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Malignant tumors of the vulva and vagina

Cancer of the vulva (PB) occurs mainly in older women and is 3-5% of all malignant diseases of the genitals. Develops against the background of involutive dystrophic processes. An important role in the occurrence of this pathology is attached 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, bounded by the vulva. Regional metastases are not defined.

• Stage II - a tumor more than 2 cm in diameter, bounded by the vulva. Regional metastases are not defined.

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

• Stage IIIb - a tumor of the same or lesser extent 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 the bladder and / or the rectum and / or the bones of the pelvis. Regional metastases are not identified or displaced.

• Stage IVb - a tumor of the same degree of local distribution with any variants of regional metastasis, including non-shiftable 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 the lower third of the urethra and / or the 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 palpated.

• N1 - the inguinal-femoral lymph nodes are palpable, but not enlarged, mobile (clinically unsuspecting metastases).

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

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

• M - distant metastases

• M0 - there are no signs of distant metastases.

• M1a - enlarged, dense, apparently metastatic ileal lymph nodes are palpated.

• M1b - other distant metastases are identified.

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

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

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

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

Diagnosis of malignant tumors of the vulva does not present any particular difficulties. Since they usually develop on the background of dystrophic processes, it is very important to determine the moment of malignancy, which often happens late. Timely treatment of these processes (excision of pigment spots, condylomas, etc.) is the basis for the prevention of vulvar malignant tumors.

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

Leading in the treatment of PB is a surgical method. The operation is considered radical when lymphadenectomy (inguinal-femoral and, if necessary, the iliac nodes) is performed along with the vulvectomy. 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.

At stage I, the PB is sufficiently extended for cure. At stage II of the process, after radical surgery, radiation therapy is performed. At stage III of PB, when the tumor is widespread, pre-operative remote radiation therapy or its combination with intracavitary (endovaginal, endocervical) is performed.

The prognosis of RV is determined depending on the stage of the process distribution, tumor localization (worse if the clitoris is affected), individual characteristics and adequacy of therapy.

Vaginal cancer is a rare disease of the genitals. 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 adenocarcinomas of the vagina were observed, which are 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 termination.

Classification of vaginal cancer exists in stages, the TNM system and histogenesis. In principle, they are similar to those described in other sites of cancer.

The clinical symptoms of vaginal cancer are bleeding, pain, leucorrhea, swelling.

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

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

  1. TUMOR GROWTH. PROGRESSION OF TUMORS. MORPHOGENESIS OF TUMORS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR MARKERS OF TUMORS. ANTI-TUMOR IMMUNITY. PARANOPLASTIC SYNDROM. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITHELIUM AND TUMORS FROM TISSUES - DERIVATIVE MESENCHYMS
    TUMOR GROWTH. PROGRESSION OF TUMORS. MORPHOGENESIS OF TUMORS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR MARKERS OF TUMORS. ANTI-TUMOR IMMUNITY. PARANOPLASTIC SYNDROM. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL CHARACTERISTICS OF TUMORS FROM EPITHELIUM AND TUMORS FROM TISSUES - DERIVATIVES
  2. Diseases of the vulva and vagina
    Cancer of the vulva 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 frequent 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 is normal. Vulva, i.e. external genitalia of the woman, includes vestibule of the vagina, large (controversial) lips and clitoris. The vestibule of the vagina is lined with stratified squamous epithelium. In the thickness of the small lips, rich in loose stroma and elastic fibers, there are numerous sebaceous glands. In addition, on the eve of the two large glands open
  4. Discontinuities of vulva, vagina, and intercourse
    Tears of the vulva. Occur usually in the region of the labia minora, clitoris and are surface cracks, tears (Fig. 23.1). The clinical picture and diagnosis. Gaps in the clitoris are accompanied by bleeding, sometimes very significant. Treatment. Gaps in the region of the labia minora are sewn up with thin catgut with continuous suture or individual sutures without trapping the underlying tissues.
  5. Polyps, cysts and other benign changes in the cervix, vagina and vulva
    This section describes polyps recognized during colposcopic examination, polypous changes, various cysts on the cervix, vagina and vulva. On the cervix most often formed retention mucous cysts. The mechanism of their formation is described in section 4.1.3. When an ectopia overlaps the flat epithelium, the mucus retention occurs and retention cysts are formed. Very rarely
  6. COLPOSCOPIC DIAGNOSTICS OF VIRAL DISEASES IN THE AREA OF THE UTERINE NECK, VLAGALA AND VULVA
    In contrast to the 4th edition of 1993, where viral infections were considered in the section of atypical and abnormal conditions, in this book I highlight the indicated important gynecological diseases in a special section. In accordance with the international terminology adopted at the International Congress on Cervical Pathology and Colposcopy in Rome in 1990, a special group 5 was created, in
  7. COLPOSCOPIC DIAGNOSTICS OF ATYPICAL AND DIFFERENT FROM THE NORM OF CHANGES IN THE AREA OF NECK, VLAGAL AND VULVA
    COLPOSCOPIC DIAGNOSTICS OF ATYPICAL AND DIFFERENT FROM THE NORM OF CHANGES IN THE AREA OF NECK, VLAGAL AND
  8. Colposcopic diagnosis of benign changes in various functional states of the cervix, vagina and vulva
    Colposcopic diagnosis of benign changes in different functional states of the cervix, vagina and
  9. Tumors of the external genital organs and the cat moist cat
    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 pedicle, whereas for malignant tumors often characterized by the release of bloody mucus from the genital slit. The cat often licks the vulva. Symptoms: in addition to these, characterized by restless behavior, rapid
  10. Malignant tumors
    SARCOMA is a malignant tumor from mesenchymal tissue. Unlike cancer of sarcoma, the first metastasis is hematogenous. Histogenesis sarcomas are classified into a number of varieties. From fibrous tissue. 1. Fibrosarcoma. 2. Bulging dermatofibroma (malignant histiocytoma) - unlike other sarcomas, it is characterized by slow growth and does not metastasize for a long time, although it grows
  11. Malignant tumors
    Malignant tumors of the nose and paranasal sinuses occupy the third place among other malignant lesions of the upper respiratory tract (larynx and pharynx) and constitute, according to literary data, 2 - 3% of malignant tumors of all localizations. Malignant tumors most often develop in the maxillary sinus. In the second place in frequency are tumors of the ethmoid labyrinth.
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