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Malignant neoplasms of the vulva constitute about 5% of all malignant neoplasms of the reproductive organ and most often affect women after the menopause. In recent years, an increase in the prevalence of both precancerous conditions and vulvar malignancies has been observed, mainly in young women, i.e. in the reproductive period.
Pre-cancerous conditions of the vulva
These are lesions where a malignant tumor develops much more often than in healthy tissue (precancerous conditions of the vulva are referred to as vulvar dysplasia or vulvar intraepithelial neoplasia; these are lesions limited to the epithelium). These changes occur regardless of age, but their significant increase is observed in people up to 40 years of age. Among the most common factors increasing the risk of precancerous conditions are tissue trophic disorders, HPV infection, and the presence of chronic inflammatory infections. The diagnosis of this ailment is based mainly on a histopathological examination of a sample taken from the affected area. On the other hand, the choice of treatment method depends on the stage of the lesion.
In Poland, cervical cancer has been a serious problem for many years. Although the number of cases is gradually decreasing, it still remains at a very high level. In turn, intraepithelial neoplasia is a lesion that can develop into invasive cancer or can remain stationary for many years. The development of cervical cancer is primarily influenced by infection with viruses characterized by a high oncogenic potential and infection with the human papillomavirus.
Types of precancerous conditions of the vulva
1. Vulva intraepithelial neoplasia – it is a precancerous condition that often causes long-lasting pain and itching of the skin that contribute to psychosexual dysfunction. The disease has a wide clinical picture, for this reason it has been divided into two types:
- Normal type VIN – caused by infection of high-risk human papilloma,
- Differential type VIN – related to lichen sclerosus.
Vulvular intraepithelial neoplasia was first described in 1912 by Bowen. In 1965, Kaufman divided precancerous lesions into three categories: Queyrat erythroplasia, bowenoid carcinoma in situ and carcinoma simplex. 1. The incidence of this condition has increased in recent years, possibly due to the greater number of HPV infections. The lifetime risk of infection with this virus in Western countries is about 80 percent. It is assumed that up to 40 percent. all sexually active women contract high-risk HPV. The symptoms of vulvar intraepithelial neoplasia vary widely. Red, white, flat or raised lesions may appear. Sometimes these are erosions and ulcers. About 60 percent. patients experience pain and itching. The diagnosis takes into account the thickness, color and location of lesions. In order to make a correct diagnosis, it is necessary to perform a biopsy under local anesthesia. The most frequently affected areas are the greater and lesser lips and the frenulum of the labia.
2. Choroba Pageta — it is an intraepithelial lesion of the vulva which is not squamous; it is a rare endothelial cancer. It occurs mainly in postmenopausal women with a diameter of 72 years. Paget’s disease is most often characterized by itching, burning, and vaginal oozing and bleeding. Very often the disease is diagnosed too late, most often when the lesions are already very visible. Lesions can be located both in the perineum and anus, and on the inner surface of the thighs. In the course of the disease, inflammatory foci are observed, which are eczematous in nature, are covered with small and pale islets and may ooze and flake. Although Paget’s disease is mainly an endothelial lesion, it can also affect the dermis. It happens that it is associated with deeper adenocarcinoma. Very often, Paget’s disease of the vulva can recur, due to the fact that the histological size of the lesions is much larger than that which can be observed with the naked eye.
3. Melanoma , – is a cancer that is rare in the vulva area. It is characterized by a slow progression to invasive melanoma. A biopsy should be taken
of all the disturbing changes in this area. However, due to the very important need to determine the depth of the lesion, it is recommended to perform a punch biopsy. Note: It is contraindicated to eliminate lesions by means of cryosurgery, laser and cauterization, because all lesions should be examined histopathologically.
Pre-neoplastic and malignant conditions of the vulva – diagnosis
Every woman, regardless of age, should see a gynecologist after noticing a change in the vulva or ailments. Detection of changes includes:
- macroscopic evaluation,
- colposcopic evaluation, also called vulvoscopy of the skin of the vulva and vestibule,
- microbiological examination of swabs taken from the vulva,
- cytological examination of cells taken from the surface of the vulva,
- histological examination of the specimen taken under the control of the colposcope.
How to prevent and treat precancerous and malignant vulvar conditions?
Changes in the nature of mild and moderate dysplasia can often persist for several months. Depending on the needs, anti-inflammatory local therapy should be used, therapy improving the trophic of the epithelium. In a situation where dysplastic changes do not go into remission, one of the surgical treatment techniques – organ-sparing – is considered.
In the case of high-grade dysplasia and cancerous changes ,if they are monofocal and there is no disturbance of the epithelial trophic, local excision of these lesions is performed. In other cases, superficial or simple excision of the vulva. In advanced neoplasms, we remove the vulva along with the inguinal, femoral, and sometimes also the pelvic lymph nodes. Usually, surgery is then supplemented with radiotherapy and / or chemotherapy.
It is worth emphasizing that in non-invasive and early invasive neoplasms there is a 100% chance of recovery. In more advanced lesions, the percentage of complete cure is lower and amounts to 60–75%. Therefore, it is very important for women to consult a gynecologist as soon as possible when they observe such changes, because they ensure a full recovery, possibly a less radical, and therefore less extensive surgery.
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