The vulvar cancer is typically a squamous cell carcinoma of the skin, which usually occurs in older women. Usually, it shows up as palpable mass. The diagnosis is made by biopsy. The treatment consists of excision and inguinal and femoral lymph node dissection.

The vulvar cancer is the fourth most common gynecologic malignancy in the United States; it is responsible for 5% of the malignancies of the female genital tract with about 4,700 new cases and 1,000 deaths in 2013. The average age at diagnosis is about 70 years, and the incidence increases with age. In young women, the incidence for vulvar cancer appears to increase. Risk factors include intraepithelial neoplasia of the vulva (VIN), infection with human papillomavirus, high cigarette consumption, lichen sclerosus, Plattenepithelhyperplasie, squamous the vagina or cervix and chronic granulomatous disease.

The vulvar cancer is typically a squamous cell carcinoma of the skin, which usually occurs in older women. Usually, it shows up as palpable mass. The diagnosis is made by biopsy. The treatment consists of excision and inguinal and femoral lymph node dissection. The vulvar cancer is the fourth most common gynecologic malignancy in the United States; it is responsible for 5% of the malignancies of the female genital tract with about 4,700 new cases and 1,000 deaths in 2013. The average age at diagnosis is about 70 years, and the incidence increases with age. In young women, the incidence for vulvar cancer appears to increase. Risk factors include intraepithelial neoplasia of the vulva (VIN), infection with human papillomavirus, high cigarette consumption, lichen sclerosus, Plattenepithelhyperplasie, squamous the vagina or cervix and chronic granulomatous disease. Pathology The VIN is a precancerous condition of the vulvar carcinoma. It can also be multifocal. Sometimes also an adenocarcinoma of the vulva, breast or Bartholin’s glands developed. About 90% of malignant Vulvatumoren are squamous; about 5% are melanomas. Others are adenocarcinomas, transitional cell carcinoma, adenoid cystic carcinoma and adenosquamous, all of which may occur in the Bartholin’s glands. Moreover, even sarcomas and basal cell carcinomas can occur with Adenokarzinomanteilen. The propagation of the vulvar cancer is carried out by direct invasive growth (z. B. urethra, urinary bladder, vagina, perineum, rectum or anus), hematogenous to the inguinal lymph nodes or inguinal lymph nodes of the pelvic and para-aortic lymph nodes to the. Symptoms and signs The most common presentation is a palpable lesion of the vulva, which was noticed by the patient herself or striking in a routine gynecological examination. Often the patients have had for a long time pruritus. At the first medical contact, the tumor may already be well advanced. The lesion may become necrotic or ulcerated and thus sometimes cause bleeding or aqueous Vaginalfluor. Melanoma can appear black and blue, pigmented or papillary. Diagnostic biopsy intraoperative staging differential diagnosis of vulvar carcinoma are ulcerative venereal diseases (see Table: chancroid), basal cell carcinoma, Paget’s disease of the vulva (a pale, eczematoid lesion), cysts of Bartholin’s gland or genital warts (condylomata acuminata). It should be considered a vulvar cancer, when a lesion of the vulva in women developed low risk for sexually transmitted diseases or if they are not responding to treatment of sexually transmitted diseases. Usually a punch biopsy of the skin under local anesthesia is diagnostic. Occasionally, an expanded local excision is necessary to distinguish a VIN from a carcinoma. Subtle lesions can be better defined by a coloring of the vulva with toluidine blue or by colposcopy. Tips and risks When a lesion of the vulva in a woman develops low risk for sexually transmitted diseases or if they are not responding to treatment against sexually transmitted diseases, a vulvar cancer should be considered. Staging Staging is based on tumor size and tumor location, and the spread to regional lymph node, as determined on the basis of lymph node dissection during surgical primary treatment (vulvar cancer by stage). Vulvar cancer by stage Stage Description 5-year survival rate * I limited to the vulva or the peritoneum and without lymph node metastases> 90% IA ? 2 cm in all dimensions and <1 mm penetration depth IB> 2 cm in all dimensions or> 1 mm penetration depth IITumor of any size with spread to adjacent organs (lower third of the urethra, the lower third of the vagina or anus) and without lymph node metastases 80% III tumor of any size, with or without spread to adjacent organs (lower third of the urethra, the lower third of the vagina or anus) and regional (inguinofemoralen) lymph node metastases 50-60% IIIA 1 or 2 lymph node metastases, respectively <5 mm or 1 lymph node metastasis ? 5 mm IIIB 3 or more lymph node metastases, respectively <5 mm, or 2 or more lymph node metastases, respectively ? 5 mm IIIC lymph node metastasis with extracapsular extension IV infestation of the other regional structures (upper two-thirds of Urthra, upper two-thirds of the vagina mucosa of the urinary bladder or rectum), fixed to the bone of the pelvis, or ulcerated regional (inguinofemorale) lymph nodes or distant metastases 15% IVA infection of the upper two-thirds of Urthra, the upper two-thirds of the vagina, of the mucosa of the urinary bladder or rectum; fixed to the bone of the pelvis or ulcerated regional lymph nodes IVB Any distant metastases, including in the pelvic lymph nodes * The risk of lymph node metastasis increases proportionally with the tumor size and depth of invasion. According to the staging systems of the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC), AJCC Cancer Staging Manual, 7th Edition New York, Springer, 2010. prognosis overall 5-year survival rate of tumor stage dependent. The risk of lymph node metastasis increases proportionally with the tumor size and depth of invasion. Melanomas metastasize frequently, depending mainly on the invasion depth but also on tumor size. Expansive treatment excision and lymph node dissection except on stromal invasion <1 mm radiotherapy, chemotherapy or both in tumors in stage III or IV In any case, a long-range (edge ??? 2 cm) is indicated radical excision of the local tumor. On stromal invasion> 1 mm, a dissection of the inguinal and femoral lymph nodes can be made; it is not necessary on stromal invasion <1 mm. Recent studies suggest that in some women, a sentinel lymph node biopsy is with carcinoma of the vulva is a sensible alternative to lymph node dissection. At lateral location lesions ? 2 cm unilateral long-range local excision and unilateral lymph node dissection can be performed. Permanent means lesions, and most lesions> 2 cm require bilateral lymph node dissection. In stage III, the long-range radical excision of the primary tumor walk a lymph node dissection and postoperative external radiotherapy, often in combination with chemotherapy (eg., 5-fluorouracil, cisplatin), above. The alternative is a more radical or exenterierende surgical treatment. Stage IV is the treatment of combinations of pelvic exenteration, radiotherapy and systemic chemotherapy. Summary Most vulvar cancer are skin tumors (eg. As squamous, melanoma). A vulvar cancer should be considered when lesions of the vulva, including itchy lesions and ulcers do not respond to treatment for sexually transmitted diseases or occur in women at low risk of sexually transmitted diseases. A diagnosis of vulvar carcinoma by biopsy, the stadiums division is made intraoperatively. The excision of malignant tumors without distant metastases occurs widely, and provided that the stromal invasion is <1 mm, a lymph node dissection or sentinel node biopsy is performed.

Health Life Media Team

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