Wilms tumor

Disease Name Confirmation

• Vulvar cancer (English: Vulvar cancer) is a medically appropriate diagnosis name. It refers to a malignant tumor that mainly occurs in the labia majora, labia minora, clitoris, and vaginal opening; histologically, squamous cell carcinoma is the most common type.

Disease Description (Causes and Symptoms)

• Causes and pathophysiology
  • Although no single clear cause has been identified, major associated factors reported include human papillomavirus (HPV) infection (positive in approximately 20–60% of patients), age (mean age at diagnosis ~65 years), smoking, and chronic skin diseases (e.g., precancerous lesions of the vulva).
  • Most cases are squamous cell carcinoma; rarely, melanoma, basal cell carcinoma, and Bartholin gland carcinoma may occur.
  • The lesion can invade from the local mucosa and skin into surrounding tissues and lymph nodes (especially the inguinal lymph nodes), and lymph node metastasis has a major impact on prognosis.
• Main symptoms
  • Vulvar itching (pruritus), localized swelling or a lump, ulcers or raised lesions, abnormal bleeding (including after urination or defecation), discharge, difficulty or pain with urination, and color changes (blackish-brown, reddish, white patches, etc.).
  • The lesion may have a thick or rough surface and may sometimes appear wart-like or ulcerated.

Treatment Methods

• Treatment principles after confirmed diagnosis (applied differently according to stage, lesion extent, and the patient’s condition)
  • Surgery
    • Early localized lesions: wide local excision or partial or total vulvectomy — preservation of urethral, vaginal, anal, and sexual function is considered whenever possible.
    • Lymph node assessment: sentinel lymph node biopsy or selective inguinal lymph node examination/dissection is generally performed to check for inguinal lymph node metastasis (determined according to tumor size and location).
  • Radiation therapy
    • Used for preoperative tumor reduction (neoadjuvant therapy), to reduce the risk of residual cancer or local recurrence after surgery (adjuvant therapy), or as standalone treatment for patients who cannot undergo surgery or for older patients.
  • Chemotherapy
    • Used for distant metastatic or recurrent lesions. It may be administered as monotherapy or as concurrent chemoradiation.
  • Preservation and reconstruction
    • Reconstruction (such as flap surgery) may be considered to preserve function and appearance after extensive excision.
• Lifestyle management and precautions
  • Rehabilitation and counseling regarding wound healing and infection prevention, as well as changes in urination and sexual function, may be needed.
  • Smoking cessation is recommended, along with HPV prevention (vaccination), regular vulvar self-examination, and gynecologic follow-up.
• Risk of complications
  • Surgery-related: wound infection, lymphedema (after inguinal lymph node dissection), pain, and changes in sexual, urinary, or bowel function.
  • Radiation- and chemotherapy-related: skin changes, radiation necrosis, systemic side effects, etc.

Outpatient Visit Checklist (Items to Prepare and Sample Questions)

• Items to prepare (bring before the visit)
  • A list of currently used medications (including prescription drugs, OTC medications, and supplements)
  • Records of previous medical conditions, surgeries, and allergies
  • Recent test results (blood tests, pathology reports, and imaging [CT/MRI/ultrasound] images and reports)
  • The time symptoms began and their progression (bleeding, discharge, pain, changes in size, etc.), and photographs of the lesion (from multiple angles if possible)
  • Smoking history and sexual history (HPV-related information), and vaccination history
• Sample questions to confirm in advance during the outpatient visit
  • When did the recent symptoms begin, and how quickly have they changed?
  • Have you previously undergone a biopsy or treatment related to the vulva?
  • What are the severity and frequency of your current pain, bleeding, and discharge?

Examples of General Questions to Ask the Doctor

• What tests (biopsy or imaging studies) are needed to determine whether this condition is definitely cancer?
• What treatment options are recommended, and what are the expected benefits and side effects of each treatment?
• To what extent will surgery affect function (sexual, urinary, and bowel function)?
• What is the prognosis according to the cancer stage and lymph node status?

Examples of Disease-Specific Questions

• If it is confirmed that my lesion is superficial (vulvar intraepithelial) or invasive, is sentinel lymph node biopsy possible?
• If HPV-positive status is confirmed, will the treatment or follow-up plan change? Is it okay to receive additional HPV vaccination?

(Key Information Summary)

• Diagnosis: Visual examination (colposcopy and vulvar examination) → biopsy of suspicious lesions (essential) → imaging studies for staging (CT/MRI/ultrasound, etc.).
• Prognosis: Inguinal lymph node metastasis is the strongest prognostic factor (5-year survival rate >90% when the lymph nodes are negative; approximately 55% when the lymph nodes are positive, decreasing to around 30% in severe cases).
• Prevention: HPV vaccination, smoking cessation, safe sexual practices, regular gynecologic examinations and vulvar self-examination, and good personal hygiene (wiping from front to back after urination or defecation, wearing breathable cotton underwear, and avoiding tight clothing).