Vulval cancer is a relatively rare condition, affecting 2 in 100,000 women in Australia. (Source: Cancer Australia)
Vulval cancer usually affects post-menopausal women (women who have gone through the menopause) between the ages of 55 and 75 years old. However, it can occur in younger or older women and is becoming more common in younger women due to Human papillomavirus (HPV) infection, which also causes cervical cancer.
Often, vulval cancer develops from vulval pre-cancer: VIN (Vulval Intra-Epithelial Neoplasia). VIN may have no symptoms, but there is usually itching around the vulva, burning, and raised patches of skin that are different colour from unaffected areas.
Treatment and Surgery
VIN treated appropriately will prevent its progression to a cancer. This will usually involve surgical removal of affected tissue (excision). There is also new evidence to suggest that the use of creams formulated with agents to boost the immune system may be effective to reverse VIN or reduce its size so a smaller surgical excision is required. However, their use will be limited to patients with lesions deemed to be at low risk of progression to cancer.
The treatment of vulval cancer will involve a ‘radical / wide local excision’ of the lesion on the vulva to ensure all of the affected tissue is removed.
Unless the cancer is in its very early stages, it is advisable to also remove the lymph nodes in the groin. This may be performed either as a full groin node dissection or a sentinel lymph node procedure. Our gynaecologic oncologist will discuss the two different approaches, which each has its advantages and disadvantages.
Chemotherapy and / or Radiation Therapy
Depending on whether an adequate clearance margin around the cancer is achievable or whether the lymph nodes are positive for tumour, radiation therapy after the surgery may be required to achieve a cure or prevent recurrence.
After Surgery and Treatment
After treatment for vulval cancer, our gynaecologic oncologist will recommend a minimum follow-up of five years as recurrence is common, and further surgical excision may be necessary.
It was previously common to do vulval smears as part of follow-up, but these have never been proven to be of benefit. A more effective approach is to perform a vulvoscopy (examining the vulva using a colposcope / microscope) at subsequent visits.
Cessation of smoking after treatment of vulval cancer will halve the risk of recurrence.
Monday – CLOSED
Tuesday – Fri 8am – 4pm
Dr Jason Tan, raised and educated in Perth, received his medical degree from the University of Western Australia in 1998. Thereafter, he completed six years of specialist training in obstetrics and gynaecology and was a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2007. He undertook further training and completed his fellowship in advanced gynaecological endoscopy at Monash Medical Centre, Melbourne, in 2008.
Dr Tan trained further for three years to subspecialise in gynaecological oncology at Mercy Hospital for Women, Melbourne; Queensland Centre for Gynaecological Cancers, Brisbane; and Ariake Cancer Research Centre, Tokyo, Japan; and completed the gynaecological oncology subspecialty training in 2010. In addition to that, he completed his fellowship in upper gastrointestinal surgery and bariatric surgery, at Sir Charles Gairdner Hospital in 2011.
Dr Tan’s special interest is surgical management of cancer, particularly in radical debulking surgery, and he specialises in laparoscopic management of gynaecological cancer. He sees patients with cancers of the ovaries, fallopian tubes, cervix, uterus, vulva and vagina. Besides that, he also sees patients with benign gynaecological conditions requiring complex surgery, such as severe endometriosis, fibroids and complex pelvic masses as well as investigation and management of abnormal Pap smears.
Dr Tan pioneered the robotic surgery for gynaecology and gynaecological oncology in Western Australia with the da Vinci System, further enhancing the legacy of minimally invasive surgery pioneered in Perth by the late Dr Tony McCartney. Robot assisted approach is advantageous in highly complicated procedures due to the better vision and dexterity, offered by the robotic instrumentation.
Dr Tan founded the WOMEN Centre, a leading multidisciplinary private centre for women’s health in Western Australia, in 2014. The specialists at WOMEN Centre provide a truly collaborative approach to patient care in order to ensure the best outcome possible and patients regaining their quality of life after treatment.
