Cancer and Pre-Cancer

Vulval cancer

Surgeons specialising in female genital tract reconstruction are often called in to treat a pre-cancerous condition known as Vulval Intra-epithelial Neoplasia, or VIN.

The term VIN refers to changes that can occur in the skin that covers the vulva. While VIN is not in itself problematic, if left untreated it can develop into full-blown vulval cancer. Around 25% of VIN cases that are not treated become cancerous. VIN can affect women of any age from 20 onwards, although it is more common in women over 50. It is most frequently caused by transmission of a virus known as the HPV virus during sexual intercourse.

What surgery is available and what techniques are involved?
Some cases of VIN do not require surgical intervention. In those cases that do, a plastic surgeon will work alongside a gynaecologist and a cancer surgeon to treat the problem. First, a local surgical excision will be carried out to remove the affected area. Occasionally, the entire vulva will need to be removed – but this is only when the affected areas are large or multiple.

Once the excision is complete, a plastic surgeon will work to reconstruct the vulva using local skin grafts or flaps. A skin graft involves taking a healthy patch of skin from one area of the body, known as the donor site, and using it to cover another area where skin is missing or damaged.  Flap surgery, meanwhile, involves the transfer of living tissue from one part of the body to another, along with the blood vessel that keeps it alive.

What should I expect as a patient?

Before surgery is carried out, a multi-disciplinary treatment team will decide whether or not radiotherapy is also needed. This treatment, along with all surgery, should be carried out in a combined gynaecological oncology clinic.

The aim of VIN treatment procedures is to help restore function and form within the damaged area; to get things looking and working as close to normal as possible. The surgical treatment of VIN has a good success rate, but patients should be aware that the healing process is not always straightforward due to the local urinary and defaecatory functions carried out in this area.

If patients can avoid infection, their post-operative wounds should heal within a couple of weeks, although some people find that certain psycho-sexual problems can arise as a result of surgery in the genital region.

There can also be problems relating to post-operative scarring, and patients may need revision surgery to correct or minimise the scarred area.  General follow-up appointments will also be needed – sometimes for up to five years, and sometimes for the rest of a patient’s life.

Cervical cancer

Cervical cancer, like VIN, is also commonly caused by the transmission of the HPV virus. Sexual intercourse at an early age, and/or having multiple sexual partners can increase the risk of catching the HPV virus.

Cervical cancer can take many years to develop. Before it does, changes occur in the cells of the cervix.

These abnormal cells are not cancerous, and are called cervical intra-epithelial neoplasia, or CIN. These changes are sometimes referred to as pre-cancerous. This means that the cells might develop into cancer if they are not treated – however, most women with CIN do not go on to develop cancer.

What surgery is available and what techniques are involved?
As with VIN, CIN is treated by excision surgery to remove the affected cells. In cases where cervical cancer has developed, radiotherapy may also be required.

In more complex cases, plastic surgeons may be required to carry out vaginal reconstruction to repair the deficit left by the excision procedure, or to tidy up scarring left by radiotherapy. These procedures can be complex, often requiring the transfer of large surgical tissue flaps.

Anal cancer

For patients with pre-cancerous cells in the anal region, surgical procedures are often carried out to remove abnormal skin growth – known as anal intraepithelial neoplasia (AIN) – in and around the anus. Following these pre-cancerous excisions, plastic surgeons are then required to replace skin and tissue in the affected area using graft or flap reconstruction. 

Patients with full-blown colorectal cancer require major surgical and non-surgical treatment. Firstly, the surgical excision or removal of the rectum may be carried out, often accompanied by radiotherapy to shrink the tumour. Reconstructive surgery is then needed to fill the large space that has been created by these interventions and to facilitate wound healing. For women, these procedures may also include vaginal reconstruction.

What should I expect as a patient?

Surgery to repair damage sustained during colorectal cancer treatment is generally very successful, although the procedures involved can be complex. Wounds in this area can be left to heal on their own, but often flap reconstruction is appropriate. Patients may sometimes need to have a temporary colostomy bag.
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