterioration of partner relationship. The aim of this article is to highlight the difficulties and challenges faced by women diagnosed and treated for vulvar cancer to provide early recognition and appropriate assistance. By implementing an integrated care model, it should be possible to detect unmet needs and improve the quality of life of these women. Abstract Women who are diagnosed and treated for vulvar cancer are at higher risk of psychological distress, sexual dysfunction and dissatisfaction with partner relationships. The aim of this article is to provide a review of the psychological, relational and sexual issues experienced by women with vulvar cancer in order to highlight the importance of this issue and improve the quality of care offered to these patients. A review of the literature was performed using PubMed, CINAHL, PsycINFO, and the Cochrane Library. The results are presented as a narrative synthesis and highlight the massive impact of vulvar cancer: depressive and anxiety symptoms were more frequent in these women, and vulvar cancer may have a negative effect on sexuality from a physical, psychological and behavioural point of view. Factors that may negatively affect these women’s lives are shame, insecurity or difficulties in self-care and daily activities. This review highlights the psychosocial and psychosexual issues faced by women diagnosed and treated for vulvar cancer, although more studies are needed to better investigate this field of interest and to identify strategies to relieve their psychological distress. Care providers should implement an integrated care model to help women with vulvar cancer recognise and address their unmet needs.
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Affiliation(s)
- Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy
| | - Federica Bevilacqua
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
| | - Mariagrazia Merola
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy
| | - Niccolò Gallio
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
| | - Sara Carletto
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy
| | - Chiara Benedetto
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
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12
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Thangarajah F, Rogeé K, Pahmeyer C, Kuhr K, Schmidt M, Fridrich C, Morgenstern B. Morbidity and quality of life in patients with vulvar cancer after inguinal sentinel lymphadenectomy compared to radical inguinofemoral lymphadenectomy. Nuklearmedizin 2021; 60:368-374. [PMID: 34169496 DOI: 10.1055/a-1491-6405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Probability of survival of patients with vulvar cancer directly depends on the lymph node status. Surgery of lymph nodes can be performed as radical inguinofemoral lymphadenectomy or in cases with certain conditions as sentinel lymph node surgery. The aim of this study is to obtain an overview of the intervention-related morbidity and quality of life in patients with vulvar carcinoma after lymphadenectomy. METHODS Quality of life and morbidity was compared between patients who underwent radical inguinofemoral lymphadenectomy with those who underwent sentinel lymph node surgery. RESULTS All recorded postoperative complications occur more frequently in the non-sentinel group, Significant difference was shown for the occurrence of lymphedema (p-value = 0.024) and sensitivity loss (p-value = 0.024). Recurrence of disease was more frequent in the non-sentinel group (38 % vs. 20 %, p = 0.621, n.s.) and satisfaction with groin surgery is slightly higher in the sentinel group (94 % vs. 89 %, p = 1.000, n.s.). CONCLUSION We could demonstrate a significantly lower morbidity of sentinel lymphadenectomy compared to conventional inguinofemoral lymphadenectomy while maintaining the same oncological safety. The low morbidity of sentinel- lymphadenectomy does not seem to influence the postoperative quality of life significantly. However, recording of the individual burden of lymphadenectomy by questionnaires should be optimized.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany
| | - Kristina Rogeé
- Department of Gynecology and Obstetrics, GFO Clinic Rhein-Berg; Vinzenz-Pallotti-Hospital, Bergisch Gladbach-Bensberg, Germany
| | - Caroline Pahmeyer
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics and Computational Biology, University of Cologne, Germany
| | | | - Claudius Fridrich
- Department of Gynecology and Obstetrics, Heilig-Geist-Krankenhaus, Cologne, Germany
| | - Bernd Morgenstern
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany
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13
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Liu J, Wang M. Development and validation of nomograms predicting cancer-specific survival of vulvar cancer patients: based on the Surveillance, Epidemiology, and End Results Program. Int J Gynaecol Obstet 2021; 156:529-538. [PMID: 33899929 DOI: 10.1002/ijgo.13722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore potential prognostic factors and develop nomograms to predict the cancer-specific survival of patients with vulvar squamous cell carcinoma (SCC) and patients with vulvar melanoma. METHODS Cases of vulvar SCC and melanoma were retrieved from the Surveillance, Epidemiology, and End Results (SEER) Program, and randomly segregated into training and test sets. Based on the training set, univariate and multivariate Cox proportional hazard regressions evaluate the association between key demographic/clinical characteristics and vulvar cancer survival. Potential prognostic factors were included to construct nomograms for the prediction of 3-year and 5-year survival probabilities. RESULTS Age, tumor size, stage, surgery, and chemotherapy were potential factors associated with vulvar cancer survival. The C-indices for the training and test sets were 0.82 and 0.81 for SCC, and 0.73 and 0.70 for melanoma. Calibration curves revealed correlated agreements between nomogram-based probability and actual survival status. CONCLUSION Nomograms were developed to predict cancer-specific survival of patients with vulvar cancer, accordingly identifying the subgroup at high risk of cancer-specific mortality.