Besides his practice at WOMEN Centre, Dr Tan devotes his time to the public health service as consultant gynaecological oncologist at King Edward Memorial Hospital, which includes the teaching and training of medical trainees and junior doctors. He is also the current lead clinician for gynaecology and gynaecological oncology for the Western Australia Cancer and Palliative Care Network and a clinical senior lecturer at University of Notre Dame and University of Western Australia as well as preceptor at various surgical skills development workshops.
|2011||Fellowship in Upper Gastrointestinal Surgery and Bariatric Surgery – Sir Charles Gairdner Hospital|
|2010||Gynaecological Oncology Subspecialty, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (CGO)|
|2008||Fellowship in Advanced Gynaecological Endoscopy – Monash Medical Centre|
|2007||Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)|
|2005||Member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (MRANZCOG)|
|1998||Bachelor of Medicine, Bachelor of Surgery – University of Western Australia (MBBS)|
Dr Tarek Meniawy manages all aspects of general medical oncology and also subspecialises in gynaecological malignancies, and melanoma. Besides his clinic at WOMEN Centre, Dr Meniawy devotes his time to Sir Charles Gairdner Hospital, King Edward Memorial Hospital and University of Western Australia as a clinical senior lecturer.
Dr Meniawy received his medical degree from Cairo University, Egypt; in 2000 and undertook postgraduate physician training at the Princess Alexandra Hospital, Brisbane. He had further training in medical oncology at Royal Perth Hospital and Sir Charles Gairdner Hospital, and was awarded the Fellowship of the Royal Australasian College of Physicians in 2011. He is a member of the Western Australia Gynaecological Cancer Service and the Western Australia Melanoma Advisory Service.
Dr Meniawy has a keen interest in research and is actively involved in clinical trials including early studies of novel therapies, and large international studies in gynaecological cancer and melanoma. He has a particular interest in tumour immunology and immunotherapy, which have resulted in major breakthroughs in cancer therapies in recent years.
In 2016, Dr Meniawy was awarded a Doctor of Philosophy by the University of Western Australia for his studies on the effects of targeted anti-cancer therapies on the immune system. He is also an active member of the Australia and New Zealand Gynaecological Oncology Group, a not-for-profit organisation, dedicated to gynaecological cancer research.
|2016||Doctor of Philosophy – University of Western Australia (PhD)|
|2011||Fellow of the Royal Australasian College of Physicians (Medical Oncology)|
|2000||Bachelor of Medicine, Bachelor of Surgery – Cairo University (MBBS)|
Dr Paul Cohen is a gynaecologist with special interests in gynaecological oncology and the management of menopausal symptoms in women who have undergone treatment for cancer (including breast, colorectal, haematological and gynaecological cancers).
Dr Cohen completed his medical degree at the University of Oxford in the United Kingdom, and subsequently undertook specialist training in obstetrics and gynaecology in Auckland, New Zealand. He was granted Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2010 and undertook full time research in the molecular biology of ovarian stromal tumours, for which he was awarded a Doctorate in Medicine by the University of Auckland in 2011. Thereafter, he undertook an additional three years of fellowship in gynaecologic oncology in Brisbane, Newcastle and Sydney, and relocated to Perth in 2013.
Dr Cohen currently works as a gynaecologist and a clinical senior lecturer at King Edward Memorial Hospital, and contributes his expertise to the Western Australia Gynaecological Cancer Service and the Menopausal Symptoms After Cancer Clinic, where he has been actively involved in research and teaching.
Dr Cohen is also the director of gynaecological cancer research at St John of God Subiaco Hospital, where he oversees a number of research projects and supervises undergraduate, Master and PhD students. He is an adjunct professor at the Institute for Health Research, University of Notre Dame, Fremantle.
More information here for gynaecological cancer research at St John of God Subiaco Hospital.
|2011||Doctorate of Medicine – University of Auckland (MD)|
|2010||Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)|
|2002||Diploma Obstetrics and Medical Gynaecology – University of Auckland (Dip Obs)|
|2001||Master of Arts in Physiological Sciences – University of Oxford (MA Oxon)|
|2000||Bachelor of Medicine, Bachelor of Surgery – University of Oxford (BMBCh)|
|1997||Bachelor of Arts in Physiological Sciences – University of Oxford (BA)|
Dr Stephen Lee manages all aspects of general obstetrics and gynaecology, with special interests in advanced laparoscopic surgery, complex gynaecological problems and fertility.
