Christina S. Chu, MD
Last Modified: November 18, 2001
I have a rare type of Gyn cancer: metastatic squamous cell cancer of the Bartholin gland. I am currently receiving radiation to the pelvis and weekly Cisplatin chemotherapy to be followed by interstitial brachy implants. I fear most the implants, as it will be the second surgery, since the tumor was removed. I am now told that it was unwise to have the tumor removed. I will be grateful to hear what information you can give me.
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
As you know, carcinomas of the Bartholin gland are very rare, and about half of carcinomas are squamous cell in origin. Traditional therapy involves surgical removal of the tumor (radical vulvectomy, or radical local excision) as well as removal of the lymph nodes in the groin. If lymph nodes in the groin are noted to be involved by tumor spread, additional surgery may be recommended to remove the lymph nodes in the pelvis as well.
Postoperative radiation has been shown to decrease the risk of local recurrence. If the tumor was limited to the vulva, local radiation may be all that is needed. However, if spread to the lymph nodes of the groin or pelvis is detected, pelvic radiation may be recommended to decrease the risk of regional recurrence. Some physicians may choose to add cisplatin chemotherapy to the radiation therapy because of the evidence that chemotherapy given with radiation improves the prognosis for patients with squamous cell carcinoma of the cervix.
Without knowing the details of your case, I cannot comment on why you say that surgical removal was not indicated. Many patients are fearful of brachytherapy (radiation implants), but most patients tolerate the procedure very well with few problems. I would encourage you to address your particular questions with your radiation oncologist, who may be better able to answer any specific concerns you may have.