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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
- 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
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