Vulvar cancer
Introduction
Introduction to vulvar cancer Vulvar malignant tumors are mainly primary, accounting for 4% of female genital tumors, accounting for 1% to 2% of women's systemic tumors. The vast majority of vulvar cancer is squamous cell carcinoma, accounting for 95% of vulvar malignant tumors. Sometimes vulvar cancer is confined to the epithelium, and it is called epithelial cancer in the epithelium. It is also called vulvar epithelial cancer. Vulvar cancer mainly occurs in elderly women. The average age of onset is 60-70 years old, but in recent years, with the increase of HPV infection, vulvar cancer has also occurred in young women. The main symptoms are nodules and lumps in the vulva, often accompanied by a history of pain or itching. Some patients present with vulvar ulcers, prolonged unhealed, and patients with advanced pus or bloody secretions, dysuria and other discomfort. basic knowledge The proportion of illness: 0.05% - 0.1% Susceptible people: women Mode of infection: non-infectious Complications: cervical lymph node metastasis vulvitis vulvar eczema
Cause
Cause of vulvar cancer
It is not clear at present, according to the performance of the precursors of the disease, the relevant factors are as follows:
Vulvar leukoplakia (20%):
This disease is closely related to the incidence of vulvar cancer. According to statistics, there are about 30-50% of leukoplakia before the onset of illness. Because the understanding and diagnostic criteria of leukoplakia are not uniform, it is not suitable for comparative analysis. Therefore, there are different views on this issue. The more consistent opinion is that the skin of the vulva or mucous membrane can not be called "white spot", but it is called white lesion, and then named according to clinical and microscopic features. "Vulvar leukoplakia" is only suitable for vulvar epithelium. Hyperplasia (N0vak1974), histological features should have varying degrees of cellular heteromorphism (Lever, 1975).
Zhang Baohe believes that leukoplakia should be classified according to the presence or absence of dysplasia and cancer (1977). As early as 1940, Taussing believed that 50% of leukoplakia could develop cancer, and 70% of squamous cell carcinoma patients had leukoplakia. Fraklin 1972 retrospective study 50% of untreated leukoplakia is destined to develop into cancer, vulvar pathology is proliferative lesions without treatment, 10-20% can be cancerous, and dysplasia is more susceptible to canceration (Gardner, 1969), vulvar dystrophy (also known as vulva white) The lesion rate is less than 5% (Jeffcoate, 1966), and domestic Cao Yu et al. (1980) reported 2%. It can be seen that the key is whether the vulvar squamous epithelium is proliferating, but not by the vulvar skin or mucous membrane whitening. The possibility of cancer.
Chronic syphilitic ulcer (20%):
Chronic syphilitic ulcers are closely related to vulvar cancer. The general report has a history of syphilis in 13 to 50%. The hospital measured 28 cases of sero-positive seroconversion in 8 cases (in the early days of liberation), accounting for 28.5%. It is believed that the positive rate of syphilis seroconversion in vulvar cancer cases is 5-6 times higher than that of the average patient. JapazeH et al. (1977) counted 20% of 192 cases of serotonin positive in serum syphilis, and Lnmin (1949) counted 60% of vulvar cancers. Granuloma, Shandong "Practical Gynecology" book collected 162 cases of negative cancer in China (1956 ~ 1964), 41% of people with a history of sexually transmitted diseases, which indicate that vulvar cancer may be related to sexually transmitted diseases.
Chronic inflammatory stimulation of the vulva (14%):
It may be the predisposing factor JapazeH and other epidemiological statistics found that 64% of the body fat, 24% of patients with diabetes, obesity and diabetes are often accompanied by acute and chronic inflammation of the vulva, promoting precancerous lesions.
The cause of the virus (15%):
In the etiology of Bowens' disease, viral particles were found by electron microscopy (Bhawen, 1980), and cases of verrucous were most likely caused by viruses (Japaze H, 1977), and 15% (Framklin 1972) to 34% (Merril). 1970) Vulvar cancer is associated with cervical cancer (in situ or invasive cancer), while herpesvirus type II is associated with the onset of cervical cancer. Chronic lymphogranuloma caused by the virus is one of the most common granulomas.
It is newly believed that human papillomavirus (HPV) can cause flat condyloma, which may be one of the causes of cervical cancer or other cancers due to cervical intraepithelial neoplasia, ie cervical precancerous lesions and cervical squamous Patients with epithelial carcinoma in situ, coexisting with this virus and sputum, found HPV by hybridization technology, HPV can be found in cells by special staining with peroxidase, the relationship between herpesvirus type II and HPV, the former catalyzes the latter .
Prevention
Vulvar cancer prevention
A) Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
B) Those who are frail or have a genetic disease of a certain disease should eat some anti-cancer foods and alkaline foods with high alkalinity as appropriate, and maintain a good mental state.
C) Have a good attitude to cope with stress, work and rest, not excessive fatigue. Visible pressure is an important cause of cancer. Chinese medicine believes that stress leads to excessive physical weakness, which leads to decreased immune function, endocrine disorders, metabolic disorders in the body, leading to the deposition of acidic substances in the body. Stress can also lead to mental stress causing qi stagnation and blood stasis. Invagination and so on.
