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Malignant tumors of the vulva and vagina

Vulvar cancer (RV) is found mainly in elderly women and accounts for 3-5% of all malignant diseases of the genitals. It develops against the background of involutive dystrophic processes. An important role in the occurrence of this pathology is given to metabolic and endocrine disorders and viral infection.



RV classification by stages

• Stage 0 - preinvasive carcinoma.

• Stage I - a tumor up to 2 cm in diameter, limited to the vulva. Regional metastases are not determined.

• Stage II - the tumor is more than 2 cm in diameter, limited to the vulva. Regional metastases are not determined.

• Stage IIIa - a tumor of any size that extends to the vagina and / or lower third of the urethra and / or anus. Regional metastases are not determined.

• Stage IIIb - a tumor of the same or lesser degree of spread with displaced metastases in the inguinal-femoral lymph nodes.

• IVa stage - the tumor spreads to the upper part of the urethra and / or bladder, and / or rectum, and / or pelvic bones. Regional metastases are not defined or displaced.

• Stage IVb - a tumor of the same degree of local distribution with any variants of regional metastasis, including non-shifting regional metastases or a tumor of any degree of local distribution with detectable distant metastases.



International classification of vulvar cancer according to the TNM system (1985)

• T - primary tumor

• Tis - preinvasive cancer

• T1 - a single tumor limited to the vulva, 2 cm or less in diameter.

• T2 - a single or multicentric tumor, limited to the vulva, more than 2 cm in diameter.

• T3 - a tumor of any size with germination in the vagina and / or lower third of the urethra, and / or perineum, and / or anus.

• T4 - a tumor of any size, infiltrating the mucous membrane of the bladder and / or the upper third of the urethra, and / or the mucous membrane of the rectum, and / or fixed to the bones of the pelvis.

• N - regional (inguinal-femoral) lymph nodes

• N0 - inguinal-femoral lymph nodes are not palpable.

• N1 - inguinal-femoral lymph nodes are palpated, but not enlarged, mobile (clinically not suspicious of metastases).

• N2 - inguinal-femoral nodes are palpated on one or both sides, enlarged, dense, mobile (metastases are clinically determined).

• N3 - inguinal-femoral nodes are motionless or ulcerated.

• M - distant metastases

• M0 - there are no signs of distant metastases.

• M1a - enlarged, dense, clearly metastatic iliac lymph nodes are palpated.

• M1b - other distant metastases are determined.

The clinical picture of RV is characterized by a variety of symptoms and manifestations. The most common symptoms of RV are: irritation, itching, inflammation, the presence of tumors and ulcers. The inguinal-femoral lymph nodes are quickly involved in the process. Often this is accompanied by the appearance of genital warts.

Large and small labia, large glands of the vestibule, clitoris are affected by the tumor. Perhaps a total lesion of the vulva, which is characterized by the most unfavorable course.

Metastasis of the tumor process occurs via the lymphogenous and hematogenous pathways.
First, regional metastases occur, mainly in the lymph nodes, and then distant metastasis occurs via the hematogenous route.

Of other malignant tumors of the vulva, malignant melanoma, sarcoma, which can be localized in the same places as the RV, are noted. They are characterized by a particularly malignant course.

Diagnosis of malignant tumors of the vulva is not particularly difficult. Since they usually develop against the background of dystrophic processes, it is very important to determine the moment of malignancy, which often occurs late. Timely treatment of these processes (excision of age spots, warts, etc.) is the basis for the prevention of malignant tumors of the vulva.

Treatment of malignant tumors of the vulva is determined by the stage of the process, the histotype of the tumor and individual characteristics (age, extragenital diseases, etc.).

Leading in the treatment of RV is the surgical method. An operation is considered radical when, along with a vulvectomy, a lymphadenectomy is performed (inguinal-femoral and, if necessary, ileal nodes). There are various options for surgical intervention, determined mainly by the nature of regional metastasis. Surgical treatment is combined with radiation therapy, which is used in the pre- or postoperative period.

In stage I of RV, an expanded operation is enough to cure. In stage II of the process, after radiation surgery, radiation therapy is performed. In stage III of RV, when the tumor is widespread, preoperative remote radiation therapy or its combination with intracavitary (endovaginal, endocervical) is performed.

The prognosis for RV is determined depending on the stage of spread of the process, the location of the tumor (worse with damage to the clitoris), individual characteristics and the adequacy of therapy.

Vaginal cancer is a rare genital disease. It is more common in older women. Radio-induced forms of vaginal cancer are noted (after radiation therapy for cervical cancer and RTM). In the 1970s, clear cell vaginal adenocarcinomas were described that were observed at a young age (10–20 years), even before the onset of sexual activity. Such tumors were detected in girls whose mothers received synthetic estrogens (diethylstilbestrol) during pregnancy in order to treat the threat of interruption.

