El Paso surgeon introduces minimally invasive procedure for vulvar cancer
A 60-year-old woman sits anxiously in an exam room waiting for the news concerning a small mass in her vulva. The gynecologist explains that her tumor is malignant and recommends that it and the lymph nodes in the pelvic basin be removed.
The woman, who is well informed on women’s health issues, counters with a procedure she had read about that involved mapping the lymphatic system to determine if the cancer had spread. If it hadn’t, only the tumor needed to be removed.
At the Paul L. Foster School of Medicine at El Paso, J. Salvador Saldivar, M.D., M.P.H., assistant professor of Gynecology Oncology in the Department of Obstetrics and Gynecology, recently performed the operation described above for the first time; colleagues Antonio Santillan, M.D., and Harvey Greenberg, M.D., both in the Department of Obstetrics and Gynecology, assisted in devising the procedure. Saldivar says while the procedure, sentinel node biopsy, is not new to the medical field, its availability to patients in El Paso has been minimal, if non-existent.
During the procedure, physicians inject radioactive dye into the area surrounding the tumor. After about 20 minutes, a special camera takes a series of pictures tracing the dye’s route through the adjacent lymph nodes. A scan of the skin’s surface via a gamma ray probe confirms the exact position of the sentinel lymph node – the first node where the malignant tumor drains. The physician will then make a small incision and remove the radioactive “hot” lymph node, also blue in color from an additional dye. The node will be sent to pathology to determine if it contains cancer cells. If the sentinel node does not contain cancer cells, only the tumor is removed, and the procedure is complete. If the node tests positive for cancer cells, additional nodes are removed and checked for malignancy.“
The lymphatic system in the pelvic nodal basin is like a river and stream drainage system. If the main river (the sentinel lymph node) contains no malignant cells, there’s a 97 percent to 99 percent chance that the tumor, which feeds into the drainage or lymphatic system, has not metastasized,” Saldivar said. “In 80 percent of early-stage malignant tumors in the vulva, the cancer has not metastasized. That means that 8 out of 10 women in these circumstances can avoid a radical lymphadenectomy – the removal of all the lymph nodes in the pelvic basin.”
Cancer of the vulva is not a common disease. It accounts for only 3 percent to 4 percent of all gynecologic malignancies in women, most of whom are older. The American Cancer Society reports that outcomes of vulvar cancer in earlier stages (I & II) are favorable. However, the face of this disease may be changing, because the incidence of this disorder has increased in younger women as a manifestation of human papillomavirus infection.
Saldivar says research suggests a correlation may exist between vulvar cancer and human papillomavirus infection, smoking or having multiple sex partners. He adds that he and other gynecologic oncologists also are studying how the sentinel lymph node biopsy procedure can be adapted to cervical and endometrial cancers.
Story produced by the Office of Communications at El Paso, (915) 545-6579.
Lymphoscintigraph
J. Salvador Saldivar, M.D.