Cancer of the vulva

By the external genitalia ( vulva ) include pubis , large and small labia , clitoris , hymen (or its remnants ), the vestibule , and two (right and left ) great ( Bartholin ) gland and bulb ( horseshoe veniplex covering urethra and extending in the thickness of both small and large labia ) . External opening of the urethra is located under the clitoris in the vestibule .

Vulvar cancer is more common in women aged 65-75 years (mean age 68 years). However, vulvar cancer can occur at a young age. Vulvar cancer is up to 5 % of all malignant neoplasms of female genital mutilation .

Causes of vulvar cancer

In vulvar cancer cells with a high frequency (not less than 50 % of cases ) detecting DNA papilloma virus (HPV ) types. DNA from these viruses detected in epithelial dysplasia of the vulva, which is considered a precancerous condition . Often preceded by vulvar cancer and genital warts , the origin of which is also caused by HPV infection . In the development of vulvar cancer is of great importance given to the hormonal changes in menopause . This explains the fact that vulvar cancer - a disease of older women , occurs on the background of other pathological conditions of the external genitalia , which include sclerosing zoster ( kraurosis vulva ) , squamous hyperplasia ( leukoplakia ) and other dermatoses . These background states constitute a group of " non-neoplastic degenerative diseases." Epithelial dysplasia of the vulva , which arose on the background of kraurosis and leukoplakia in older women will inevitably be transformed into cancer , while at a young age dysplasia, developed on the background of normal intact skin or mucous membranes of the external genitalia may disappear on their own without treatment.

 Risk factors for vulvar cancer :1. Age (see above).2 . HPV infection . There are more than 70 types of HPV ; different types of viruses cause papillomas or dysplastic epithelium of the palms and soles , lips and tongue , penis, cervix, vulva , vagina and anal canal . These viruses are sexually transmitted .3 . Human immunodeficiency virus ( HIV).4 . Non-tumor degenerative disease of the vulva (see above) .5 . Epithelial dysplasia of the vulva. It is now also adopted the term " vulvar intraepithelial neoplasia " or " vulvar intraepithelial neoplasia ," VIN. Distinguish grade 4 VIN.I WINE degree corresponds mild dysplasia ,Grade II - moderate dysplasia ,Grade III - severe dysplasia ,IV degree - is vulvar cancer in situ, or intraepithelial cancer.6. Frequent change of sexual partners.7. Smoking. 

Symptoms of vulvar cancer 

Patients with dysplasia and vulvar cancer in situ ( or intraepithelial which is only within the epithelial layer - see above) , the only complaint may be itchy . With further progression of the malignant process , patients complain of a tumor , usually in the form of warts, cauliflower or ulcer that does not heal . Later join pain , bloody or purulent discharge , painful urination , increased inguinal lymph nodes due to their metastatic lesions .As stated above, vulvar cancer can develop on the background of non-neoplastic degenerative diseases. Sclerosing zoster ( kraurosis ) leads to a thinning of the subcutaneous tissue of the vulva. The skin becomes pale yellowish color , shiny , " parchment ", cracks , vagina narrows . Foci of leukoplakia may occur not only in the vulvar area , but also in the vagina and on the cervix . They are flat or raised above the surface of the skin or mucous membranes , single or multiple , are not removed by using cotton balls , have the form of films or plaques with white pearl shade . Kraurosis and leukoplakia , and their combination ( degenerative changes of the mixed type ) accompanied by paroxysmal itching , often unbearable , cracking , pain during sexual intercourse .On clinical manifestations and affects tumor localization . In decreasing order of frequency localization of the tumor located on the major and minor sexual lip clitoris and perineum. Sometimes there are mirrored, or " kissing " of the tumor on the labia lips, resembling a butterfly. 

Classification of vulvar cancer in stages : 

Stage I - Tumor limited to the vulva only or is located on the area of ​​skin between the vagina and anal canal ( at the crotch ) and not more than 2 cm in diameter ;Stage II - location of the tumor as well as in stage I , but the tumor is larger than 2 cm;Stage III - tumor of any size goes on the urethra , vagina (their lower thirds ) and the anal canal or has metastasized to the lymph nodes ;Stage IV - tumor of any size extending to the upper part of the urethra or vagina , the mucosa of the bladder, rectum, soldered to the pelvis or have distant metastases ( liver , lungs, and other organs ) 

 Diagnosis of cancer of the vulva 

Begins with a thorough survey of patient complaints , the time of their appearance , and these prior diseases. For suspected cancer of the vulva doctor examines female external genitalia in good daylight using a magnifying glass or a colposcope ( device for inspection of the cervix under magnification ) . In this case, the procedure is called vulvoskopiey . In case of non-neoplastic diseases of the vulva dystrophy ( leukoplakia, kraurosis and other dermatoses ) doctors should not start treatment without further diagnosis using cytological (taken smears ) or histological ( biopsy) . Vulvoskopiya allows you to perform biopsy , ie produce fence material for histological examination with suspected cancer of the vulva sites . This is especially important if there vulval cancer in situ or at the stage of a shallow germination underlying tissues . In case of severe tumor biopsy is also needed to confirm the diagnosis . The survey is complemented by bimanual examination , chest X-ray , clinical analyzes , and other methods . 

Treatment of vulvar cancer 

On the choice of treatment affect the patient age and general condition, and location of the tumor stage , histology and differentiation grade ( low, moderate or high degree of malignancy ) neoplasms, depth of invasion ( tumor spread to the underlying tissues ) , the presence or absence of metastases in the inguinal and pelvic lymph nodes , etc.Main treatment of vulvar cancer is surgical. In the embodiment of self- it is used only for stage I vulvar cancer . If the tumor is small and depth of invasion of 1 mm , only the tumor was excised . In other cases, surgery is the removal of the external genitalia ( large and small labia, clitoris, subcutaneous fat ) and is called vulvectomy . If you suspect the presence of lymph node metastases vulvectomy complement the removal of lymph nodes ( lymphadenectomy ) . In this case, the operation is called the extended vulvectomy .At stages II and III shows the combined treatment: surgery ( extended vulvectomy ) complement irradiation or, conversely, to begin operation after irradiation. If surgical treatment is contraindicated due to comorbidities , applies only radiotherapy .At stage IV conduct comprehensive treatment : chemotherapy combined with radiation and surgery. Chemotherapy is administered to reduce the tumor volume at the common stages of the disease , thereby reducing stage and operation. Drugs administered intravenously , orally and in lymphatics. Each of these methods of treatment may be accompanied by certain complications.

 Figures 5-year survival of patients after treatment of vulvar cancer :

 Stage 0 ( intraepithelial cancer, or cancer in situ, or VIN IV degree ) - 100%Stage I - 90%II - 70-80%III - 30-70% ( depending on the number of affected lymph node metastasis )IV -10-20%Similarly, other malignancies , these figures suggest the need for early diagnosis of cancer of the vulva.After treatment, all patients should be under the supervision of cancers , visit mode which is set individually .

 Prevention of vulvar cancer is : 

1. In the prevention of diseases , sexually transmitted diseases. This prevention should begin at a young age , with onset of sexual activity .

 2 . In cases of non-neoplastic dystrophic diseases of the vulva ( leukoplakia, kraurosis , etc. ) the doctor must show oncological alertness and should not start treatment without further diagnosis using cytological and / or histological examination . In identifying vulvar dysplasia should consider surgical treatment . 

3 . Treatment of degenerative diseases of the vulva with no effect should not be long - need to raise the question of surgical treatment .If symptoms listed in this article , timely seek medical help .