Crosbie Emma J, Slade Richard J, Ahmed Ahmed S
The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, United Kingdom.
Cancer Treat Rev. 2009 Nov;35(7):533-9. doi: 10.1016/j.ctrv.2009.01.005. Epub 2009 Aug 20.
Referral of women with vulval carcinoma to tertiary centres is now established practise in the UK. The centralisation of care for these women promotes the development of specialist teams of gynaecological oncologists, clinical oncologists, pathologists and clinical nurse specialists with expertise in the management of this relatively rare tumour. The primary care physician plays an essential role in the early detection and subsequent urgent referral of women with suspicious vulval lesions. Improved education and awareness campaigns may encourage women to report vulval symptoms early. Where vulval carcinoma is diagnosed at an early stage, surgical excision is likely to be curative. There is, however, a move away from radical surgery for all patients irrespective of stage of disease towards an individualised approach, which takes into account the size and position of the tumour. The challenge is to reduce morbidity associated with treatment without compromising on cure rates. Restricting groin lymphadenectomy to women with lymph node metastases may be possible with the advent of sentinel node technology and it is anticipated that expertise in this area will show significant advances over the coming years. There is still a place for radical surgery, often in combination with other treatment modalities, in the management of advanced or recurrent disease. This article will review the evidence for the current management of vulval carcinoma.
在英国，将外阴癌女性患者转诊至三级医疗中心现已成为既定做法。对这些女性患者的集中护理促进了由妇科肿瘤学家、临床肿瘤学家、病理学家以及临床护士专家组成的专业团队的发展，这些专家在管理这种相对罕见的肿瘤方面具备专业知识。初级保健医生在早期发现并随后紧急转诊有可疑外阴病变的女性患者方面发挥着至关重要的作用。加强教育和开展提高认识活动可能会鼓励女性尽早报告外阴症状。在外阴癌早期被诊断出来时，手术切除有可能治愈。然而，目前正从对所有患者不论疾病分期都进行根治性手术转向个体化方法，这种方法会考虑肿瘤的大小和位置。面临的挑战是在不影响治愈率的情况下降低与治疗相关的发病率。随着前哨淋巴结技术的出现，有可能将腹股沟淋巴结清扫术限制在有淋巴结转移的女性患者中，预计在未来几年这一领域的专业知识将取得显著进展。在晚期或复发性疾病的管理中，根治性手术通常与其他治疗方式联合使用，仍有其用武之地。本文将综述外阴癌当前管理方法的相关证据。