Before relocating to Perth, Dr Lee completed a two-year laparoscopic gynaecology fellowship under the mentorship of Dr Catarina Ang, Head of Gynaecology 1 Unit at Royal Women’s Hospital in Melbourne, an accredited training site of the Australasian Gynaecological Endoscopy and Surgery Society (AGES). During the fellowship, Dr Lee was able to perfect a wide range of minimally invasive gynaecology skills and was invited to speak at AGES and AAGL (American Association of Gynaecologic Laparoscopists) conferences to present his research.
Prior to his fellowship, Dr Lee completed basic obstetrics and gynaecology training at Monash Medical Centre in Melbourne. Subsequently, Dr Lee was a research fellow under the guidance of Associate Professor Sue Walker and Associate Professor Stephen Tong, at The Mercy Hospital for Women and University of Melbourne, investigating intrauterine growth restriction. Thereafter, he travelled to England to work as a clinical fellow in urogynaecology at Nottingham University Hospital under the supervision of Consultant Urogynaecologist Dr Paul Hooper.
Dr Lee devotes his time to the public health service as a consultant obstetrician and gynaecologist at King Edward Memorial Hospital. He is keen on improving the education and training of general practitioners, with an interest in women’s health, and budding obstetricians and gynaecologists.
Dr Lee earned his Bachelor of Medicine, Bachelor of Surgery from the University of Melbourne, and he is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. In his spare time, he likes to cycle, play tennis and practise Chinese martial art.
|2013||Master of Business Administration, Melbourne Business School, University of Melbourne|
|2012||Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)|
|2010||Member of Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (MRANZCOG)|
|2007||Postgraduate Diploma in Management, Melbourne Business School, University of Melbourne|
|2002||Bachelor of Medicine, Bachelor of Surgery – University of Melbourne (MBBS)|
Dr Fred Busch manages all aspects of general obstetrics, including high-risk obstetrics, and gynaecology.
Dr Busch’s special interests in gynaecology include advanced laparoscopic surgery (including hysterectomy and endometriosis), hysteroscopic surgery, pelvic floor repair and incontinence surgery, menorrhagia management, and colposcopy.
Dr Busch received his medical degree from the University of Stellenbosch in South Africa. He trained in the United Kingdom for paediatrics, ear nose and throat surgery, and obstetrics and gynaecology before relocating to Australia. He undertook the integrated obstetrics and gynaecology training program at King Edward Memorial Hospital and was granted Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2007.
|2001||Australian Medical Council Equivalency Examinations|
|2000||Diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (DRANZCOG)|
|1993||Bachelor of Medicine, Bachelor of Surgery – University of Stellenbosch (MBChB)|
Dr Su Hamid manages all aspects of general obstetrics up to 20 weeks of pregnancy and general gynaecology.
Dr Hamid’s special interests in gynaecology include colposcopy and management of abnormal Pap smear, endometriosis, ovarian cysts, Polycystic Ovarian Syndrome (PCOS), fibroids, pelvic pain, incontinence (including urodynamics) and pelvic organ prolapse, menstrual problems, painful intercourse, post coital bleeding, post-menopausal bleeding, vulval conditions, gynaecological cancer assessment and diagnosis, family planning, infertility assessment, and menopause management.
Dr Hamid graduated with a first class honours in Bachelor of Medical Sciences in 1990 and Bachelor of Medicine and Bachelor of Surgery in 1992, from the University of Nottingham in the United Kingdom. She has been working in obstetrics and gynaecology since 1993 and was granted membership to the Royal College of Obstetricians and Gynaecologists (United Kingdom) in 1998. She completed her Specialist Certificate of Training in Obstetrician and Gynaecologist in 2004 and obtained fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2008. After her move to Australia in 2003, she has worked in Perth, Melbourne and Geraldton. She is multilingual and can consult in Malay and English fluently.
