Lecture on vulvar cancer

2021-03-21 12:00 AM

The vulva and groin are naturally wet by nature that is a favourable condition to absorb foreign substances through the skin of the vulva, the degree of absorption depends on the wet condition.

Ratio

Vulvar cancer accounts for about 3-4% of the gynaecological cancers and ranks fourth among genital cancers, after endometrial cancer, uterine cancer, and ovulation. The average age of sick adults is about 63 years old and 75% of patients over 50 years old, about 15% occurs in women under 40 years old.

Pathogenesis

Itching

Chronic itching, scratching forms irritants.

Pussy humid chili

The vulva and groin is naturally wet by nature, which is a favourable condition to absorb foreign substances through the skin of the vulva, the degree of absorption depends on the wetness of the bilayer of the vulvar epithelium. . People who are obese and have an unhealthy condition are favourable conditions that cause vulvar carcinoma.

Industrial waste

Stacey has reported that some toxic substances cause vulvar cancer in the UK such as tar ...

Arsen

In the past, arsenic was used frequently in medicine to treat conditions such as syphilis, leukaemia, anaemia and some dermatological diseases. Some detergents contain arsenic if not washed thoroughly, then underwear containing arsenic, causing irritation to the vulva forming an itch-scratching spiral.

Sanitary chemicals

Some deodorants, soaps, and cleaning sprays contain cancer-causing chemicals.

Personal hygiene

Using water for unclean cleaning creates irritants that cause itching. The vulva is prone to wetness such as urinary incontinence, dyed underwear or irritating synthetic fabrics, and tight-fitting underwear that limits ventilation.

Cancer in the vulvar epithelium

Vulvar carcinoma is more common in women under 40 years old, while vulvar cancer is more common in women over 60 years old, and carcinoma of the epithelium has a fairly long injection stage of about 25 years. -30 years to develop into invasive cancer.

Infection

In ancient literature, it is found that about 30-50% of vulvar cancer patients have syphilis and also found that venereal granulomatosis is also common.

Vaginal dysfunction

Approximately 5% of patients with vulvar dystrophy develop into invasive carcinoma.

Genital warts virus.

Symptom

The patient may present with vague vulvar symptoms or irritation such as itching. Pain near the clitoris or urethra causes discomfort when urinating. Superinfection of the malignant tumor also causes pain and discharge. The physical examination can reveal tumor lesions, ulcers, and bleeding. About 5% have lymph nodes in the groin or have abscesses.

Diagnose

Diagnosis is confirmed by biopsy of all vulvar lesions such as white spots, redness, pigmentation, ulcerative lesions, and warts.

Cytology, magnification, green toluidin to target the lesion.

Stage evaluation

Mainly based on clinical judgment.

About 25-50% of clinical judgment is incorrect about lymph node metastasis.

Classified by the International Association of Obstetrics and Gynecology

Stage 0: local carcinoma such as Bowen's disease, Paget's disease is not invasive.

Stage 1: The tumor is localized in the vulva, 2 cm or less, the inguinal lymph nodes cannot feel or feel on the same side, but not large and still mobile.

Stage 2: The tumor is localized in the vulva, 2 cm or more in size, the inguinal lymph nodes do not feel or feel on the same side, but not large and mobile.

Stage 3: Tumor of any size: (1) has spread to the urethra or vagina, epithelium, anus (2) lymph nodes are palpable in one or both sides of the groin, enlarged, firm, portable and not sticky.

Stage 4: Tumor of any size: (1) has infiltrated the bladder, bladder lining, rectal mucosa or both, including the upper part of the urethral mucosa (2) adhesion bone or distant metastasis.

Classified by the TNM system

T: primary tumor.

TI: Local tumor in the vulva, diameter <2cm.

T2: Local tumor in the vulva, largest diameter> 2cm.

T3: Tumor of any size that has spread to the urethra and/or vagina and/or episiotomy and/or anus.

T4: Tumor of any size has infiltrated the bladder and/or rectal mucosa including the upper urethral mucosa and/or has stuck to the bone.

