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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 extending 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 with non-shifted 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 lymphogenously and hematogenously.
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 radical 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 the process, the location of the tumor (worse with damage to the clitoris), individual characteristics and 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 localizations of cancer.
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
- 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
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