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Affiliation(s)
- Jin Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Mengqiao Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
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Preti M, Micheletti L, Borella F, Cosma S, Marrazzu A, Gallio N, Privitera S, Tancredi A, Bevilacqua F, Benedetto C. Vulvar Paget's disease and stromal invasion: Clinico-pathological features and survival outcomes. Surg Oncol 2021; 38:101581. [PMID: 33892433 DOI: 10.1016/j.suronc.2021.101581] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate clinico-pathological features, treatments and survival outcomes of vulvar Paget's disease (VPD). METHODS We retrospectively reviewed VPD diagnosed between 1983 and 2018 at the Department of Surgical Sciences, Sant'Anna Hospital, Turin. Clinico-pathological characteristics and surgical treatment outcomes were investigated according to the depth of invasion. RESULTS A total of 122 patients were identified. Eighty-seven patients were diagnosed with intraepithelial VPD, 22 with microinvasive (<=1 mm) VPD and 16 with invasive VPD. The median follow-up was 94.6 months (interquartile range 25th-75th, 26-120). Most of patients 95/122 (77%) were treated by surgery. Local recurrence was observed in 69/95 (73%) patients without significant difference between the 3 groups (p = 0.33), however, total vulvectomy showed better local control in microinvasive and invasive VPD than in intraepithelial tumors. At 120 months the cancer-specific survival was 100% for intraepithelial and microinvasive VPD versus 31% for invasive VPD (log-rank p = <0.0001) Age ≥65 years (OR: 4.17 CI 1.12-15.5, p = 0.03) and VPD's area ≥15 cm2 (OR: 5.83 CI 1.75-19.3, p = 0.004) were associated with risk of invasiveness. CONCLUSION Microinvasive VPD has an identical prognosis to intraepithelial VPD, suggesting the omission of lymphadenectomy or adjuvant treatments are safe in this subset of patients. We recommend caution to propose medical treatment in patients who are ≥65 years old and with wide tumor area, as they are at the greatest risk of invasiveness.
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Affiliation(s)
- Mario Preti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Leonardo Micheletti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
| | - Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Adriano Marrazzu
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Niccolò Gallio
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Sebastiana Privitera
- Pathology Unit, Department of Oncology, City of Health and Science, University of Torino, Torino, Italy
| | - Annalisa Tancredi
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Federica Bevilacqua
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
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15
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Hashimoto H, Kaku-Ito Y, Furue M, Ito T. Mucosal Invasion, but Not Incomplete Excision, Has Negative Impact on Long-Term Survival in Patients With Extramammary Paget's Disease. Front Oncol 2021; 11:642919. [PMID: 33937045 PMCID: PMC8082157 DOI: 10.3389/fonc.2021.642919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Extramammary Paget’s disease (EMPD) sometimes spreads from the skin to mucosal areas, and curative surgical excision of these areas is challenging. The aim of this study is to analyze the impact of mucosal involvement and surgical treatment on the survival of patients with EMPD. Methods We conducted a retrospective review of 217 patients with EMPD. We also assessed the associations between tumor involvement in boundary areas (anal canal, external urethral meatus, vaginal introitus), prognostic factors, and survival in 198 patients treated with curative surgery. Results Of 217 patients, 75 (34.6%) had mucosal boundary area involvement. Lesions in these areas were associated with frequent lymphovascular invasion (p = 0.042), lymph node metastasis (p = 0.0002), incomplete excision (p < 0.0001), and locoregional recurrence (p < 0.0001). Boundary area involvement was an independent prognostic factor associated with disease-specific survival, per multivariate analysis (HR: 11.87, p = 0.027). Incomplete excision was not significantly correlated with disease-specific survival (HR: 1.05, p = 0.96). Conclusion Boundary area tumor involvement was a major risk factor for incomplete excision, local recurrence, and poor survival outcomes. However, incomplete removal of primary tumors was not significantly associated with poor prognosis. A less invasive surgical approach for preserving anogenital and urinary functions may be acceptable as the first-line treatment for resectable EMPD.
