Cancer of the vulva
Vulvar cancer is a malignant neoplasm of epithelial tissue localized in the area of the external female genital organs. The frequency is 3-4% of all gynecological tumors. The predominant age is 60-79 years (postmenopausal); less than 15% of patients are younger than 40 years.
- History of vulvar warts or granuloma venereum, kraurosis, and leukoplakia
- Cancer in situ
- A history of invasive squamous cell carcinoma of the cervix or vagina.
- TNM system (see also Tumor, stages)
- T: tumor no larger than 2 cm, not extending beyond the vulva
- T2: tumor larger than 2 cm, not extending beyond the vulva
- PM: A tumor of any size that has spread to the urethra, vagina, perineum, or anus
- T4: tumor of any size, infiltrating the mucosa of the bladder and rectum, the upper 30% of the urethra
- Clinical classification
- Stage 0: preinvasive carcinoma
- Stage I: tumor only of the vulva up to 2 cm in diameter
- Stage I: the size of the tumor exceeds 2 cm, affects only the vulva, there are no metastases in the regional lymph nodes
- Stage IIIA: tumor of any size that has spread to the vagina, lower 30% of the urethra, and anus. No metastases
- Stage SB: displaceable metastases in the inguinal-femoral lymph nodes
- Stage IVA: The tumor has spread to the upper urethra, bladder, rectum, and pelvic bones
- Stage IVB: the same, additionally the presence of non-displaceable metastases in regional lymph nodes or distant metastases.
Pathomorphology. Squamous cell carcinoma with a tendency to keratinization – 90% of tumors. The remaining 10% are glandular squamous cell carcinoma, adenocarcinoma, malignant melanoma, and warty cancer. Possible detection of sarcoma.
- With cancer in situ – itching. There are no other symptoms until the tumor is 1–2 cm in size.
- Epithelial changes (typical or atypical hyperplastic dystrophy) are detected in 40% of cases
- History of chronic vulvar irritation or ulceration
- Visible lesions of the labia are signs of lichen sclerosus, vulvar kraurosis. Distribution pattern
- Spread per continuitatem – nearby urethra, vagina, perineum, anus, rectum, and pubic bones
- Lymphatic distribution. Metastasis occurs to superficial inguinal lymph nodes, deep femoral groups and pelvic nodes
- Hematogenous dissemination occurs in advanced or recurrent cases of the disease.
- microinvasive cancer. Treatment includes wide (within 3 cm of healthy tissue) local excision and biopsy of superficial inguinal lymph nodes on the same side. Signs of microinvasive cancer:
- The lesion is less than 1 cm in size
- Focal invasion does not exceed 5 mm in depth
- The lymphovascular space is not involved
- Invasive squamous cell carcinoma
- Stages I and II – radical vulvectomy with removal of the inguinal and deep femoral lymph nodes. Pelvic radiotherapy is recommended for patients with lymph node involvement
- Stages III and IV – treatment depends on the prevalence of the disease and the general condition of the patient, treatment includes exenteration or its combination with radiation therapy. Chemotherapy
- Metastasis or recurrence of the disease. Treatment depends on the specific situation.
Forecast. 5 year survival
- Stage I – 71.4%
- Stage II -47.2%. Stage III – 32.0%
- Stage IV – 10.5%.
methods of treatment; Tumor, stages
ICD C51 Malignant neoplasm of the vulva