Vulvar metastatic cancer

　　1. Etiology

　　Vulvar metastatic cancer has the same tissue source and etiology as the primary cancer. The spread of the primary tumor is mainly through retrograde metastasis to the vulva via venous cancer thrombi, and can also occur through lymphatic metastasis or direct extension.

　　Cervical cancer can metastasize to the vulva via blood circulation and lymphatic channels, or can directly involve the vulva through the vagina. Endometrial cancer, ovarian cancer, and choriocarcinoma can retrogradely metastasize to the vulva through blood flow, and are also often transferred to the inguinal lymph nodes via the round ligament lymphatic pathway. Rectal cancer can directly infiltrate surrounding tissues or metastasize to the vagina and perineum through lymph nodes. The left ovarian vein directly drains into the left renal vein, therefore, the vulvar metastasis of primary renal cancer mostly originates from the left side.

　　2. Pathogenesis

　　Cancer foci are mostly located in the dermis or subcutaneous tissue, showing an image of expansive growth under light microscopy, with multiple lesions, no intracellular neoplastic changes, and extensive vascular infiltration can be seen. The pathological morphology and differentiation degree of the metastatic tumor are basically consistent with the primary tumor. The metastatic squamous cell carcinoma is a clear epithelial cell nest in the dermis, which does not invade the epidermis, while the metastatic adenocarcinoma has a tendency to invade the vulvar squamous epithelium. The metastatic site of malignant lymphoma is located within the dermis, generally not invading the epidermis.

　　Vulvar metastatic cancer is relatively rare, but the number of reports has gradually increased in recent years. Vulvar metastatic cancer mostly originates from cervical cancer, endometrial cancer, vaginal cancer, and choriocarcinoma, involving the vulva via the vagina, or through lymphatic and hematogenous metastasis. Vulvar metastatic cancer has the same tissue source and etiology as the primary cancer. The spread of the primary tumor is mainly through retrograde metastasis to the vulva via venous cancer thrombi, and can also occur through lymphatic metastasis or direct extension.

　　What are the typical symptoms of vulvar metastatic cancer?

　　How to prevent vulvar metastatic cancer?

　　Prevention:

　　1. Regular physical examination: to achieve early detection, early diagnosis, and early treatment. Active treatment of the primary lesion has a certain effect on preventing vulvar cancer.

　　2. Do a good follow-up: prevent the deterioration of the condition.

　　3. Pay attention to personal hygiene, especially the hygiene of the vulva during the menstrual period and postpartum period.

　　1. Blood tumor marker detection

　　Tumor markers refer to chemical substances produced by tumor tissues that can reflect the existence of tumors. Generally, they are chemical components that are significantly increased and have significant significance compared to the corresponding normal tissues of tumor tissues. Tumor markers include enzymes, hormones, and non-enzyme non-hormonal proteins, tumor-associated antigens, cytokines, and gene markers, etc. The origin of tumors can be judged according to the markers secreted by tumors. Many literature reports suggest that the combined detection of tumor markers can help in the early detection and diagnosis of tumors and can be used as a monitoring method for tumor treatment. However, the specificity for determining the tissue origin of tumors is poor.

　　2. Pathology

　　Through histological examination, the benign and malignant nature of tumors is first determined, followed by the determination of whether it is a primary or secondary tumor. According to the pathological characteristics of the metastatic tumor, it is generally easy to obtain a diagnosis when there is an existing primary tumor. Literature reports indicate that clinical diagnosis can also be obtained in the absence of pathological diagnosis based on the clinical characteristics of the tumor, the course of the disease, and the treatment response.

　　3. Immunohistochemical examination

　　Immunohistochemistry is based on the principle of specific binding between antigens and antibodies to identify the special components contained in cells, which is used to identify the tissue origin and type of tumors. With the gradual application and promotion of immunohistochemical methods in clinical practice, histochemical methods play a crucial role in determining the origin of metastatic cancer tissues. Cupta et al. applied the fine needle aspiration cytology method (fine needle aspiration cytology, FNAC) to study 146 cases of skin and subcutaneous metastatic nodules from malignant epithelial tumors, including vulvar metastases. The results showed no false-negative or false-positive results, and no secondary tumors occurred. The authors believe that FNAC can quickly, safely, and accurately diagnose metastatic nodules originating from known existing tumors. FNAC combined with immunostaining can also effectively determine the location of unknown primary tumors.

　　4, Electron Microscopy Examination

　　When there is inconsistency in the examination of the source of the tumor under the ordinary light microscope, electron microscopy is helpful to judge the tissue source of the tumor.

　　The purpose of imaging and ultrasound examinations is to first understand the size of the lesion in the vulvar area, the depth of tumor invasion into the pelvis and periosteum, whether the inguinal lymph nodes and pelvic lymph nodes are involved, and then according to the characteristics of the possible primary sites of vulvar metastatic cancer, based on the patient's condition and economic status, use imaging and ultrasound examination methods to target the search for the primary site of the tumor.

　　Firstly, dietetic recipes for vulvar metastatic cancer

　　1, He Shou Wu Egg Soup

　　Composition: He Shou Wu 120 grams, eggs 4 pieces.