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Affiliation(s)
- Hiroki Hashimoto
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yumiko Kaku-Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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16
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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17
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Gitas G, Proppe L, Baum S, Kruggel M, Rody A, Tsolakidis D, Zouzoulas D, Laganà AS, Guenther V, Freytag D, Alkatout I. A risk factor analysis of complications after surgery for vulvar cancer. Arch Gynecol Obstet 2021; 304:511-519. [PMID: 33420814 PMCID: PMC8277626 DOI: 10.1007/s00404-020-05949-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022]
Abstract
Introduction Despite the less frequent use of surgery in patients with vulvar cancer, the high rates of postoperative complications are still a matter of concern. The aim of the present study was to identify risk factors that influence postoperative complications rates in vulvar cancer and identify specific clinical parameters that may influence their incidence.
Materials Patients who underwent curative-intent surgery for squamous cell carcinoma of the vulva from 2003 to 2018 were selected. All patient characteristics were analyzed as risk factors for the development of postoperative lymphocele, lymphedema, and wound dehiscence. The patients were followed up for 2 years postoperatively.
Results The investigation comprised 121 patients, of whom 18.1% developed wound dehiscence, 17.7% a lymphocele, and 20.4% lymphedema. We found no significant evidence of an association between patient’s characteristics and postoperative complications. The depth of tumor invasion and the appearance of lymph-node metastasis were significantly associated with postoperative complications. Free resection margins of 5 mm or more were associated with a reduced risk of postoperative complications compared to resection margins less than 5 mm. No complications were encountered after sentinel node biopsy (SNB). Complication rates were associated with inguinofemoral lymphadenectomy, but not with the extent of lymphadenectomy. The development of a lymphocele or wound dehiscence may be correlated with the development of long-term lymphedema. Conclusion FIGO stage at diagnosis influences the risk of postoperative complications. The use of SNB minimized postoperative complications. Correlations between the free microscopic resection margin distance and the risk of postoperative wound dehiscence must be investigated further.
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Affiliation(s)
- Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany.
| | - L Proppe
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - S Baum
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - M Kruggel
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - A Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - D Tsolakidis
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Zouzoulas
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A S Laganà
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - V Guenther
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - D Freytag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - I Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
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18
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Segarra Vidal B, Cañete Mota S, Andrade Cadena P, Llueca Abella A. Adenoid cystic carcinoma of the Bartholin's gland. Int J Gynecol Cancer 2020; 31:292-298. [PMID: 33214217 DOI: 10.1136/ijgc-2020-002183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Blanca Segarra Vidal
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarai Cañete Mota
- Department of Gynecologic Oncology, General University Hospital of Castellón, Castellon de la Plana, Comunidad Valenciana, Spain
| | - Paul Andrade Cadena
- Department of Pathology, General University Hospital of Castellón, Castellon de la Plana, Comunidad Valenciana, Spain
| | - Antonio Llueca Abella
- Department of Gynecologic Oncology, General University Hospital of Castellón, Castellon de la Plana, Comunidad Valenciana, Spain
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19
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Elessawy M, Schneekloth S, Günther V, Maass N, Mettler L, Alkatout I. Postoperative Telephone-Based Questionnaire on Quality of Life after Robotic-Assisted Laparoscopic Hysterectomy versus Conventional Total Laparoscopic Hysterectomy. J Clin Med 2020; 9:jcm9092849. [PMID: 32887523 PMCID: PMC7565397 DOI: 10.3390/jcm9092849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
Aim: The objective of the study was to evaluate the benefits of robotic-surgery for hysterectomy compared to conventional laparoscopy for benign indications. A specially prepared telephone-based questionnaire was used postoperatively. Method: All women (n = 155) undergoing total laparoscopic hysterectomy for benign indications either by the robotic-assisted procedure (RALH) or conventional laparoscopy (CL) between 1 January 2013 and 31 December 2017 at the Department of the Gynecology, University Hospitals, Campus Kiel, Germany, were eligible for analysis. Intra-operative and postoperative parameters affecting the patients’ quality of life were assessed by a telephone-based questionnaire. The latter addressed postoperative pain, limitations of basic hygiene, daily activity, active pursuit of hobbies, sexual intercourse, and days of sick leave. All patients received the questionnaire by post at least three weeks prior to being contacted on the phone. Results: 78% of the contacted patients responded to the questionnaire; 96% (n = 115) of the patients said they would recommend the operation to other patients. Both groups needed 42 days to resume their regular hobbies. In whole 90.8% (n = 108) were total satisfied with the cosmetic result of the abdominal incision; the numbers in the respective groups were 80% (80% n = 36) in RALH and 97.3% (n = 72) in CL. The difference was significant on the Chi-square test (p = 0.002). 5% (n = 7) were dissatisfied with the scar (13.3%; n = 6) in the RALH group, and 1.4% (n = 1) in CL. In all 1.7 % of patients were dissatisfied with the position of the incisions; the respective numbers were 4.4 % (n = 2) in the RALH group and no patient in the CL group. 33% of patients experienced no limitations in regard of sexual intercourse after the operation. The median number of days taken to resume sexual intercourse after the operation was 56 days in the CL group, and 49 days in the RALH group. Nearly 30% (n = 25) were hesitant to resume intercourse. The median operating time was 145 min in the RALH group, which was significantly longer than the 117 min taken in the CL group (p < 0.001). Conclusions: The RALH procedure was associated with some minor advantages for the patients according to the results, however it does not have major significant advantages, especially in regard of early restoration of sexual function, while the CL shows shorter operating times and similar limitation. Postoperative counseling of patients should be aligned to their fears and expectations in regard of sexual function.
