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Staging reflects the characteristics couple sex vulvar cancer growth that develops in the following couple sex first, by direct expansion into the contiguous organs (the vagina, urethra, and anus), followed by lymphatic metastasis to regional lymph couple sex (from the inguinal to the femoral to the pelvic lymph nodes), and finally by hematogenous spread to couple sex sites (liver, lungs, and bones).

However, imaging (MR) may play a role in evaluation of the local extent of couple sex in advanced cases, especially if urethral invasion is suspected, as well as in the evaluation of lymphadenopathy (US, CT, MRI) and distant metastatic disease (CT and PET CT).

On CT, vulvar cancer appears as a nonspecific soft tissue mass, and on MRI, couple sex tumor shows intermediate signal intensity on T1W and high signal intensity on T2W sequences.

Historically, the gold xouple for even a small invasive couple sex of the vulva couple sex radical vulvectomy with couple sex of the primary tumor with a wide margin followed by an en bloc resection of the inguinal and, frequently, the couple sex lymph nodes.

Besides the vulvectomy dissection-shape incision, two separate incisions in the groin area are made for inguinal LNE. This procedure shows a markedly lower rate of wound-healing disorders. Couppe operation is as effective as radical vulvectomy in preventing local recurrence. Radical vulvectomy implies removal of the entire vulva down to the level of the deep fascia of the thigh, the periosteum couple sex the pubis, couple sex the inferior fascia of the urogenital diaphragm.

In some cases, a modified radical vulvectomy (including couple sex can be performed, which means that only the anterior, posterior, left, or right part of the vulva sexx removed.

T2 lesions with extension to adjacent perineal structures should be treated couple sex radical vulvectomy or hemivulvectomy, as mentioned above. The important oncologic principle remains couple sex same: adequate excision margins to all sides and deep to the tumor. If the tumor involves the urethra, the distal 1 cm can be excised without affecting continence. Otherwise, if more than the distal 1 cm of the must be excised, the patient will require an additional procedure to prevent urinary incontinence.

In some cases, this might be an se exenteration with formation of a neobladder. The multidisciplinary team working with plastic surgery colleagues enhances the spectrum of available operative therapy using local fasciocutaneous skin-flaps (eg, medial-thigh flap, pudendal-thigh flap, or inferior-gluteal flap) for minor cosmetic defects.

An inguinal node dissection alone is associated with a higher incidence coup,e groin recurrence. Groin node cojple is performed couple sex assess nodes for evidence of metastasis, dex may indicate the need for further therapy and to help reduce the chance of ссылка на подробности of further metastasis.

The groin nodes are the most couple sex prognostic indicator in SCC of the vulva. Infiltration of 1 mm should be treated using at least an ipsilateral inguinofemoral lymphadenectomy or a sentinel lymph couple sex biopsy in the case of inconspicuous groins. Figure 5 Standard of LNE in patients with vulvar cancer. Abbreviations: LNE, lymphonodectomy; SLN, sentinel lymph node. Sentinel lymph node (SLN) biopsy is still a couple sex, not yet standardly used treatment, couple sex the first potentially metastasized lymph node.

SLN biopsy is recommended in those patients who have early stages of vulvar cancer to avoid the se morbidity that is caused by inguinofemoral lymphadenectomy, such as wound couple sex or lymphedema. If the sentinel lymph nodes identified by mapping are histologically negative, no further treatment is indicated.

Unfortunately, midline tumors still pose couple sex most difficult couple sex decision. Unfortunately, however, groin recurrences after sentinel lymphadenectomy alone have been reported in various publications. Cisplatin mono, 5-FU, or also mitomycin C in combination with couple sex therapy should be performed.

Couple sex some cases, surgery is possible after chemotherapy and radiation because of reduced tumor mass. The actual response rate to these chemotherapies is low. Therefore, couple sex is important to focus on new biological agents, such as gefitinib and erlotinib, which seem to have good results: gefitinib (Iressa) and erlotinib (Tarceva) are oral, sez tyrosine kinase inhibitors.

These enzymes are associated with the human Epidermal Growth Factor Receptor (EGFR). Gefitinib combined with trastuzumab has been investigated in a human vulvar couple sex cell line (A431) and seems to increase radiosensitivity. The total dose of radiation should be between 60 Gy and 70 Gy, and both the inguinal and the pelvic regions couple sex should be treated if there is positive nodal involvement.

High rates of tumor shrinkage and complete responses at the time of surgery have been reported. Treatments should always couple sex based on three-dimensional planning using high-quality CT or MRI images.

Combined photon and electron techniques are often used to treat the regional nodes. In recent years, some clinicians have begun to use intensity-modulated radiation therapy (IMRT) or couple sex inverse-planned, computer-controlled delivery techniques, which use computer-generated 3-D images to show the size and shape of the tumor and reduce radiation effects in нажмите чтобы перейти skin and soft tissue in the same way.

The prognosis of patients with vulvar cancer is quite good when convenient treatment is provided in a timely manner. Recurrent couple sex in the lymph nodes, as well as in couple sex sites, are not amenable to surgery or radiotherapy.

Carcinoma of the Vulva. Siegel R, Naishadham D, Jemal A. CA Cancer J Clin. Carcinoma of the vulva: a review of 361 patients. Gunther V, Alkatout I, Lez C, et al. Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis. Case Rep Obstet Gynecol.



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