D) Strengthen physical exercise, enhance physical fitness, and exercise more in the sun. Excessive sweating can excrete acidic substances in the body with sweat, avoiding the formation of acidic constitution.
E) People who have regular life and irregular living habits, such as singing karaoke, playing mahjong, and not returning to the night, will have aggravated physical acidification and are prone to cancer. Good habits should be developed to maintain a weak alkaline constitution and keep various cancer diseases away from you.
Complication
Vulvar cancer complications Complications, cervical lymph node metastasis, vulvitis, vulvar eczema
1. Spread: The tumor in the vulva is gradually enlarged, but rarely invades the fascia of the muscular layer or adjacent structures such as the pubic periosteum. Once the vagina is invaded, it quickly affects the levator ani muscle, rectum, urethra or bladder.
2. Lymphatic metastasis: The vulva is rich in lymphatic vessels, and the lymphatic capillaries of the vulva are in communication with each other. Therefore, the cancer of one vulva can spread through the bilateral lymphatic vessels, and initially metastasize to the superficial lymph nodes of the inguinal region. The femoral canal lymph nodes located under the groin, and then enter the pelvic cavity, the obturator and the intraorbital lymph nodes, and finally transferred to the para-aortic lymph nodes and the left subclavian lymph nodes. The clitoris cancer can bypass the superficial lymph nodes of the inguinal region directly to The femoral lymph nodes, the posterior vulva and the lower vaginal cancer can be directly transferred to the pelvic lymph nodes by avoiding the shallow inguinal lymph nodes.
Symptom
Vulvar cancer symptoms Common symptoms Itching vulvar pain Urinagia vulvar skin swelling vulvar ulcer
The main symptoms are nodules and lumps in the vulva, often accompanied by a history of pain or itching. Some patients present with vulvar ulcers, prolonged unhealed, and patients with advanced pus or bloody secretions, dysuria and other discomfort.
Clinical stage, vulvar cancer can be divided into four phases in clinical.
Stage I: All lesions are confined to the vulva, with a maximum diameter of 2 cm or less, and no inguinal lymph nodes are suspicious.
Stage II: All lesions are confined to the vulva, with a maximum diameter of more than 2 cm, and no metastasis of the inguinal lymph nodes is suspicious.
Stage III: The lesion is more than the genital area, and there is no metastasis or metastasis of the inguinal lymph nodes.
Stage IV: One of the following conditions is true;
1 Inguinal lymph node fixation or rupture, clinically known as metastasis;
2 lesions invade the rectum, the mucosa of the bladder or urethra, or the cancer has been fixed with the bone.
3 distant metastasis or touch deep pelvic lymph nodes.
Examine
Vulvar cancer examination
1. Gross observation: 1 squamous cell carcinoma can be characterized as simple ulcer, white lesion, subcutaneous mass or polypoid lesion. In the early stage, the epithelial foot of the epidermis infiltrates into the interstitial, gradually forming subcutaneous nodules, and this nodule can also be broken. Collapse, become smaller, and misdiagnosed as inflammation, and later developed into a cauliflower-like axillary or ulcer.
2 Bowen's disease is dark red rough spots, the boundary is clear and irregular, the surface is crusted, and the granulation tissue and exudation surface are seen after the deafness. The lesions of Paige's disease are eczema-like changes, which are red, slightly Protuberances, accompanied by white lesions or small particles, sometimes with shallow ulcer formation and scarring.
2 microscopic examination: 1 squamous cell carcinoma, most of the differentiation is good, often epithelial bead formation or keratinization; but the clitoris or vestibular partialization is poor, in addition to the adjacent normal tissues can also see nucleic acid synthesis disorders, indicating treatment It is necessary to remove the entire vulva when vulvar cancer occurs.
2 Bowen's disease, hyperkeratosis of the epidermis, parakeratosis, acanthosis, disordered cell arrangement, deep and irregular nuclear staining, intact basement membrane of the epidermis, and typical Paijie cells in the deep epidermis. The cells are large, round, oval or polygonal, the cytoplasm is empty and translucent, and the basement membrane of the epidermis is intact, but the extent of tumor cells often exceeds the edge of the lesion seen by the naked eye. Sweat adenocarcinoma under the epithelium; 3 adenocarcinoma, with glandular hyperplasia, multiple layers of epithelium, disordered arrangement, deep nuclear staining and abnormal shape.
Diagnosis
Diagnosis and diagnosis of vulvar cancer
Mainly based on clinical symptoms and biopsy biopsy, the lesions of the vulva should be carefully observed, such as the discovery of long-lasting ulcers, papular sputum, or white lesions, the treatment effect is not obvious, should take biopsy, in addition to Very early, similar to benign lesions, difficult to diagnose, general diagnosis is no difficulty, but should be differentiated from papilloma, vulvar tuberculosis, proliferative malnutrition, basal cell carcinoma, Pei's disease, biopsy is the only reliable identification method, Biopsy is taken at the non-decolorizing area after toluidine blue staining, and a more accurate diagnosis result can be obtained. If necessary, multiple times are required, and multiple biopsies can be finally diagnosed.