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Affiliation(s)
- Mohamed Elessawy
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
- Correspondence:
| | - Sarah Schneekloth
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany;
| | - Veronika Günther
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
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20
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Bacalbasa N, Balescu I, Vilcu M, Dima S, Brezean I. Risk Factors for Postoperative Complications After Vulvar Surgery. In Vivo 2020; 34:447-451. [PMID: 31882512 DOI: 10.21873/invivo.11794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although the trends of surgical treatment in vulvar cancer patients are towards less extended resections, a significant number of cases are still diagnosed with locally advanced diseases imposing performing extended resections. The aim of this paper is to identify the prognostic factors for the development of early postoperative complications following vulvar surgery. PATIENTS AND METHODS Between 2017 and 2019, 145 patients with vulvar cancer were submitted to surgery with a curative intent. RESULTS Among these cases there were 93 cases diagnosed with early stages of the disease and 52 cases diagnosed with advanced stages. The risk of postoperative complications was significantly influenced by: i) the stage of the disease, ii) the preoperative levels of serum albumin, iii) the status of the resection margins, iv) previous history of irradiation, v) length of hospital stay and vi) association of comorbidities. CONCLUSION Vulvar cancer surgery for locally advanced disease is still associated with high rates of postoperative complications, and an attentive selection of cases submitted to surgery is mandatory.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania.,Department of Surgery, "Fundeni" Clinical Institute - Center of Excellence in Translational Medicine, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania
| | - Mihaela Vilcu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Simona Dima
- Department of Surgery, "Fundeni" Clinical Institute - Center of Excellence in Translational Medicine, Bucharest, Romania
| | - Iulian Brezean
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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Morrison J, Baldwin P, Buckley L, Cogswell L, Edey K, Faruqi A, Ganesan R, Hall M, Hillaby K, Reed N, Rolland P, Fotopoulou C. British Gynaecological Cancer Society (BGCS) vulval cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 252:502-525. [PMID: 32620514 DOI: 10.1016/j.ejogrb.2020.05.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this guideline is to collate evidence and propose evidence-based guidelines for the diagnosis and management of adult patients with vulva carcinoma treated in the UK. Malignant melanoma may present via similar routes and will be discussed. The reader is referred to the Ano-uro-genital Mucosal Melanoma Full Guideline [1] for more detailed recommendations. The management of vulval sarcoma is outside of the scope of this guideline. For further information, including details of guideline development and GRADE of recommendations, please see BGCS website for details (https://www.bgcs.org.uk/professionals/guidelines-for-recent-publications/).
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Affiliation(s)
- Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, TA1 5DA, UK.