　　Usage: Boil He Shou Wu to get a concentrated decoction, boil 4 eggs. This is a daily dose, taken twice a day.

　　2, Sesame Brown Sugar Porridge

　　Composition: Black sesame 200 grams, brown sugar 30 grams.

　　Usage: Clean black sesame seeds, slightly fry, store in a bottle for later use or grind and store in a bottle. Use 2 tablespoons with an appropriate amount of brown sugar, dip steamed buns or use boiling water to serve.

　　3, Walnut and Sesame Seed Porridge

　　Composition: Walnut kernel 200 grams, sesame 100 grams, glutinous rice 100 grams.

　　Usage: Grind walnuts and sesame seeds into powder. Cook glutinous rice with an appropriate amount of water, then add walnuts and sesame seeds and it can be eaten.

　　4, He Shou Wu Yam Lamb Soup

　　Composition: He Shou Wu 30 grams, Yam 100 grams, lamb meat 500 grams, ginger 9 grams.

　　Secondly, what to eat for vulvar metastatic cancer

　　1, It is advisable to eat more foods with anti-external genital tumor effects, such as sesame seeds, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, green mamba, pork pancreas, chrysanthemum, black plum, peach, lychee, spurge, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, tortoise shell.

　　2, Pain can be alleviated by eating horseshoe crab, red, lobster, clam, sea cucumber, tiger fish, beetroot, mung bean, radish, chicken blood.

　　3, Itching can be alleviated by eating amaranth, Chinese cabbage, rapeseed, taro, kelp, laver, chicken blood, snake meat, pangolin.

　　4, To enhance physical fitness and prevent metastasis, it is advisable to eat silver ear, black fungus, mushrooms, truffles, gizzards, sea cucumber, Job's tears, walnuts, crabs, monitor lizards, needlefish, etc.

　　5, After surgery, Qi consumption and blood injury, it is advisable to eat more foods that tonify Qi and nourish blood, such as jujube, longan, mung bean, glutinous rice, lychee, mushrooms, carrots, quail eggs, lotus root powder, beans, etc.

　　6, Radiotherapy after surgery: consumes Yin and fluid, it is advisable to eat more nourishing Yin and fluid foods, such as spinach, Chinese cabbage, lotus root, radish, watermelon, banana, grapes, sea cucumber, sugarcane, lily, etc.

　　7, Chemotherapy after surgery: easily damages both Qi and blood, it is advisable to eat more foods that nourish Qi and blood, such as mushrooms, walnuts, mulberries, Job's tears congee, red dates, longans, sea cucumber, etc.

　　Thirdly, it is best to avoid eating certain foods for vulvar metastatic cancer.

　　Avoid stimulant drinks such as coffee.

　　Avoid spicy and irritant foods such as scallions, garlic, ginger, and cinnamon.

　　Avoid smoking and drinking.

　　Avoid greasy, fried, moldy, and preserved foods.

　　Avoid chicken, goose, mutton, shrimp, crab, eel, salted fish, black fish, and other irritant foods.

　　When itching is severe, avoid seafood and刺激性, allergenic foods.

　　Western medicine treatment for vulvar metastatic cancer Western medicine treatment:

　　1. Simple Radiotherapy

　　For patients with surgical contraindications or special locations with extensive lesions (near the anal urethra) where it is estimated that the surgery cannot be cleaned up completely, 60Co, 8MV X-ray, or 10-25MeV β-rays are used for vertical irradiation of the vulvar lesions. The radiation dose is 20-70Gy. Rest for 2 weeks when half the dose is administered, and the radiation field is determined according to the size of the tumor. When there is vulvar metastasis and external irradiation during cervical cancer, the radiation field is lowered to include the vulvar lesions. After the full course of radiotherapy for cervical cancer, vertical irradiation of 10-20Gy is given to the vulvar lesions. For patients with recurrence of cervical cancer and vagina at the same time, intracavitary irradiation is given to the reproductive tract tumors and inguinal lymph nodes involved, and also vertical irradiation is given to the inguinal area.

　　2. Simple Chemotherapy

　　There is no unified chemotherapy regimen. Common regimens include CP (cyclophosphamide + cisplatin), ACP (doxorubicin + cyclophosphamide + cisplatin), PVB (cisplatin + vincristine + bleomycin), FCP (fluorouracil + cyclophosphamide + cisplatin), and FACV (fluorouracil + doxorubicin + cyclophosphamide + vincristine). These are generally applied for 3-6 courses, and cyclophosphamide, vincristine, mitomycin, and methotrexate can also be administered alone.

　　3. Surgery plus Chemotherapy

　　Different surgical methods can be adopted according to the degree of the disease, such as palliative vulvectomy, extensive vulvectomy, extensive vulvectomy plus partial urethrectomy and vaginectomy, etc. After surgery, systemic chemotherapy for 2-4 courses is given as adjuvant treatment.

　　4. Radiotherapy plus Chemotherapy

　　After the vertical external irradiation of 30-50Gy of the vulvar metastasis, systemic chemotherapy for 1-3 courses is given. This is mainly for patients who are not suitable for surgery or have local recurrence or distant metastasis.

　　5. Comprehensive Treatment

　　After local surgery on the vulva, systemic chemotherapy and local irradiation are given.