Vulvar cancer is a malignant tumor that occurs in the vulva. Although it mostly occurs after menopause, in recent years, patients and medical staff have become more vigilant about vulvar viral infections such as genital warts, herpes and other sexually transmitted diseases. , In addition, the vulva is an easily exposed part of the body and is convenient for biopsy, so young patients are prone to this disease, and vulvar cancer can gradually be detected, diagnosed and treated early.
So what are the methods to treat vulvar cancer?
The first is surgical therapy: Surgery is the main method to treat vulvar cancer. The scope of surgery is generally determined based on the clinical stage, the location of the lesion, the degree of differentiation and depth of tumor cell infiltration, the patient's physical condition and the patient's age. If it is vulvar carcinoma in situ, which means that the lesion is limited to the epidermis of the vulva, it is generally accepted that simple excision of the vulva is sufficient. The depth of resection can be limited to the epidermis and dermis, while retaining most of the subcutaneous fat. However, some experts believe that a simple wide vulvectomy should be performed, including the skin resection margin being 3 cm away from the tumor and the vaginal resection margin being 2 cm away from the tumor. If the lesion is large, the skin resection range is wide, and the sutures are too tight, skin grafting may be possible on the wound. If it is invasive cancer of the vulva, that is, vulvar cancer cells infiltrate from the epidermis to the deep layers, extensive vulvar resection is required, as deep as the fascial layer, and superficial and deep inguinal lymph nodes should be dissected.
The second is radiation therapy. Radiation is only an auxiliary therapy because the normal tissues of the vulva skin, anus and urethra cannot tolerate radiation. The vulva area is moist, and the skin reacts greatly to radiation stimulation, causing local tissue necrosis and ulcer formation, which is difficult to heal and affects the appearance of the vulva. Therefore, radiotherapy is suitable for patients with inguinal lymph node metastasis. Because 20% to 40% of patients may have local recurrence after surgery, pelvic irradiation can be performed after surgery to control the lymph nodes there. If the local lesions are extensive and cannot be removed, or are difficult to remove, or involve the perineum and anus, preoperative radiotherapy can make the original inoperable patients operable. Create surgical opportunities for patients and extend their lives.
The third method is a comprehensive treatment of radiation and chemotherapy at the same time. Most of them are used as treatment before surgery, and a few are used as the main treatment method. The effect is relatively satisfactory, with a complete remission rate of 42% to 78%. Therefore, it can have a positive auxiliary effect on surgical treatment.
What are the symptoms of functional hemorrhage during menopause and how to treat it?
Functional uterine bleeding (referred to as functional hemorrhage) is one of the common gynecological diseases, about 50% of which occur during menopause. Menopausal women who have irregular menstruation can be diagnosed with menopausal hemorrhage after a detailed examination by a doctor to rule out pregnancy, tumors, inflammation, trauma and blood system diseases, and confirm that there is no intrauterine device. It is generally believed that functional bleeding is uterine bleeding caused by neuroendocrine disorders. Its main manifestation is the change of menstruation, including changes in cycle and amount. It has the following characteristics:
1. Irregular menstrual cycles. One is that the menstrual cycle is shortened to about 20 days, the duration of menstruation is short, and the amount of menstruation gradually decreases until it stops. Another manifestation is that the menstrual cycle is prolonged, which may occur once every 2 to 3 months or longer, or menopause occurs alternately with regular menstruation.
2． Irregular menstrual cycles and periods. Menstrual cycles and periods may be long or short, frequent or infrequent, or may be characterized by constant bleeding.
3． Changes in menstrual flow. Some women experience a gradual decrease in menstrual flow, but some women experience a significant increase in menstrual flow, accompanied by large blood clots, heavy bleeding, palpitation, dizziness, and anemia.
4. A very small number of people experience sudden cessation of menstruation. No other obvious discomfort.
Don’t be careless about menopausal menstruation. You mistakenly believe that abnormal menstruation can occur at this stage and will disappear naturally by the time of menopause. Instead, it should be treated aggressively. The principle of treatment for menopausal hemorrhage is to stop bleeding, adjust the cycle, and reduce menstrual flow. Here are several treatment methods:
1. Diagnostic dilation and curettage is the preferred hemostatic measure for menopausal hemorrhage. The scraped tissue from the official cavity is sent for pathological and histological examination to rule out endometrial cancer and stop bleeding. For older patients or patients who cannot be cured after long-term treatment, segmented diagnosis and curettage should be adopted, that is to say, the curettage of the cervical canal and the official cavity should be sent for examination separately.
