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ONCOLOGY OF VULVA AND VAGINA

ONCOLOGY OF VULVA AND VAGINA. THE VULVA. INCIDENCE: OVER 400, OVER 200 DETHS (ANNUAL IN POLAND) 40-60% STAGE III and IV – FIGO – inolved lymph nodes.

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ONCOLOGY OF VULVA AND VAGINA

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  1. ONCOLOGY OF VULVA AND VAGINA

  2. THE VULVA

  3. INCIDENCE:OVER400, OVER 200DETHS (ANNUAL IN POLAND)40-60% STAGE III and IV – FIGO – inolved lymph nodes

  4. Risk factorslow level of hygiene, HSV, HPV(40%), chlamydia trachomatis,cosmeticsage – organism involution (i.e. metabolic abnormalities)

  5. Prognosis 5-year survivalI (FIGO) - 90%IV (FIGO) - 18%(all togother 35%)

  6. VIN - vulvar intraepithelial neoplasia(SIL –squamos intraepithelial lesion)

  7. VIN 1(low grade dysplasia)– 1/3 lower part of epitheliumVIN 2(intermediary grade dysplasia)– 2/3 lower part of epithelium VIN 3(high grade dysplasia)– 1/3 upper part of epithelium or whole epithelium - ca praeinvasivum or 1/3 lower part similar - ca planoepitheliale G1

  8. Ca planoepitheliale- 90% Bartholin gland Ca - 5%other glandular – Paget disease sarcomas metastatic – breast, kidney, stomach, melanoma

  9. Two types of vulvar cancer

  10. 1/3papillar or basal cell carelatively young womenbefore ca – VIN and virus infectionmultifocal

  11. 2/3planoepithelial keratodesin older agebefore no VINlichen sclerosusplanoepithelial hyperplasia virus infection rare monofocality

  12. Symptoms - no - itching - pain (clitoris) - abnormalities of defecation and miction - smell secretion

  13. Ways of invasion - infiltration of neighbour structures(urethra, vagina, anus) - metastasis into regional lymph nodes

  14. DiagnositicEVERY disease in region of vulva needs histioathological verification

  15. If melanoma suspection:resection of the whole abnormal tissue with margin of normal tissue

  16. in20% of cases vulvar malignancy coexist with second malignancy of FGT

  17. Stage O(carcinoma in situ, intraepithelial carcinoma)treatment simple resection of vulva local resection

  18. Stage I(tumor infiltrating vulva or perineum; in largest diam max 2 cm; no metastasis to lymph nodes)vulvectomy with bilateral inguinal lymph nodesmargin min.: 8 – 10 mm

  19. If metastasis in lymph nodes – complementary radiation theraphy

  20. In case of patient who does not agree for surgery– radical radiotheraphy

  21. Stage II((tumor infiltrating vulva or perineum; in largest diam over 2 cm; no metastasis to lymph nodes)

  22. Radical vulvectomy (margin of inaffected tissues - min 10 mm)with bilateral inguinal lymph nodes

  23. Complementary radiotheraphy - metastasis in inguinal lymph nodes (2 or more without cossing the capsule of LN or 1 with cossing the capsule of LN or macroscopic invasion)- margin smaller than 8 mm- deph of invassion larger than 5 mm- lymph or capillary vassels invassion

  24. Stopień III(tumor of any size infiltrating urethra, vagina, anus or/and unilateral metastasis to LN)

  25. Deep radical vulvectomy with superficial and profundal inguinal LN, urethraresection, partial resection of anus

  26. Radiotheraphy in patients who can not be qualified to surgery or do not agree

  27. Stopień IVIV A – tu infiltration upper part of urethra, urinal cyst mucose, mucose of anus, pelvic bones, and/or bilateral inguinal LNIV B – distant metastasis including pelvic LN

  28. 1. Radical vulvectomy with involved organs (urethra, urinal cyst, anus), with regional LN complementary radiation 2. Radical radiotheraphy 3. Paliative radiation 4. Symptomatic treatment.

  29. Chemotheraphy - as a part of radiochemotheraphy in preoperative radiation in stageIII/IV - in recurence5-fluorouracyl i cisplatin

  30. SROM

  31. SROM

  32. The Vagina

  33. Ca of vagina – primary - Very rare 1-2% of all FGT cancers 80-90% secondary Planoepithelial ca - (85%) - in this 80% cervical ca, 17% vulva ca Glandular ca - – endometrium (32%), colon (26%), ovary (17%) kidney, breast, chorioncarcinoma

  34. Ethiology of primary ca of vagina • ? • mechanic contraceptives • persistent leukorrhea • leucoplakia • vaginitis • late menopause • masturbation • viral infection • pessars • lack of estrogenes

  35. Location Most frequent - 1/3 – back-upper wall Less frequent - 1/3 low part Sporadic in the middle part of vagina

  36. Symptoms At the beginning – NO In advanced stages – Contact bleeding, leukorrhea, urinal bladder, anus abnormalities

  37. Diagnosis - hist-pat verification of the tumor - colposcopy with biopsy - exclussion of cervical cancer (cervical tissue sections / abrasion) - other cancer than planoepithelial - Uteral cave abrassion, USG, mammography - cystoscopy + tissue sections ( front wall) - rectoscopy + tissue sections ( back wall)

  38. Treatment • Surgery (partly!) • radiotheraphy ! • teleradiotheraphy • brachyteraphy • (chir + rtp) • chemotheraphy (advanced stages) (Cisplatyna, 5Fu, Mitomycyna)

  39. 5-year survival average 35 % Iº - 70% - 80% IVº - 0% - 18%

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