N: lymph node in place.

No: don't feel it.

NI: palpable paranasal ganglion, not enlarged, mobile (clinically not think of malignant lymph nodes).

N2: lymphadenopathy is palpable in one or both sides of the groin, enlarged, chubby, mobile (clinically suspected malignant lymph nodes).

N3: placenta, non-mobile or ulcerative.

M: distant metastasis.

Mo: There is no clinical manifestation of distant metastasis.

M1A: deep pelvic inguinal lymph nodes can be palpated.

M2A: Other distant metastases.

Treatment

Surgery

The principle of treatment of vulvar invasive carcinoma is the surgical removal of the vulva thoroughly to remove the bilateral inguinal lymph nodes.

Prognostic factors

The most important factor is the presence or absence of lymph node metastases. There are also other factors such as: tumour size, level of malignancy of cells, vascular and lymphatic systems are infected, the tumour fumes stick together into a tumour, deep infiltration of the tumour.

Survival rate

And after 5 years for vulvar carcinoma without inguinal ganglion infection is 90%, if lymphadenopathy, this rate decreases to only 38-40%.

Turn them off by radical vulvectomy and curettage of bilateral femoral groin nodes

Infection

Infections of the vulvar or inguinal ganglion area are about 50%. Careful constriction of the lymphatic branches to or form as well as limiting the anaemia nourishing the skin flap, antibiotic treatment and draining the lymph nodes will significantly reduce this complication. In the case of pecking incisions, it is necessary to take careful local hygiene care, remove all necrotic tissue pieces, test for bacterial culture and make an antibiotic.

Angioedema

Occurs in over a third of patients with a radical surgery to remove the groin ganglia on both sides. Chronic lymphoedema can lead to vasculitis and meningitis, and the use of tight socks and compresses in combination with antibiotic therapy may partially address this complication.

Paralysis of the thigh nerve

Injury to the thigh nerve during inguinal ganglion dissection can cause loss of sensation and pain in the front of the thigh, which can go away on its own in a few months, possibly in conjunction with therapy.

Secondary bleeding

Bleeding from a venous or femoral artery can occur, but very rarely, often due to an infection of the groin leading to a rupture of the blood vessel. Preventive treatment can be done by using the chance to cover large blood vessels in the surgical amputation of the inguinal ganglion, carefully shutting the blood during surgery, draining the blood to avoid the accumulation of blood and lymph.

Lymphoma

It is a buildup of inguinal lymph that forms painful cysts and can cause the secondary infection. Usually occurs in patients with pre-operative radiation, metastasis has spread to the lymphatic system, radical vulvectomy with bilateral femoral inguinal lymphadenectomy, heparin treatment. Preventive treatment with cautious weighing surgery to constrict the incoming or outgoing branches of the lymphatic tract, absorb the population, use pressure gas to block the dead spaces. When lymphocytic complications occur, drainage should be administered.

Thromboembolism caused by thrombosis

Radical surgery plus lymphadenectomy of large blood vessels are favourable conditions for thrombosis to occur as well as pulmonary embolism. Using pressure socks as well as prophylactic heparin can significantly reduce this complication. When this complication occurs, treatment with anticoagulants is required.

Urinary tract

For patients with radical vulvectomy plus lymphadenectomy, it is necessary to save the sonde to drain the bladder for a few days, which is a favourable condition for urinary infection to occur, when the sonde is removed, the patient feels hard pee. Persistent urinary retention is also common in patients with large lip removal. Some rare cases such as surgical removal of the urethra completely remove the primary tumor, altering the anatomical structure of the bladder.

Have sex

Reduced libido, orgasm disorder, painful intercourse, it is necessary to consult a psychologist.

Other types of vulvar cancer

90% of vulvar cancers are carcinoma, in addition, there are other forms of cancer such as:

Melanoma

It ranks second in vulvar cancer, after carcinoma. The rate of about 5%, of which 1% of the skin on the body also has manifestations. This disease is more common on the small lips and clitoris than carcinoma and very often spread to the vagina and urethra. Presently, black melanoma is present, particularly like sticky moles.

