Less invasive new treatment for early-stage vulvar cancer

Every year, some 320 women in the Netherlands are diagnosed with vulvar carcinoma (in other words, cancer of the labia). In an effort to improve the treatment on offer, Maaike Oonk, gynaecologist at the University Medical Center Groningen, has been exploring new methods that will make it easier to establish whether the cancer has spread to the lymph nodes in the groin (metastasis). A fairly minor procedure, whereby which the sentinel lymph node is removed and examined, has proved successful. If no metastases are found in the sentinel lymph node, the other lymph nodes do not need to be removed. This results in far fewer complications than in the past. This examination has changed the standard treatment for women with vulvar cancer across the globe. On 18 May 2011, Oonk will be awarded a PhD for her research at the University of Groningen.

The traditional treatment for vulvar carcinoma involved an operation to remove the tumour and all the lymph nodes in both groins. The procedure often led to serious complications such as infection, problems with the wound and swelling in the legs (lymph oedema). Most of these complications were due to the removal of the lymph nodes. But metastases were only found in the lymph nodes of about a third of patients. The lymph nodes had therefore been removed unnecessarily in the other two-thirds of patients. To prevent complications in this group, Oonk researched a less invasive way of establishing whether the cancer has spread to the lymph nodes.

Sentinel lymph node

Oonk discovered that other methods, such as sonography, CT, MRI and PET, were not accurate enough to rule out metastases in the lymph nodes of the groin. However, the fairly minor procedure whereby the sentinel lymph node is removed for examination turned out to be a good alternative. In her research, Oonk shows that it is safe to leave the other lymph nodes in the groin if the sentinel lymph node has not been affected. The research also shows patients undergoing the new treatment to remove just the sentinel lymph node sustain fewer complications in the long term than patients undergoing the former standard treatment to remove all the lymph nodes. Patients with metastases in the sentinel lymph node undergo another operation to remove the remaining lymph nodes.

Curriculum Vitae

Maaike Oonk (Almelo, 1977) studied medicine at the University of Groningen. She carried out her PhD research in the Obstetrics & Gynaecology Department of the UMCG. The Dutch Cancer Society co-funded her research. Her thesis is entitled ’New diagnostic and therapeutic options in early-stage vulvar cancer’. Supervisors: A.G.J. van der Zee, H. Hollema. Co-supervisor: J.A. de Hullu. Oonk is currently working as a gynaecologist at the UMCG.