| | - Peter Baldwin
- Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Lynn Buckley
- Department of Gynae-Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, East Yorkshire, HU16 5JQ, UK
| | - Lucy Cogswell
- Consultant Plastic & Reconstructive Surgeon, Department of Plastic &Reconstructive Surgery, Oxford University Hospitals NHS Trust, Headington, Oxford, OX3 9DU, UK
| | - Katharine Edey
- Centre for Women's Health Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
| | - Asma Faruqi
- Department of Cellular Pathology, The Royal London Hospital, Barts Health NHS Trust, London, E1 2ES, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham, B15 2TG, UK
| | - Marcia Hall
- Dept Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middx HA6 2RN, UK
| | - Kathryn Hillaby
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire, Hospitals NHS Foundation Trust, GL53 7AN, UK
| | - Nick Reed
- Beatson Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, Scotland, UK
| | - Phil Rolland
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, GL53 7AN, UK
| | - Christina Fotopoulou
- Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, SW7 2DD, UK
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Hami LT, Lampe B, Mallmann P, Forner DM. The Impact of Age on the Prognosis of Vulvar Cancer. Oncol Res Treat 2018; 41:520-524. [DOI: 10.1159/000488800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
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23
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Perrone AM, Galuppi A, Borghese G, Corti B, Ferioli M, Della Gatta AN, Bovicelli A, Morganti AG, De Iaco P. Electrochemotherapy pre-treatment in primary squamous vulvar cancer. Our preliminary experience. J Surg Oncol 2018; 117:1813-1817. [DOI: 10.1002/jso.25072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Anna M. Perrone
- Oncologic Gynaecology Unit; Sant'Orsola- Malpighi Hospital; Bologna Italy
| | - Andrea Galuppi
- Radiotherapy Unit; Sant'Orsola- Malpighi Hospital; Bologna Italy
| | - Giulia Borghese
- Oncologic Gynaecology Unit; Sant'Orsola- Malpighi Hospital; Bologna Italy
| | - Barbara Corti
- Pathology Unit; Sant'Orsola- Malpighi Hospital; Bologna Italy
| | - Martina Ferioli
- Radiotherapy Unit; Sant'Orsola- Malpighi Hospital; Bologna Italy
| | | | | | | | - Pierandrea De Iaco
- Oncologic Gynaecology Unit; Sant'Orsola- Malpighi Hospital; Bologna Italy
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Assessing Patient-reported Quality of Life Outcomes in Vulva Cancer Patients: A Systematic Literature Review. Int J Gynecol Cancer 2018; 28:808-817. [DOI: 10.1097/igc.0000000000001211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ObjectivesVulva cancer (VC) treatment carries a high risk of severe late effects that may have a negative impact on quality of life (QoL). Patient-reported outcome measures (PROMs) are increasingly used when evaluating disease- and treatment-specific effects. However, the adequacy of measures used to assess sequelae and QoL in VC remains unclear. The aims of the present study were to evaluate disease- and treatment-related effects as measured by PROMs in VC patients and to identify available VC-specific PROMs.Methods/MaterialsA systematic literature search from 1990 to 2016 was performed. The inclusion criterion was report of disease- and treatment-related effects in VC patients using PROMs in the assessment. Methodological and reporting quality was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. This systematic review was performed as part of phase 1 of the development of a European Organisation for Research and Treatment of Cancer QoL questionnaire for VC patients.ResultsThe search revealed 2299 relevant hits, with 11 articles extracted including a total of 535 women with VC; no randomized controlled trials were identified. The selected studies exhibited great heterogeneity in terms of PROMs use. Twenty-one different instruments assessed QoL. Most of the questionnaires were generic. Different issues (sexuality, lymphedema, body image, urinary and bowel function, vulva-specific symptoms) were reported as potentially important, but the results were not systematically collected. Only one VC-specific questionnaire was identified but did not allow for assessment and reporting on a scale level.ConclusionsVulva cancer treatment is associated with considerable morbidity deteriorating QoL. To date, there is no validated PROM available that provides adequate coverage of VC-related issues. The study confirms the need for a VC-specific QoL instrument with sensitive scales that allows for broad cross-cultural application for use in clinical trials.
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Dadzie MA, Aidoo CA, Vanderpuye V. Vulva cancer in Ghana - Review of a hospital based data. Gynecol Oncol Rep 2017; 20:108-111. [PMID: 28409179 PMCID: PMC5382029 DOI: 10.1016/j.gore.2017.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 11/17/2022] Open
Abstract
•Seventy- 5% of vulvar cancer cases present with advance disease.•Definitive radiotherapy/chemoradiation is the main stay of treatment.•One third of patients default treatment.•Five year survival following radiotherapy was 36.7%.