Predictive phase :

The Clark classification is based on the introduction of melanoma into the structure of the skin:

Level

Parts of the skin

1

Epithelium

2

Dermal papillae

3

Intermediate class

4

Mesh area

5

Organized under the skin

Sometimes the dermis papillae have not clearly defined boundaries, so it is difficult to read the pathology.

Classification according to Breslow is based on the depth infiltration from the surface of the epithelium.

 

Level

Penetration depth (mm)

1

<0,76

2

0,76-1,5

3

1,5-3

4

>3

5

>4

Treatment :

Based on clinical evaluation as well as anatomical site pathology and the spread of leukaemia there is a decision to remove a large local tumour and unilateral inguinal lymph node removal or radical cauterization, dredging of the groin ganglion. both sides.

Adenocarcinoma

Usually rare and originating from the Bartholin's gland, all infections that enter the gland cause swelling and pain and require an incision to eliminate the possibility of malignancy. When there are symptoms of painful intercourse, palpable tumour, or ulceration of the Bartholin gland, it is necessary to have surgical treatment to thoroughly cut the vulva and dredge the inner thigh ganglia.

Basal cell carcinoma

Usually, basal cell carcinoma occurs in all areas of the body hair and sometimes occurs in large lips: (1) red or brown patches or plaques (2) a small tumor with a central ulcer. This lesion never metastasizes the lymph nodes, and local extensive tumor resection is appropriate treatment.

Paget disease

It is a lesion in the epithelium of the vulva and is usually related to the adenocarcinoma of the sebaceous gland accounting for about 20-25%. Usually has clinical manifestations. The lesion is blotchy in colour, with small, white, itchy patches raised. Treatment is done by removing a largely localized lesion to remove the skin's skin manifestations to test cytology for adenocarcinoma attached. If the disease recurs in place, the lesion should be removed again. If adenocarcinoma is attached, it is necessary to remove the vulva thoroughly with the dredging of the groin ganglia on both sides.

Carcinoma of the wart form

Lesions show cauliflower-like or papillae-like papillae. This lesion was formerly known as Buscheke - Lewenstein giant genital warts. In general, the lesions are only local infection, rarely lymph node metastases. The cytological examination is very important, allowing to distinguish this lesion from genital warts and papillomas. A deep biopsy is needed. If the biopsy is shallow, it will be difficult to read. Anatomical picture of normal keratinized papilloma or keratinized papillae, urchin cells with deeply ingested papillae with highly differentiated epithelium without a nucleus. Treatment is with extensive local lesion resection. Combined radiotherapy only when the cytologic response is undifferentiated carcinoma.

Pussy sarcoma

This damage is very rare and often causes distant metastasis. Usually caused by leiomyosarcoma, sometimes by liposarcoma, lymphoma, rhabdomyosarcoma, fibrosarcoma, angiosarcoma, epithelioid sarcoma. Treatment with extensive local lesions is combined with radiation and chemotherapy.

The disease recurs

About 80% of vulvar carcinoma recur within 24 months. Treatment is based on local recurrence, lymphadenopathy or distant metastasis. Usually, local recurrence is treated with resection of the lesion. Inguinal lymph node metastases need surgery to remove, but for pelvic lymph node metastases, radiation therapy is required. Chemotherapy is not highly effective against vulvar carcinoma.

Radiation treatment

Treatment with radical vulvectomy and removal of bilateral femoral inguinal lymph nodes has a therapeutic effect in 90% of patients without inguinal lymph node metastases, patients with inguinal lymph node metastases, this rate decreases. down dramatically. Positive unilateral or bilateral inguinal lymph nodes are valid in prognosis. Patients with positive or less bilateral lymph nodes have a better prognosis than patients with positive bilateral or bilateral inguinal lymph nodes positive. In patients with positive bilateral or bilateral inguinal lymph nodes positive, radiotherapy to the inguinal and subframe areas may be required after surgery, which may or may not is combined with chemotherapy.