2． Treatment with hemostatic drugs. If the uterine bleeding is heavy and prolonged, and the patient is obviously anemic, he or she can be hospitalized. Hemostatic drugs can be used intravenously, such as 6-aminocaproic acid. The initial dosage is 4 to 6 grams added to 100 ml of normal saline, and the drip is completed in 10 to 30 minutes. The maintenance dosage is 1 gram per hour; hemostatic acid 0.25 g/time. Intravenous infusion or intravenous injection twice a day, and blood transfusion if necessary. You should also pay attention to rest and nutrition. For patients with milder conditions, general hemostatic drugs can be injected intramuscularly or orally, such as hemostasis 0.25 to 0.75 grams intramuscularly, 2 to 3 times a day. Vitamin K4, 4 mg orally, 3 times a day; Anluoxue, 5 mg, 3 times a day, and vitamin C, 100 mg, 3 times a day.
3． Hormone therapy. The hemostatic dosage of sex hormones is directly proportional to the amount of bleeding at that time. When massive bleeding occurs, the dosage of hormones required exceeds the normal physiological amount. Therefore, attention should be paid to reducing the dosage after the bleeding has stopped. Generally, the dosage is reduced by 1/3, once every 3 days. Maintain normal physiological volume for one menstrual cycle.
(1) Progesterone drugs: such as Fukang tablets (norethindrone), which have better hemostatic effect, but have a greater impact on liver function during medication. Usage: 5 mg once every 8 hours, bleeding It should be stopped within 3 days and then tapered off. Reduce the dosage by 1/3 every 3 days, then maintain it at 2.5 mg per day, and stop taking the medicine about 20 days after the bleeding stops.
If the patient has a small amount of uterine bleeding for a long time. If the amount of bleeding is not large, there is no obvious anemia, and there is a certain amount of estrogen in the body, 4 to 8 mg of medroxyprogesterone can be used each time, 2 to 3 times a day. After the bleeding stops, gradually reduce the dosage to 5 to 10 mg or 4 to 8 mg per day, and stop taking the medicine completely after 3 weeks when the bleeding stops. Withdrawal bleeding occurs 3 to 5 days after stopping the drug. It lasts for 5 to 7 days, so this therapy is also called "drug-induced dilation and curettage".
(2) Androgen treatment. In order to reduce pelvic congestion and counteract the effects of estrogen, androgens can also be taken, such as methyltestosterone 5 mg twice a day, taken orally for 20 days, stopped for 10 days, and can be stopped for 3 months. When using androgens, it should be noted that the patient's age should be close to menopause, and the monthly dosage should not exceed 300 mg.
(3) Oral contraceptive drug treatment. Oral contraceptive pill No. 1 or 2, 1 tablet each time, once every 6 to 8 hours. After bleeding stops within two days, gradually reduce to 1 tablet per day for 20 days. Menstruation will occur after stopping the pill. Regarding oral contraceptive treatment, many menopausal women mistakenly believe that they are taking contraceptive measures. Why should they take this drug? In fact, one of the functions of oral contraceptives here is to adjust the cycle, and the other is to reduce menstrual flow.
(4) Traditional Chinese medicine treatment. Traditional Chinese medicine has a unique effect on the treatment of functional hemorrhage. Drugs that can replenish qi and blood can be used, or Chinese patent medicines such as compound donkey-hide gelatin and ginseng Guipi pills can be used.
(5) Surgical treatment is possible if drug treatment is ineffective or recurrence occurs. There are two methods of surgery: one is a new surgery that has been carried out in some hospitals, namely endometrial resection, which removes the functional layer of the endometrium, the basal layer and the muscle layer 2 to 3 mm below it, so that the endometrium cannot regenerate. , thereby achieving the purpose of artificial amenorrhea. The curative effect of this kind of surgery is better, reaching more than 90%. Moreover, it does not require laparotomy, has minimal trauma, short operation time, less bleeding, fast recovery, does not affect ovarian function, and has very few complications. Another surgical method is the traditional total hysterectomy. For those who are older and cannot rule out organic diseases, hysterectomy can be considered.