Dr Hamid was born in Malaysia and moved to the United Kingdom where she studied and worked for 20 years before moving to Australia with her family; drawn by the quality of life and abundance of sunshine here. In her spare time, she enjoys working out in the gym and cycling.
|2004||Specialist Certificate of Training, Obstetrician and Gynaecologist|
|1998||Member of Royal College of Obstetricians and Gynaecologists (MRCOG)|
|1992||Bachelor of Medicine, Bachelor of Surgery – University of Nottingham (BM BS)|
|1990||Bachelor of Medical Sciences – University of Nottingham (B Med Sci)|
Dr Jeremy Tan completed his Bachelor of Medicine, Bachelor of Surgery (MBBS) at the University of Western Australia in 1999. He went on to undertake specialist training is general surgery and was awarded Fellow of the Royal Australasian College of Surgeons in 2007. He further subspecialises in upper gastrointestinal surgery and bariatric surgery after completing his fellowship for both at Sir Charles Gairdner Hospital in 2007.
Dr Tan attends obstetric and gynaecological operations where there may be concurrent surgical problems such as hernias or diseases that involve the bowel. He also contributes his expertise in gynaecological cancer surgery where the tumour deposits are in anatomical locations that require the expertise of a surgeon with extensive upper gastrointestinal surgical experience for a complete resection of tumour.
A joint approach gynaecological cancer surgery with Dr Tan facilitates the highest chance of optimal debulking with lower morbidity when the cancer require extensive surgical debulking in the upper abdomen. Dr Tan is also available for outpatient service such as vasectomy procedure at WOMEN Centre.
|2007||Fellowship in Upper Gastrointestinal Surgery and Bariatric Surgery – Sir Charles Gairdner Hospital|
|2007||Fellow of the Royal Australasian College of Surgeons (FRACS)|
|1999||Bachelor of Medicine, Bachelor of Surgery – University of Western Australia (MBBS)|
Dr Tim Pavy, after graduating from the University of Adelaide, trained extensively in anaesthesia and intensive care in South Africa, Zimbabwe, England and Canada. He settled in Perth, in 1987, and is one of the key medical practitioners at King Edward Memorial Hospital, where he founded Australia’s first public Pelvic Pain Clinic in 2008.
Dr Pavy became a fellow of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists in 2000. His particular interests, on which he has published extensively and lectured at national, and international level, include anaesthesia and pain relief for pregnant women, and persistent pelvic pain.
|1988||Fellow of the Australian and New Zealand College of Anaesthetists (FANZCA)|
|1986||Fellow of the Royal College of Anaesthetists (FRCA)|
|1982||Diploma in Midwifery (Obstetrics) (Dip.Mid.COG)|
|1980||Diploma in Anaesthesia (DA)|
|1976||Bachelor of Medicine, Bachelor of Surgery – University of Adelaide (MBBS)|
Dr Golledge has more than 25 years of consultant experience as a Physician in Infection Management and Clinical Microbiologist. He trained initially in medicine at Princess Alexandra Hospital in Brisbane, Sir Charles Gairdner Hospital and Royal Perth Hospital. He subsequently completed his microbiology training at Royal Perth Hospital, Sir Charles Gairdner Hospital and Fremantle Hospital.
Dr Golledge did advanced training in infectious diseases at the City Hospital and Western General Hospital in Edinburgh and since 1991 has been a consultant at Sir Charles Gairdner Hospital and also consults at St John Of God Subiaco Hospital, Hollywood Hospital and Bethesda Hospital.
Dr Golledge was instrumental in setting up the inaugural Infectious Diseases Service at Sir Charles Gairdner Hospital and was also responsible for the Western Australia’s first Hospital In The Home Service through Sir Charles Gairdner Hospital.
|2011||Fellow of the Royal Geographical Society (FRGS)|
|2001||Fellow of the Royal College of Physicians (FRCP)|
|2000||Fellow of the Royal Society of Tropical Medicine (FRSTM)|
|1995||Fellow of the Australian College of Tropical Medicine (FACTM)|
|1991||Fellow of the Royal College of Pathologists of Australasia (FRCPA)|
|1990||Diploma of Tropical Medicine and Hygiene (DTM&H)|
|1980||Bachelor of Medicine, Bachelor of Surgery – University of Queensland (MBBS)|
|1977||Bachelor of Medical Science (BSc Med)|
Dr Lesley Ramage has more than 25 years of experience in women’s health as a general practitioner. She obtained her medical degree from Leeds University in the United Kingdom and completed her postgraduate general practitioner training in 1986.