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Affiliation(s)
| | | | - Verna Vanderpuye
- National Centre For Radiotherapy And Nuclear Medicine, Korle Bu Teaching Hospital, P.O Box Kb 369, Ghana
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Maiorino MI, Chiodini P, Bellastella G, Giugliano D, Esposito K. Sexual dysfunction in women with cancer: a systematic review with meta-analysis of studies using the Female Sexual Function Index. Endocrine 2016; 54:329-341. [PMID: 26643312 DOI: 10.1007/s12020-015-0812-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/20/2015] [Indexed: 02/04/2023]
Abstract
Cancer may impair sexual function in women. We provide an overview of studies that address Female Sexual Dysfunction (FSD) in women with cancer with a meta-analysis of observational studies that used a validated diagnostic tool. Searches included MEDLINE, Scopus, and Google Scholar for studies published from January 2000 to 31 December 2014. Every included study had to involve at least 30 cancer patients, to investigate FSD based on the Female Sexual Function Index (FSFI), and to have been published in peer-review journals. Duplicate independent data extraction and quality assessment were performed. Data were pooled using a random effects model if statistical heterogeneity was present. The main outcomes were FSFI total score and FSD prevalence. FSFI is a 19-item self-report instrument for assessing key dimensions of female sexual function. A value less than 26.55 is consistent with FSD. Thirty-five studies met the inclusion criteria. Among these, 27 reported FSFI scores, and 16 FSD prevalence. Most studies (56 %) had low to moderate quality. The mean value of FSFI was lower than 20 at all cancer sites: 16.25 (pooled random effect, 95 % CI 14.91-17.58, I 2 = 14.5 %) for colorectal cancer, 18.11 (95 % CI 14.45-21.77, I 2 = 97.8 %) for gynecological cancer, and 19.58 (95 % CI 17.64-21.53, I 2 = 90.9 %) for breast cancer. FSD prevalence was higher than 60 % at all cancer sites, with the highest value for gynecological cancer (78.44 %, 95 % CI 68.36-88.52 %, I 2 = 94.1 %). Women with cancer showed low FSFI scores with a high prevalence of FSD.
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Affiliation(s)
- Maria Ida Maiorino
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Diseases and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy.
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, via L. Armanni n° 5, 80138, Naples, Italy
| | - Giuseppe Bellastella
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Diseases and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy
| | - Dario Giugliano
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Diseases and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, via Pansini n° 5, 80131, Naples, Italy
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Perceived Health-Related Quality of Life in Women With Vulvar Neoplasia: A Cross Sectional Study. Int J Gynecol Cancer 2016; 26:1313-9. [DOI: 10.1097/igc.0000000000000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of the study was to determine health-related quality of life (HRQoL) of women with surgically treated vulvar intraepithelial neoplasia (VIN) and vulvar cancer (VC) during the first week after hospital discharge. Further objectives were to investigate differences between women with VIN and VC as well as to examine whether correlations exist between women’s symptom experience and HRQoL.MethodsThis cross-sectional study was conducted in 8 hospitals in Germany and Switzerland. Women with VIN and VC rated HRQoL with the validated German Short-Form 36. Differences between HRQoL in women with VIN and VC were tested with Wilcoxon rank-sum score. The WOMen with vulvAr Neoplasia (WOMAN) - Patient reported Outcome (PRO) self-report instrument was used to measure women’s symptom experience. Correlations between symptoms and HRQoL were calculated using Spearman correlation coefficient.ResultsWomen with VIN and VC (n = 65) reported lower HRQoL in physical aspects (Physical Component Summary [PCS], 34.9) than that in mental aspects (Mental Component Summary, 40.5). Women with VC had lower HRQoL than women with VIN, as manifested by significant differences concerning the dimensions of “physical functioning” and “role-physical.” “Difficulties in daily life” as a distressing symptom correlated with MCS and PCS. Wound-related symptoms correlated with PCS and psychosocial symptoms/issues with MCS.ConclusionsAnalysis showed that women with vulvar neoplasia reported lower HRQoL in the physical and mental dimensions 1 week after discharge than comparable studies referring to months or years after surgery. Health-related quality of life is influenced by physical impairment because physical symptoms are prevalent 1 week after discharge. Patient education should focus on symptom management in an early postsurgical phase to enhance women’s HRQoL.
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Walker AJ, Benrubi ID, Ward KK. Care of survivors of gynecologic cancers. World J Obstet Gynecol 2016; 5:140-149. [DOI: 10.5317/wjog.v5.i2.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/16/2015] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.
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van der Linden M, Meeuwis K, Bulten J, Bosse T, van Poelgeest M, de Hullu J. Paget disease of the vulva. Crit Rev Oncol Hematol 2016; 101:60-74. [DOI: 10.1016/j.critrevonc.2016.03.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/25/2016] [Accepted: 03/03/2016] [Indexed: 01/03/2023] Open
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Trends in surgery and outcomes of squamous cell vulvar cancer patients over a 16-year period (1998–2013): a population-based analysis. J Cancer Res Clin Oncol 2016; 142:1331-41. [DOI: 10.1007/s00432-016-2135-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
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Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol 2016; 140:359-68. [PMID: 26556768 PMCID: PMC4835814 DOI: 10.1016/j.ygyno.2015.11.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. METHODS A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. RESULTS Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy-negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. CONCLUSION Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems.
