Vulvar invasive squamous cell carcinoma
Introduction
Introduction to vulvar invasive squamous cell carcinoma Vulvar squamous cell invasive carcinoma is generally considered to be a further development of intraepithelial neoplasia (VIN) through early vulvar invasive squamous cell carcinoma. According to the etiology, vulvar squamous cell carcinoma can be divided into two types: one is more common and is keratinized. Squamous cell carcinoma. Another less common is HPV-associated spastic cancer and basal cell-like cancer. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: bacterial infections urinary infections
Cause
Causes of invasive squamous cell carcinoma of the vulva
(1) Causes of the disease
The etiology of invasive squamous cell carcinoma of the vulva has not yet been fully clarified, but some pathogenic factors related to the cause, such as sexually transmitted diseases, viral infections, low immune function, chronic skin diseases of the vulva, smoking, etc., have been found.
(two) pathogenesis
Pathology of invasive squamous cell carcinoma of the vulva:
Generally
In the early stage, similar invasive squamous cell carcinoma of the vulva, the vulva may have a small superficial appearance, a high-hard ulcer or a small hard nodule, and a large-scale fusion with infection, necrosis, hemorrhage, and most cancerous lesions. It is surrounded by white lesions or may have erosions and ulcers.
2. Under the microscope
The maximum diameter of the tumor is >2cm, and the depth of invasion is >1mm. The histological type of invasive carcinoma of the vulva is the same as that of the early invasive squamous cell carcinoma. Similarly, the size and quantity of the lesion should be noted when performing histopathological examination. Depth, pathological grade, presence or absence of lymphatic or vascular involvement and other vulvar disorders coexisting.
Prevention
Vulvar invasive squamous cell carcinoma prevention
Early diagnosis, active treatment, and good follow-up.
Complication
Vulvar invasive squamous cell carcinoma Complications, bacterial infection, urinary infection
Early invasive squamous cell carcinoma of the vulva can be complicated by the following conditions:
1, because the cancerous lesions gradually increase to the urethra, perineal body and vagina, can be combined with perineal cancer.
2, some advanced patients will have cancer cell lung metastasis, so early invasive squamous cell carcinoma of the vulva may be complicated by lung cancer.
3, due to the decline in the patient's body resistance, can lead to imbalance in the body and outside the colon, and finally lead to infection.
Symptom
Vulvar invasive squamous cell carcinoma common symptoms pruritus urinary pain purulent secretion urinary frequency edema papule nodules lymphatic metastasis secondary infection squamous cell carcinoma
Symptom
Long-term intractable genital itching is a common symptom of vulvar squamous cell invasive cancer patients, the course of disease is generally longer, itching is heavy at night, due to scratching, local ulcers, pain with vulva, increased secretion, local bleeding, etc. Other symptoms may occur depending on the location of the lesion, such as tumors adjacent to the urethra or advanced cases. Tumors invading the urethra may have frequent urination, dysuria, burning sensation and difficulty in urinating.
2. Signs
Vulvar invasive squamous cell carcinoma is mostly located in the labia majora, followed by the labia minora, clitoris and posterior joints, especially the right labia majora. The early stage is localized papules, nodules or small ulcers, and the late lesions often show ulcer type. Cauliflower pattern or papillary mass, the surface may have bloody or purulent secretion due to rupture and secondary infection, tenderness, often coexist with vulvar dystrophy, clinical vulvar cancer morphology is variable, the size varies The color can be white, gray, pink or dark red. The surface can be dry and clean, and there are secretions and necrosis. The cancer can be either single or multiple. Single-focal cancer can be divided into cauliflower. Type and ulcer type, the cauliflower type of outward growth is mostly a well-differentiated lesion. The ulcerated type of cancer is infiltrated and grows, mostly occurs in the posterior part of the vulva, often invading the Barthel's gland, the perineal and ischial rectal fossa, multifocal carcinoma. Accounted for about 1/4 of vulvar cancer, the vulva has more pigmentation, often combined with vulvar dystrophy, diffuse lesions, rare small lesions, sometimes one or both groin can be touched to increase, hard, fixed, no Tenderness Knot, but it should be noted that the enlarged lymph nodes are not all metastasis, and the lymph nodes are not removed. The squamous cell carcinoma originating from the vestibular gland is often characterized by the labia majora near the labial ligament. Hard edema, but the surface of the skin may be good.
3. Transfer route
(1) Direct infiltration: The cancerous lesion gradually increases to the urethra, perineal body and vagina; the posterior vulvar cancer tends to invade the vaginal opening and the anus, and the later stage can invade the pubic bone and extend around the anus or the bladder neck.
(2) Lymphatic metastasis: Lymphatic metastasis is the most common and most important metastasis pathway. The lymphatic metastasis rate can reach 21% to 59%. The metastasis pathway is mainly determined by the characteristics of lymphatic drainage. See Invasive early invasive squamous cell carcinoma.
(3) Hematogenous metastasis: rare, usually only in advanced patients, can be transferred to the lungs.
4. Clinical staging
There are many clinical staging criteria for primary vulvar squamous cell carcinoma. There are two main types of primary vulvar epithelial cancer. One is the surgical pathology staging method revised in 1994 by the international federation of obstetrics and gynecology (FIGO). The other is the TNM staging method of the 1997 International Association Against Cancer (UICC), which has its own advantages.
Examine
Examination of vulvar invasive squamous cell carcinoma
1. Secretory examination, tumor marker examination.
2. Cytological examination
Smear cytology of suspicious lesions, often seen in cancer cells, because the vulvar lesions often combined with infection, the positive rate is only about 50%.
3. Imaging examination
In order to determine the clinical stage before treatment, in order to facilitate the objective formulation of the treatment plan, it is feasible to check the B-ultrasound, CT, magnetic resonance and lymphography of the para-aortic lymph nodes.
4. Bladder, proctoscopy for some of the more advanced vulvar cancer, cystoscopy and proctoscopy to understand the bladder, rectal conditions are necessary.
5. Pathological biopsy
All genital sputum organisms, including cauliflower stoves, ulcers, nodules, white lesions, etc., need to be examined by biopsy. When biopsy, there is no extensive lesions of obvious lesions. In order to avoid misdiagnosis, it may be used. Vaginal magnifying glass and/or vulvar staining with 1% toluidine blue (nuclear stain), then rinsed with 1% acetic acid to determine the suspected lesion, then biopsy, positive results due to inflammation and cancer Therefore, toluidine blue staining can only be used to select the biopsy site. The lesions with combined necrosis should have sufficient depth, and should be taken at the edge of the necrotic tissue to avoid taking only necrotic tissue and affecting the test results.
Diagnosis
Diagnosis and differentiation of invasive squamous cell carcinoma of vulva
Vulvar squamous cell invasive carcinoma is located on the body surface. According to the history, symptoms and signs, it is not difficult to diagnose clinical invasive carcinoma. However, even clinically typical invasive cancer should be biopsied before treatment. Clear diagnosis, guide treatment, and estimate prognosis.
Differential diagnosis
Vulvar squamous cell invasive carcinoma should be differentiated from the following diseases:
Vulvar
The disease often occurs in young women, with a soft, ulcer-free papillary outward growth, sometimes a pedicled mass that can coexist with other sexually transmitted diseases.
2. Vulvar dystrophy lesions
Skin lesions are extensive and varied, and can be keratinized thickening, hardening, or atrophy. They can be pigmented or grayish white, and genital itching can be repeated.
3. Other
Vulvar vitiligo and vulvar eczema see "invasive early invasive squamous cell carcinoma", in addition, should be distinguished from local vulvar ulcers and other inflammatory diseases.