Dr Ramage has worked in general practice since moving to Australia with her family in 1993. Since 2007, she has also held an appointment at King Edward Memorial Hospital where she consults in menopause and menopause symptoms after cancer clinics. She is actively involved in the teaching and training of medical undergraduates and doctors.
Dr Ramage holds a Postgraduate Diploma in Women’s and has been an invited speaker at a number of educational events. She regularly attends local, national and international scientific meetings to keep up to date with new developments in the field of women’s health.
Dr Ramage’s special interests include family planning and the management of menopause (both natural and following a diagnosis of cancer). She performs Pap smears and sexual health screening and provides osteoporosis and cardiovascular disease risk assessments.
|2006||Postgraduate Diploma in Women’s Health (PGDip Women’s Health)|
|1986||Family Planning Certificate|
|1986||Royal College of General Practice United Kingdom (RCGP)|
|1983||Bachelor of Medicine, Bachelor of Surgery – Leeds University (MBChB)|
Dr Paige Tucker completed a Bachelor of Science in Biomedical Science and Applied Statistics at Murdoch University in 2005 before completing a Bachelor of Medicine, Bachelor of Surgery with Honours at The University of Western Australia in 2011. She has a strong interest in gynaecological oncology research and is currently undertaking a Doctor of Philosophy at Notre Dame University.
Dr Tucker has worked for three years as a surgical resident medical officer at Fremantle Hospital and St John of God Subiaco Hospital. She works at WOMEN Centre as a clinical and surgical assistant to Dr Jason Tan.
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This document was last updated on Sept 3, 2015
The WOMEN Centre adheres to the National Privacy Principles as outlined by the Privacy Commissioner, 21 December 2001. This means that we collect and maintain your personal information in a secure and confidential manner. Further information regarding collection of and access to your information is shown below.
Collection, use and disclosure of your information.
Information about a patient’s medical and family health history is needed to provide accurate medical diagnoses and appropriate treatment. We will be fair in the way we collect information about our patients. This information is generally collected from the patient and in other ways with the patient’s consent. However, from time to time we may receive patient information from others. When this occurs we will, wherever possible, make sure the patient knows we have received this information.
Medical care requires full knowledge of patient health information by all members of a medical team. To ensure quality and continuity of patient care, a patient’s health information has to be shared with other health care providers from time to time. Some information about patients is also provided to Medicare and private health funds for billing purposes.
The surgeons in this practice are members of various medical and professional bodies including medical defence organisations. There may be occasions when disclosure of patient information is required for medical defence purposes.
There are also circumstances where a medical practitioner is legally bound to disclose personal information. An example of this is the mandatory reporting of communicable diseases.
It is necessary for us to keep patients’ information after their last attendance at this practice for as long as is required by law or is prudent having regard to administrative requirements.
A patient has a right to access their information. They may ask to view the information or ask for a copy of a part or of the whole record. While not required to give reasons for their request, a patient may be asked to clarify the scope of the request.
There are some circumstances in which access may be denied but, in such an event, the patient will be advised of the reason.
A charge may be payable where the practice incurs costs in providing access. This will depend on the nature of the access.
The material over which the doctor has copyright might be subject to conditions that prevent further copying or publication without the doctor’s permission.
If a patient finds that the information held on them is not accurate or complete, the patient may have that information amended accordingly.
Upon request, a patient’s health information held by this practice will be made available to another health service provider.
Disclosure of Your Personal Information
Your surgeon and/or his staff may disclose some of your personal information to:
If you do not wish such disclosure to occur, please inform us.
Parents/guardians and children
The right of children to privacy of their health information, based on the professional judgement of the doctor and consistent with the law, might at times restrict access to this information by parents or guardians.
It is important to us that your expectations about the way in which we handle your information are the same as ours. Please do not hesitate to discuss any concerns, questions or complaints about any issues related to the privacy of your personal information with your doctor. You may also contact our friendly practice staff with your concerns.