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Affiliation(s)
- Laura B Huffman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ellen M Hartenbach
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Joanne K Rash
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - David M Kushner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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Abstract
BACKGROUND During the past decade there has been considerable progress in developing new radiation methods for cancer treatment. Pelvic radiotherapy constitutes the primary or (neo) adjuvant treatment of many pelvic cancers e.g., locally advanced cervical and rectal cancer. There is an increasing focus on late effects and an increasing awareness that patient reported outcomes (PROs) i.e., patient assessment of physical, social, psychological, and sexual functioning provides the most valid information on the effects of cancer treatment. Following cure of cancer allow survivors focus on quality of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors. METHODS An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities. RESULTS The literature search revealed a few RCTs with FSD evaluated as a PRO and being a secondary outcome measure in endometrial and in rectal cancer patients. Very limited information could be extracted regarding FSD in bladder, vulva, and anal cancer patients. The literature before and after 2010 confirms that pelvic radiotherapy, independent on modality, increases the risk significantly for FSD both compared to data from age-matched healthy control women and compared to data on patients treated by surgery only. There was only very limited data available on modern radiotherapy modalities. These are awaited during the next five years. Several newer studies confirm that health care professionals are still reluctant to discuss treatment induced sexual dysfunction with patients. CONCLUSIONS Pelvic radiotherapy has a persistent deteriorating effect on the vaginal mucosa impacting negatively on the sexual functioning in female cancer patients. Hopefully, modern radiotherapy modalities will cause less vaginal morbidity but results are awaited to confirm this assumption. Health care professionals are encouraged to address potential sexual dysfunction both before and after radiotherapy and to focus more on quality than on quantity.
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Affiliation(s)
- Pernille Tine Jensen
- 1 Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark ; 2 Department of Gynecology and Obstetrics, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Ligita Paskeviciute Froeding
- 1 Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark ; 2 Department of Gynecology and Obstetrics, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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Zhang W, Zeng A, Yang J, Cao D, He X, Wang X, You Y, Chen J, Lang J, Shen K. Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies. BMC Cancer 2015; 15:851. [PMID: 26542779 PMCID: PMC4635970 DOI: 10.1186/s12885-015-1792-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background The use of flaps in vulvar cancer-related reconstruction has been increasing, but few studies have evaluated the outcome and quality of life of patients after this surgery. The purpose of this study was to evaluate the outcomes of vulvar reconstruction using musculocutaneous/skin flaps in patients with advanced and recurrent vulvar malignancies. Methods Patients with vulvar malignancies who underwent vulvar reconstruction using different types of flaps were retrospectively reviewed. Patient outcomes were evaluated with a focus on quality of life and prognosis. Results Thirty-six patients were enrolled, 58.33 % of them used anterolateral thigh flap (ALT), 16.67 % of them used pudendal thigh flap (PTF), 11.11 % of them used deep omferior epigastric perforator (DIEP) and gracilis myocutaneous flap were used in 2.78 % of the patients, the other 11.11 % patients used two types of flaps. Eleven patients (30.56 %) developed complications, including 5 patients (13.89 %) with partial necrosis, 5 (13.89 %) with minimal wound dehiscence and 1 (2.78 %) with flap cellulitis. All patients who developed partial necrosis (13.89 %) underwent reoperation. The mean verbal rating scale score was 1.44 before reconstruction and 0.17 after surgery (P < 0.0001). The mean performance status was 1.67 before surgery and improved to 0.31 after surgery (P < 0.0001). The median overall follow-up time after vulvar reconstruction was 9 months. Twenty-one patients (58.3 %) developed recurrence at a median interval of 5 months after vulvar reconstruction. After a median follow-up time of 14 months, 41.7 % of the patients were living and disease-free. The 5-year survival of the 36 patients was 53.8 %. Conclusion Soft tissue reconstruction in patients undergoing resection of advanced/recurrent vulvar malignances is associated with a low rate of postoperative complications, decreased pain, and improved functional status. Although the recurrence rate in this patient population is high, a reasonable proportion of patients who undergo resection for advanced/recurrent vulvar cancer and reconstructive surgery appear to benefit.
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Affiliation(s)
- Wei Zhang
- Departments of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No.1,Dongcheng District, Beijing, 100730, China.
| | - Ang Zeng
- Departments of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jiaxin Yang
- Departments of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No.1,Dongcheng District, Beijing, 100730, China.
| | - Dongyan Cao
- Departments of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No.1,Dongcheng District, Beijing, 100730, China.
| | - Xiaodong He
- Departments of General Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Xiaojun Wang
- Departments of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Yan You
- Departments of Pathology,
- Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jie Chen
- Departments of Pathology,
- Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jinghe Lang
- Departments of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No.1,Dongcheng District, Beijing, 100730, China.
| | - Keng Shen
- Departments of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No.1,Dongcheng District, Beijing, 100730, China.
