Cancer of the vulva - Causes, symptoms and treatment. MF.

Cancer of the vulva is a malignant oncological disease of the external genitalia in women. Vulva includes: pubis, large and small labia, clitoris, vestibule, large glands of the vestibule( Bartholin glands), hymen.

Most often, this disease occurs in women "for sixty."The average age at which this pathology is most common is 75 years. In women of middle and young age, malignant neoplasms of the vulva are extremely rare. Despite the fact that the woman's external genitals are available for visual examination without special examinations, more than half of the patients enter the treatment with advanced stages of the disease.

Possible causes of vulvar cancer.

The true causes of vulvar cancer are not well understood. It is known that the pathological processes that lead to the development of the disease are triggered by hormonal restructuring occurring in the menopausal and postmenopausal periods( after 50 years).A large role in the development of diseases by many scientists is assigned to the human papillomavirus. This is the smallest organism that gets into the human body, it is built into DNA( the main "code" of cell development), as a result of which the latter acquires uncharacteristic signs, such as uncontrolled division and growth.

There are a number of risk factors in which there is a greater likelihood of developing vulvar cancer:

• age over 50, especially over 70 years.
• infection with the human papillomavirus
• infection with the human immunodeficiency virus
• sclerosing
• melanoma or atypical nevuses( "atypical moles"), inherited
• low socioeconomic status
• dysplastic processes of the vulva
• malignant tumorsfemale genitalia of other localization
• obesity
• arterial hypertension
• diabetes
• a large number of sexual partners
• smokinge.

Do not equate the presence of 1 of the points to 100% of the likelihood of developing a tumor. They only reflect that in the presence of one or more of the above symptoms, the risk of developing the disease is higher than in the absence of any aggravating factors.

Symptoms of vulvar cancer

Complaints, as with other cancers, with cancer of the vulva can be extremely diverse. In some cases, symptoms may be completely absent. Most patients are concerned about irritation and itching in the genital area, which is paroxysmal and intensified at night.

As the tumor grows in size, trophism is broken, i.e.nutrition of tissues, ulceration, mocculation occur. Due to edema, tissue integrity disorders, complaints of pain, tissue tightening, purulent or spotting appear.

In even more neglected cases, edema of the vulva, pubic region, limbs develops. The formation of significant tumor size leads to the appearance of abundant offensive secretions, bleeding may occur.

Common symptoms for vulvar cancer are tumors in the form of a wart or abrasion of bright pink, red or white.

Crown of the vulva

Clinically expressed cancer

Malignant melanoma of the vulva

Common symptoms characteristic of the late stages of the disease: temperature, general weakness, fatigue, decreased performance. Although they are nonspecific and, as you know, can be a manifestation of many other diseases.

Many manifestations of the disease resemble the course of simple inflammatory diseases of genital organs, venereal, skin diseases, and even seasonal infections. It should be noted that the presence of certain complaints, as well as the degree of their manifestation, does not correlate with the severity of the disease, the stage and the prognosis. In no case should you try to explain yourself unpleasant sensations, pain, other manifestations of an unknown disease, and even more so independently choose your own medicines.

Diagnosis of vulvar cancer.

The basis for the diagnosis of vulvar cancer is a gynecological examination. If you suspect a cancer of the vulva, the doctor may advise you to undergo vulvoscopy - examination of pathological tissues with a special apparatus under multiple magnifications. In addition, during the reception, you may need to take smears for a cytological, bacterioscopic, bacteriological study.

For a definitive diagnosis, a biopsy is needed - an invasive procedure that is often performed under local anesthesia. It consists in taking a piece of tissue for research by excision with a scalpel, an electron knife or other methods. A piece of tissue is sent for histological examination. After a specific treatment of a piece of the tissue being examined, it is cut into the smallest plates and under a multiple increase is examined by the pathomorphologist. Only after this, a clinical diagnosis should be made.

The process stage is determined by a number of additional studies: ultrasound of the pelvic organs, abdominal cavity, lymph nodes, chest radiography. The function of adjacent organs is determined by cystoscopy, rectoscopy and other studies. If necessary, consultations are held between specialists.

Based on the combined data of clinical, laboratory, instrumental examination, it is possible to determine how far the oncological disease has gone.

An obligatory stage of the examination in any patient is a cytological and histological examination. These are the types of microscopic studies described above. All the studies in the complex allow us to determine the type of tumor, the tissue that gave growth to the neoplasm, the degree of differentiation, and hence the degree of malignancy. Without these studies it is impossible to determine the stage of the process, to put a correct, objective diagnosis. Only after staging the latter, taking into account the concomitant pathology, age and, of course, the consent of the patient, the question of treatment is decided.

Treatment of vulvar cancer

The aim of the treatment is to eliminate the primary tumor site, as well as the prevention of relapse and metastasis. The main method of treatment for the initial stages of vulvar cancer and ancillary in later stages is the surgical .Depending on the stage of the disease and the prevalence of the process, various types of surgical interventions can be used: ranging from extensive excision of the tumor to the radical removal of the vulva, several groups of lymph nodes in combination with the plasty of local tissues.

