Cancer of the vulva

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.

Risk factors

• • 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.

Classifications

• • 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.

Clinical picture

• • 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.

Diagnostics. The diagnosis is confirmed by biopsy after excision of the suspicious area, performed under local or general anesthesia. The main problem is late diagnosis.

Treatment:

• • 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%.

See also: Tumor, radiotherapy, Tumor, markers; Tumor,

methods of treatment; Tumor, stages

ICD C51 Malignant neoplasm of the vulva