Classification of vaginal cancer exists by stage, TNM system, and histogenesis. In principle, they are similar to those described in other cancer localizations.

The clinical symptoms of vaginal cancer are bleeding, pain, leucorrhoea, edema.

Diagnosis is not very difficult and is based on examination data and auxiliary research methods (ultrasound, colposcopy, cytology, histology).

In the treatment of vaginal cancer, cavity radiation therapy, cytostatics from the group of antimetabolites (5-fluorouracil), cryodestruction and laser exposure (for pre-invasive cancer) are used. Surgery is effective in local forms. Combination radiation therapy is considered preferred. Complications of the latter method of therapy are frequent narrowing and even vaginal atresia.
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Malignant tumors of the vulva and vagina

  1. TUMOR GROWTH. TUMOR PROGRESSION. TUMOR MORPHOGENESIS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR TUMORS MARKERS. ANTITUMOR IMMUNITY. PARANEOPLASTIC SYNDROMES. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITELIUM AND TUMORS FROM TISSUES - DERIVATED MESENCHIMES
    TUMOR GROWTH. TUMOR PROGRESSION. TUMOR MORPHOGENESIS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR TUMORS MARKERS. ANTITUMOR IMMUNITY. PARANEOPLASTIC SYNDROMES. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITELIUM AND TUMORS FROM TISSUES - DERIVATIVES
  2. Diseases of the vulva and vagina
    Vulvar cancer in its frequency is up to 4% of the total number of malignant tumors of the female genital tract. The average age of patients is 60 years, and the most common histological type of tumor is squamous cell carcinoma of the vulva. Among the proven risk factors for the development of this disease, extragenital pathology occupies an important place: atherosclerosis, obesity, diabetes and
  3. Diseases of the vulva and vagina
    Basic data on the structure of the vulva and vagina are normal. Vulva, i.e. the external genitalia of a woman, includes the vestibule of the vagina, large (shameful) lips and the clitoris. The vestibule of the vagina is lined with stratified squamous epithelium. In the thickness of small lips, rich in loose stroma and elastic fibers, numerous sebaceous glands are located. In addition, two large glands open on the threshold.
  4. VOLVA, VAGINA, AND SURGEON RIPPINGS
    Tears of the vulva. They usually occur in the region of the labia minora, the clitoris and are surface cracks, tears (Fig. 23.1). The clinical picture and diagnosis. Ruptures in the clitoris are accompanied by bleeding, sometimes very significant. Treatment. Gaps in the labia minora are sutured with a thin catgut with a continuous suture or with separate sutures without grabbing the underlying tissue
  5. Polyps, cysts, and other benign changes in the cervix, vagina, and vulva
    This section describes polyps recognized by colposcopic examination, polypous changes, various cysts on the cervix, in the vagina and vulva. On the cervix, retention mucous cysts are most often formed. The mechanism of their formation is described in section 4.1.3. When the ectopia overlaps the squamous epithelium, retention of the mucus occurs and retention cysts form. Rarely
  6. COLOSCOPIC DIAGNOSTICS OF VIRAL DISEASES IN THE REGION OF THE Cervix, Vagina and Vulva
    Unlike the 4th edition of 1993, where viral infections were considered in the section of atypical and abnormal conditions, in this book I highlight these important gynecological diseases in a special section. In accordance with international terminology adopted at the International Congress on Cervical Pathology and Colposcopy in 1990 in Rome, a special group 5 was created, in
  7. COLOSCOPIC DIAGNOSTICS OF ATYPICAL AND DEVIATED FROM THE STANDARD OF CHANGES IN THE AREA OF THE Cervix, Vagina and Vulva
    COLOSCOPIC DIAGNOSTICS OF ATYPICAL AND DEVIATED FROM THE NORM OF CHANGES IN THE AREA OF THE Cervix, Vagina and
  8. Colposcopic diagnosis of benign changes in various functional conditions of the cervix, vagina and vulva
    Colposcopic diagnosis of benign changes in various functional conditions of the cervix, vagina and
  9. TUMORS OF EXTERNAL GENITAL ORGANS AND VITA OF CATS
    These tumors usually occur in the urogenital vestibule and in the vagina itself. Benign tumors are characterized by a rounded shape, a smooth surface and often hang on the leg, while malignant neoplasms are often characterized by the release of bloody mucus from the genital gap. The cat often licks the vulva. Symptoms: in addition to these, characterized by restless behavior, frequent
  10. Malignant tumors
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  11. Malignant tumors
    Malignant tumors of the nose and paranasal sinuses take third place in frequency among other malignant lesions of the upper respiratory tract (larynx and pharynx) and, according to published data, comprise 2 - 3% of malignant tumors of all localizations. Malignant tumors most often develop in the maxillary sinus. In second place in frequency are lattice maze tumors.
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