Recurrent Vulva Cancer
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|What Is A Recurrence?
A recurrence means that cancer has returned after the initial treatment. It can come back to the vulva or to another part of the body. There is no clear timeline as to what qualifies as a recurrence but there is a difference between recurrence and progression. A progression is where the original cancer continues to grow after treatment, although symptoms may not be immediately apparent. Recurrence is where the original cancer is considered ‘cleared’, and a new one has formed. If a woman undergoes vulva cancer treatment and cancer recurs after a few months, doctors will question - is it recurrence or was it ever really gone (progression)? It may be difficult to say. However there is a consensus among medical experts that if cancer comes back within 12 months of treatment, then it is progression and not recurrence. It may be that the original treatment was not completely successful and some tiny cancer cells remained behind but were too small to pick up by imaging and blood tests. Those cells then grow back and eventually cause symptoms to return. If cancer comes back after 12 months it is considered a recurrence. Most recurrences of cancer of the vulva occur within the first 2 years. See, also what does cancer remission mean?
Vulva cancer survival rates give the statistical probability of a person surviving the disease. This is also known as prognosis or outcome. Vulva cancer returns in about 24 percent of women after primary treatment (although some studies indicate as few as 10 percent). The prognosis for the patient will depend on the extent of the recurrence and their overall general health and age. Very likely the woman will need to go through the vulva cancer diagnosis process again and her doctors will want to stage the tumor(s) (see vulva cancer staging) so that they can learn as much as possible about it. One study by the Division of Gynecologic Oncology, Jackson Memorial Hospital (2002) reported an excellent cure rate (70 percent) for patients with local recurrences confined to the vulva area. The prognosis was not as fortunate for those with regional recurrences where cancer had spread to pelvic lymph nodes (higher mortality rates were reported). The sooner the recurrence is diagnosed, the better the prognosis. This is why follow-up care after primary (original) treatment is so important.
cancer treatments will have their blood checked regularly afterwards for the tumor marker CA 125. Rising levels can indicate the return of a tumor. If a recurrence is local, then any of the following symptoms of vulva cancer can return:
• Changes in the texture or color of the vulva skin.
• Persistent itching of the vulva.
• Burning sensation when passing urine.
• White raised patches of skin or warts on the vulva.
• An ulceration or sore that will not heal.
Most patients with advanced stages of the disease will experience pain that can significantly reduce their quality of life. Pain can be acute or chronic. Acute pain is sudden and does not last; once the cause of the pain is identified it can usually be successfully managed. Chronic pain on the other hand is persistent and normally lasts longer than 3 months. This sort of pain can be caused by the progression of the disease or the result of treatment. It may cause depression and insomnia. How pain affects a patient will depend on a number of factors including their personal threshold for pain, their age, general health and past experiences with pain.cancer surgery and more lately chemoradiation. Which treatment is used depends on a number of factors including the extent of the cancer, symptoms present and what treatment the patient received in the past. Surgery continues to be the main form of treatment but it may be combined with either radiation therapy and/or chemo (see chemotherapy guide). The treatment options are:
• Wide local excision with/without radiation therapy.
• Radical vulvectomy combined with pelvic exenteration.
• Radiation therapy and chemo, applied in the same time period. With/without surgery.
• Radiation therapy followed by chemo or surgery.
• Palliative radiation therapy to help relieve symptoms and improve quality of life.
• Participation in cancer clinical trials to try experimental treatments.
Most recurrences are local which means they can be treated with wide local excision (cutting out the tumor) and inguinal lymphadectomy (removal of lymph nodes). See vulva cancer treatment for more details on these procedures. The cure rate is normally about 70 percent. In rare cases, advanced cancer may be treated by radical vulvectomy and pelvic exenteration. This can mean the removal of the vulva, vagina and cervix as well as the lower colon, bladder or rectum. As this is such a radical procedure doctors will always try to look for other possible treatments first. The use of radiotherapy and chemoradiation combined with radical local excision has had some success in avoiding the necessity of pelvic exenteration and has led to better survival rates (a 5 year survival rate greater than 50 percent).
If doctors feel the patient is not a candidate for surgery (possibly due to previous treatments or advanced age), they may recommend the use of radiotherapy, possibly followed by chemotherapy. Patients with metastatic disease (which has spread to distant parts of the body) may be offered radiation therapy for palliative reasons. As there is no standard chemotherapy or systemic treatment for metastatic vulva cancer, such women should consider clinical trials. A few studies indicate an improvement in their 5 year survival rate by doing so. Metastatic cancer, while a very serious diagnosis, is viewed by progressive doctors as a 'chronic disease' which may be possible to manage. Patients can undergo treatment and experience periods of remission and their quality of life can be good throughout.
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