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Li L, Kou X, Feng X, Liu F, Chao H, Wang L. Clinical application of sartorius tendon transposition during radical vulvectomy: a case control study of 58 cases at a single institution. J Gynecol Oncol 2015; 26:320-6. [PMID: 26404124 PMCID: PMC4620369 DOI: 10.3802/jgo.2015.26.4.320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/09/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to investigate the clinical effects of sartorius tendon transposition versus sartorius transposition during bilateral inguinal lymphadenectomy of radical vulvectomy. Methods A total of 58 vulvar cancer patients who had surgery from May 2007 to October 2013, in which 30 patients received sartorius transposition and 28 patients received sartorius tendon transposition. All patients were matched by age, body mass index, stage, histology, and grade. Intraoperative variables and postoperative complications, recurrence, progression-free survival (PFS), and overall survival (OS) and postoperative life quality were compared and analyzed. Results No significant differences were found at median surgical times and amounts of bleeding (p=0.316 and p=0.249, respectively), neither at the incidences of groin cellulitis and lymphocele (p=0.673 and p=0.473, respectively), but the recovery times of the inguinal wounds were shorter (p=0.026) and the incidences of wound break and chronic lymphedema were significantly decreased in the tendon transposition group (p=0.012 and p=0.022, respectively). Postoperative quality of life in tendon transposition group was significantly improved as indicated by the EORTC QLQ-C30 questionnaire. Recurrences were similar (p=0.346) and no significant differences were found at PFS and OS (p=0.990 and p=0.683, respectively). Conclusion Compared to sartorius transposition, sartorius tendon transposition during inguinal lymphadenectomy led to improved patient recovery, reduced postoperative complications, and improved life quality without compromising the outcomes.
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Affiliation(s)
- Lei Li
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China.
| | - Xinxin Kou
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojie Feng
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Fenghua Liu
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongtu Chao
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Liying Wang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
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Grimm D, Eulenburg C, Brummer O, Schliedermann AK, Trillsch F, Prieske K, Gieseking F, Selka E, Mahner S, Woelber L. Sexual activity and function after surgical treatment in patients with (pre)invasive vulvar lesions. Support Care Cancer 2015; 24:419-428. [DOI: 10.1007/s00520-015-2812-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/08/2015] [Indexed: 01/06/2023]
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Zhang W, Zeng A, Yang J, Cao D, Huang H, Wang X, You Y, Chen J, Lang J, Shen K. Outcome of vulvar reconstruction by anterolateral thigh flap in patients with advanced and recurrent vulvar malignancy. J Surg Oncol 2015; 111:985-91. [PMID: 25974742 DOI: 10.1002/jso.23908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 03/03/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Wei Zhang
- Department of Obstetrics and Gynecology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Ang Zeng
- Department of Plastic Surgery; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Huifang Huang
- Department of Obstetrics and Gynecology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiaojun Wang
- Department of Plastic Surgery; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yan You
- Department of Pathology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jie Chen
- Department of Pathology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Keng Shen
- Department of Obstetrics and Gynecology; Peking Union Medical College (PUMC) Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
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Stabile C, Gunn A, Sonoda Y, Carter J. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer. Transl Androl Urol 2015; 4:169-85. [PMID: 26816823 PMCID: PMC4708131 DOI: 10.3978/j.issn.2223-4683.2015.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention.
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Alkatout I, Schubert M, Garbrecht N, Weigel MT, Jonat W, Mundhenke C, Günther V. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health 2015; 7:305-13. [PMID: 25848321 PMCID: PMC4374790 DOI: 10.2147/ijwh.s68979] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
EPIDEMIOLOGY Vulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders. HISTOLOGY Squamous cell carcinoma (SCC) is the most common malignant tumor of the vulva (95%). CLINICAL FEATURES Pruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain. THERAPY The gold standard for even a small invasive carcinoma of the vulva was historically radical vulvectomy with removal of the tumor with a wide margin followed by an en bloc resection of the inguinal and often the pelvic lymph nodes. Currently, a more individualized and less radical treatment is suggested: a radical wide local excision is possible in the case of localized lesions (T1). A sentinel lymph node (SLN) biopsy may be performed to reduce wound complications and lymphedema. PROGNOSIS The survival of patients with vulvar cancer is good when convenient therapy is arranged quickly after initial diagnosis. Inguinal and/or femoral node involvement is the most significant prognostic factor for survival.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Melanie Schubert
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nele Garbrecht
- Institute for Pathology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marion Tina Weigel
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Walter Jonat
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Veronika Günther
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
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