Cancer of the vulva (external genitalia) is the rarest localization of malignant tumors of the female genital organs. The frequency of the disease is 2.2-8%; it is more common in women older than 60 years. Although cancer of the external genital organs can be seen visually, most patients are admitted to hospital in the advanced stages of the disease. The first place in terms of the frequency of localization is occupied by cancer of the labia majora and clitoris, the second – the labia minora, the third – Bartholin glands and urethra.
An exophytic form is distinguished – when a cancer tumor has the appearance of a nodule rising above the surface, endophytic – with the formation of a crater-shaped ulcer with dense edges – and diffuse – dense diffuse infiltrate.
Cancer of the vulva is characterized by severe malignancy due to the abundance in this area of the lymph nodes and the special structure of the lymphatic system.
There are 4 stages of the spread of vulvar cancer:
- Stage I – a tumor with a diameter of up to 2 cm, limited to the vulva;
- Stage II – a tumor with a diameter of more than 2 cm, limited to the vulva;
- Stage III – a tumor of any size extending to the vagina and
(or) on the lower third of the urethra and (or) on the anus. There are metastases in the inguinal
femoral lymph nodes;
- IV stage – a tumor of any degree of spread with distant
According to the histological structure, vulvar cancer may be squamous.
keratinizing (90%), non-keratinizing, basal cell carcinoma, adeno carcinoma, melanoblastoma.
Clinical symptoms and diagnosis. In cancer of the vulva, patients may have complaints of a painful swelling in the perineal region, purulent or bleeding, irritation or itching of the vulva. With the germination of the tumor in the underlying tissue (in advanced stages) pain in the sacrum, difficulty urinating, cachexia join.
A common and affordable method for the diagnosis of vulvar cancer is a gynecological examination, which should begin with an examination of the external genital organs (preferably through a magnifying glass). The tumor may be in the form of a tuberous growth, bleeding when touched, in the form of a dense node, a flat ulcer with an uneven bottom and valikoobraznymi edges or growths such as warts. By palpation determine the consistency of the tumor, its relationship to the underlying tissues, the prevalence of the process.
Inspection with the help of mirrors allows you to assess the condition of the mucous membrane of the vagina and cervix, rectovaginal examination – to find out the state of parametric tissue.
Of great importance for the diagnosis of vulvar cancer is a cytological examination of smears, prints from the surface of ulcerations and smears prepared from scrapings from suspicious areas of the mucous membrane.
To clarify the diagnosis and determine the morphological structure of the tumor, a biopsy with subsequent histological examination is recommended. Colposcopy and vulvoscopy are used to select the correct biopsy site.
In cancer of the vulva, lymphography is advisable to determine the condition of the external iliac lymph nodes. To identify the state of the surrounding organs, cystoscopy, excretory urography, rectoromanoscopy, and chest x-rays are used.
The prognosis for vulvar cancer depends on how timely the treatment was started and how correctly it was carried out.
Prevention is based on the timely detection and adequate treatment of the background and precancerous processes of the vulva.
Vaginal cancer can be primary and metastatic (secondary). Among all malignant diseases of the genital organs in women, primary vaginal cancer is 1-2%, can occur at any age, but mostly develops in 50-60 years.
In most cases, vaginal cancer is metastatic, it is a consequence of the transition of the malignant process from the cervix and uterus to the walls of the vagina. Primary vaginal cancer most often affects its posterior wall, especially in the posterior fornix, then the side walls and, least of all, the anterior. Metastatic cancer affects the vagina in the arches and lower third.
There is an exophytic form of growth, when the tumor is represented by papillary growths that look like cauliflower protruding above the vaginal walls, and the endophytic form, when the tumor process from the very beginning grows into the underlying tissues, infiltrating them.
According to the histological structure, cancer of the vagina is almost always flat-cell with a tendency to keratinization and very rarely adenocarcinoma (if the cancer of the vagina arises from the remnants of Hartner’s moves into the vagina).
The risk group for the development of vaginal cancer includes women aged 50-60 years, with chronic irritations due to the wearing of pessaries, loss of the uterus and vagina infected with HSV 2, PVI, as well as with cervical cancer and radiation in history. Classification of vaginal cancer:
Stage 0 – preinvasive carcinoma (synonyms: Ca in situ, intra-epithelial cancer);
Stage I – a tumor with a diameter up to 2 cm, grows no deeper than the mucous membrane, regional metastases are not detected;
Stage II – a tumor with a diameter of more than 2 cm with the same depth of invasion or a tumor of the same or smaller size with paravaginal infiltration that does not extend to the pelvic walls; regional metastases are not detected;
Stage III – a tumor of any size with paravaginal infiltration extending to the walls of the pelvis, with mobile regional metastases;
Stage IV – a tumor of any size, grows into adjacent organs (mucous membrane of the urethra, bladder, rectum) and tissue (perineum, pelvic bones) with fixed regional metastases or distant metastases.
Clinical symptoms and diagnosis. In the early stages, vaginal cancer is asymptomatic. In the subsequent whites appear, spontaneous or contact blood-like discharge from the genital tract. As the tumor grows and collapses, pains in the pubis, sacrum and groin areas join, functions of adjacent organs are disturbed (frequent urination appears, difficulty defecation), later white or blue edema of the lower extremities develops.
Diagnosis of vaginal cancer in clinically obvious cases does not cause difficulties. During the inspection of the vagina in case of suspicion of cancer, it is advisable to use spoon-shaped mirrors that allow you to carefully inspect the walls of the vagina. On examination, a dense, hilly formation with the infiltration of surrounding tissues, having the shape of a knot, or a bleeding ulcer with dense jagged edges and a hard bottom can be detected.
Cytological examination of discharge from the tumor site or ulcer, biopsy, followed by histological examination of a piece of tissue plays a crucial role in establishing the diagnosis, especially in dysplasia and pre-invasive cancer. They can be suspected with colposcopy. To clarify the prevalence of the process and the state of the surrounding organs, cystoscopy, excretory urography, radionuclide renography, rectoromanoscopy, radionuclide lymphography, and chest x-rays are used.
To exclude a metastatic tumor, an ultrasound of the pelvic organs, separate diagnostic curettage of the mucous membrane of the cervix and the walls of the uterus, examination of the mammary glands, according to the indications hysteroscopy.