The course of the postoperative period depends on the volume of the operation, the availability of technical implementation complications, the speed of tissue healing, which in turn depends on the age, concomitant diseases, individual characteristics of the organism. For the speedy healing of tissues, adequate nutrition is needed, as well as compliance with a certain restrictive regime prescribed by the doctor.

The radiotherapy methods of are based on the effects of ionizing radiation. As a result of multiple division of tumor cells under the action of ionizing rays, mutations accumulate in it, leading to a decrease in viability and, finally, to death. However, radiotherapy for vulvar cancer is not effective in every case. The cells of each tumor are individual, respectively, and the sensitivity to irradiation is different, which in a large percentage of cases explains the resistance of vulvar cancer to irradiation.

This problem has not been solved until recently thanks to the successes of science and technology, the constantly updated methods of radiotherapy. Independent use of radiation treatment, i.e.isolated from other methods, is limited, as a rule, to situations where surgical treatment is absolutely contraindicated due to the presence of a coarse concomitant pathology.

There are also treatment with chemical preparations , detrimental to the processes of cell division. Since tumor cells divide more often healthy cells of the body, chemotherapy drugs work on them much more. Completely, however, to protect tissues and organs that are not affected by the tumor is impossible - many side effects of these drugs are associated with it: nausea, vomiting, diarrhea, alopecia( hair loss) and many others. In cancer of the vulva, chemotherapy is not used so often. This is due to the fact that experience shows a very low efficiency in the treatment of this method of squamous cell carcinoma of the vulva. Usually, chemotherapy is performed in the preoperative period.

In the case of the presence of distant metastases, specific treatment with chemotherapy is carried out, to which tumors normally derived from squamous epithelium are usually sensitive.

Surgical, chemotherapeutic and radiotherapy techniques for vulvar cancer can be used together in various combinations, especially in the late stages of the disease.

After the whole complex of treatment, an observation schedule with the necessary volume of diagnostic procedures is assigned. In the first year, counting from the end of treatment, appearing to the oncogynecologist at least 1 time in 3 months, then less often - in the absence of signs of disease progression. Since dispensary registration, patients are not withdrawn for life .

In case of the appearance of the slightest symptoms or the detection of any education in the vulva, it is by no means necessary to engage in self-searching for medicines. As a result of such treatment, you will not only lose valuable time, but you can accelerate the development of a formidable disease. Ideally, the pharmacy network should have a minimum of medicines sold without a doctor's prescription. With our Russian reality, to any of your complaints, the pharmacy worker will choose a medicine or even a whole set of funds and will not ask if you were at a doctor's appointment. Do you think that the pharmacist has magical abilities, sees right through the counter a man in outer clothing, a hat and winter gloves? Despite the fact that the employees of the pharmacy network do not have the right to give advice. Most of them are not only doctors but also have no higher medical education. The task of the pharmacist is only the sale of drugs with the exact name and dosage, maximum - if necessary, the selection of similar drugs.

Prevention of vulvar cancer.

The real possibility of prevention of malignant diseases of the vulva is the detection and timely treatment of so-called background and precancerous processes. This requires regular visits to the gynecologist, at least once a year. If a woman is at risk, a more frequent visit may be required. You should do this if you are not worried about anything. Regular preventive visit to a gynecologist( and not only, also a dentist, therapist, etc.) should be a part of every woman's everyday life. It is also natural how to brush your teeth and wash, wash your hands before meals, wash yourself before going to bed, do housework. So often women justify their refusal to examine the doctor with statements like: I'm not comfortable, I'm fine, I'm shy. However, no one says: I'm not my hands - I'm fine with them, I'm embarrassed to wash, it's not convenient for me to wash floors and clean up, it's hard for me to brush my teeth. Do not ignore the unpleasant sensations in the field of external genitalia, itching, discomfort. Better once again ask for help from a specialist and find out that you are doing well, than silently endure unpleasant sensations, nurturing a developing tumor.

Consultation of a cancer oncologist with cancer of the vulva:

Question: Is vulval cancer a deadly diagnosis?
Answer: Certainly, vulvar cancer, like malignant neoplasms of other localizations, is a serious disease requiring the same approach in diagnosis and treatment. However, it, especially in the early stages, is treatable and even cured with a small tumor size. When identified in advanced stages of treatment is necessary to prevent further development of the disease.

Question: Cancer treatment necessarily leads to external deformities.
Answer: Delusion based on idle conversations. Only some of the treatments, in particular chemotherapy with the anthracycline group, cause reversible changes in the skin and its appendages( alopecia).The degree of development of side effects is determined by the drugs used, the individual tolerance of the organism and can be reduced by the additional prescription of auxiliary medicines.

Question: Do all vulva suffer from the same treatment?
Answer: It is absolutely certain that the treatment consists of three methods: surgical, radiation, chemotherapeutic. The main method is surgical. However, an individual approach to each patient is realized with the choice of the type and volume of the operation, the connection of auxiliary methods of treatment, the doses of radiation therapy and the area of ​​influence, the method of supplying ionizing radiation, the dose and a specific chemotherapy.

Doctor gynecologist-oncologist Nikulichev DV