Obstetrics and Gynecology - A.M. Hromova 2000

Malignant neoplasms of the female reproductive organs
Vulvar cancer

Cancer of the external genitalia is the rarest localization of gynecological neoplasms. The pathology predominantly occurs at the age of 60–70 against the Background of prior precancerous conditions (Leukoplakia, kraurosis). According to the pattern of spread, exophytic, infiltrative, ulcerative, and nodular forms of vulvar cancer are distinguished; histologically, they are classified into squamous Cell (keratinizing and non-keratinizing), poorly differentiated, or glandular forms.

Clinical staging of vulvar cancer

Stage I - tumors or ulcers up to 2 cm in diameter localized in the superficial layers of the Skin or mucous membrane without metastases;

Stage II - the tumor infiltrates the underlying soft Tissues, or it is a large tumor located superficially with single Metastases in the inguinal regions;

Stage III - the tumor deeply infiltrates the underlying tissues. Fixed or restrictedly mobile metastases are present in the inguinal regions;

Stage IV - the tumor has spread to adjacent Organs or distant metastases are present.

According to the international TNM Classification of vulvar cancer (1985), recommended for clinical use, the stage of the disease is determined by three criteria: the extent of the primary tumor (T - tumor), the status of regional Lymph Nodes (N - nodus), and the presence of distant metastases (M - metastases).

International TNM Classification

Tis - preinvasive carcinoma;

Т₀ - primary tumor cannot be assessed;

Т₁ - single tumor not exceeding 2 cm in diameter;

Т₂ - single tumor from 2 to 5 cm in diameter;

Т₃ - single tumor greater than 5 cm in diameter, or a tumor of any size with extension to the Vagina (up to 2 cm), anus (without mucosal involvement), and Urethra. Multiple tumors within an area not exceeding 10 cm;

Т₄ - single tumor of any size with extension to the vagina (more than 2 cm), anus (with mucosal involvement), or rectovaginal septum. Multiple tumors within the area;

N₀ - no regional lymph nodes palpable;

N₁ - freely movable lymph nodes palpable on the ipsilateral side (N1a - non-metastatic, N1b - metastatic);

N₂ - freely movable lymph nodes palpable bilaterally or contralaterally (N₂a - non-metastatic, N₂b - metastatic);

N₃ - fixed or matted lymph nodes;

М₀ - no evidence of distant metastases;

М₁ - distant metastases present.

Clinically, vulvar cancer is initially characterized by the onset of pruritus in the external genitalia area, followed by pain and spotting. The latter symptoms indicate tumor invasion into the underlying tissues and its breakdown.

Vulvar cancer metastasizes primarily via the lymphatic pathway. The regional lymph nodes for this pathology are the superficial and deep inguinal lymph nodes located near the femoral vessels.

The Diagnosis of vulvar cancer is established based on the analysis of medical history, the presence of ulcers and infiltrates upon examination of the external genitalia, and the performance of colposcopy and microcolposcopy. Cytological examination of scrape-smears from the affected vulvar areas is of high diagnostic value. To determine the extent of the pathological process, lymphography and aspiration biopsy of the inguinal lymph nodes are performed.

Combined modality Treatment and Radiation therapy are used to treat women with vulvar cancer.

Combined treatment (surgery and radiation therapy) is prescribed for stages I–III of the disease and ensures a 5-year survival rate in nearly 60% of patients. The surgical Procedure involves vulvectomy with the removal of regional lymph nodes.

Radiation therapy as part of a combined treatment regimen involves irradiating the lesion site and regional lymph nodes using gamma- or X-ray therapy equipment before and during surgery. As a somatic treatment method, it is used for stage I–III vulvar cancer when surgical intervention is contraindicated. The efficacy of this therapy (five-year patient survival rate) ranges within 30%.

The low patient survival rate in the treatment of vulvar cancer is associated with the distinctively malignant Nature of the pathology and the early appearance of metastases.