Diagnostik und Therapie von Dysplasien und malignen
Tumoren der Vulva
Vulvar cancer compromises about five percent of malignancies
of the female genital tract. It is predominantly a
cancer of the postmenopausal woman (mean age at diagnosis 65 years) although rising numbers in the age group
under 50 were observed over the past years. Risk factors for
vulvar cancer and intraepithelial neoplasia, ist potential
precursor lesion, include vulvar dystrophy (e.g. lichen sclerosus), cigarette smoking, human papillomavirus (HPV)
infection and immunodeficiency syndromes.
Over 90% of vulvar cancers are squamous cell carcinomas.
As the intraepithelial lesions they can be subdivided in HPV
associated lesion and HPV independent lesion. HPV associated lesions are mostly seen in younger women and tend
to be multifocal (basaloid type) whereas HPV independent
lesions are often unifocal, combined with vulvar dystrophy
and affect mainly postmenopausal women (simplex type).
Other histologic types of vulvar cancer include melanoma,
Bartholin gland adenocarcinoma, sarcoma, Paget's disease
or basal cell carcinoma.
Diagnosis of vulvar intraepithelial neoplasia and cancer
is based on clinical examination, thorough colposcopy of
vulva, cervix and vagina and biopsy of the suspect lesion.
Additional radiographic and endoscopic studies can
be considered for women with large tumors or suspect
Treatment of the disease is depending on ist stage and histological findings. For carcinoma first and foremost surgery
(to varying extent) is performed, a lymphadenectomy
(ipsilateral or bilateral) is added for all stages of invasive
disease except stage 1a. As the inguinofemoral lymph node
status is of capital importance for the prognosis, sentinel
node biopsy to avoid complete groin dissection is still under
investigation and not yet the standard clinical option.
Adju vant radiotherapy of the groin and pelvis will be necessary if at least two inguinofemoral lymph nodes are
positive. Primary radiotherapy or (radio)chemotherapy can
be an option for inoperable disease.
Given the rising numbers of younger women affected by
vulvar cancer this disease should mainly be treated and
followed in specialized centres to avoid a loss of life quality
due to improper treatment.
Jörg Schwarz, Linn Wölber
Reviewer: Marcus Schmidt, Mainz
und Roberto Kurzeja, Berlin
CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2007;3(2):64-75