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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{Infobox_Disease
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| | Name = {{PAGENAME}}
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| | Image =
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| | Caption =
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| | DiseasesDB = 14013
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| | ICD10 = {{ICD10|C|51|.9|c|51}}
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| | ICD9 = {{ICD9|184.4}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 000902
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| {{Vulvar cancer}} | | {{Vulvar cancer}} |
| {{CMG}} | | {{CMG}}{{AE}}{{MD}}{{sali}} |
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| ==Overview==
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| '''Vulvar cancer''', a malignant invasive growth in the [[vulva]], accounts for about 4 % of all gynecological cancers and typically affects women in later life. It is estimated that in the United States in 2006 about 3,740 new cases will be diagnosed and about 880 women will die as a result of vulvar cancer.<ref>{{cite web | url = http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf | author = American Cancer Society | year = 2006 | title = Cancer facts and Figures 2006 | accessdate = 2006-10-13}}</ref> Vulvar carcinoma is separated from [[vulvar intraepithelial neoplasia]] (VIN), a non-invasive lesion of the [[epithelium]] that can progress via [[carcinoma-in-situ]] to squamous cell cancer, and from [[Extramammary Paget disease|Paget disease of the vulva]].
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| == Types ==
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| === Squamous cell carcinoma ===
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| The vast majority of vulvar cancer is caused by [[squamous cell carcinoma]] originating from the [[epidermis]] of the vulva tissue. Carcinoma-in-situ is a precursor stage of squamous cell cancer prior to invading through the [[basement membrane]]. Most lesions originate in the labia, primarily the [[labia majora]]. Other areas affected are the [[clitoris]], and [[fourchette]], and the local glands. While the lesion is more common with advancing age, younger women who have risk factors (v.i.) may also be affected. In the elderly treatment may be complicated by the interference of other medical conditions.
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| Squamous lesions tend to be unifocal, growing with local extension, and spreading via the local [[lymph system]]. The lymphatic drainage of the labia proceeds to the upper vulva and mons, then to the inguinal and femoral nodes with both superficial and deep lymph nodes. The last deep femoral node is called the Cloquet’s node; spread beyond this node affects the lymph nodes of the pelvis. The tumor may also invade adjacent organs such as the [[vagina]], [[urethra]], and [[rectum]] and spread via their lymphatics.
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| A verrucous carcinoma of the vulva is a subtype of the squamous cell cancer and tend to appear as a slowly growing [[wart]].
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| === Melanoma ===
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| About 5% of vulvar malignancy is caused by [[melanoma]] of the vulva. Such melanoma behaves like melanoma in other locations and may affect a much younger population. Contrary to squamous carcinoma, melanoma has a high risk of [[metastasis]].
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| === Basal cell carcinoma ===
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| [[Basal cell carcinoma]] affects about 1-2% of vulvar cancer is a slowly growing lesion and affects the elderly. Its behavior is similar to basal cell carcinoma in other locations that is it tends to grow locally with a low potential of deep invasion or metastasis.
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| === Other lesions ===
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| Vulvar cancer can be caused by other lesions such as [[adenocarcinoma]] or [[sarcoma]].
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| == Signs and Symptoms ==
| | {{SK}} Vulva cancer, cancer of vulva, vulvar carcinoma, vulvar neoplasm, neoplasm of vulva, malignant tumor of vulva, primary vulval cancer, primary vulvar cancer, primary vulva cancer, vulval carcinoma, vulva carcinoma, carcinoma of vulva, vulval cancer, vulval neoplasia. |
| Typically a lesion is present in form of a lump or [[ulceration]], often associated with itching, irritation, sometimes local bleeding and discharge. Also [[dysuria]], [[dyspareunia]] and pain may be noted. Because of modesty or embarrassment, symptoms may not be heeded in a timely fashion.
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| Melanomas tend to display the typical dark discoloration.
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| Adenocarcinoma can arise from the [[Bartholin gland]] and results in a lump that may be quite painful.
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| == Diagnosis == | | ==[[Vulvar cancer overview|Overview]]== |
| Examination of the vulva is part of the gynecologic evaluation and may reveal ulceration, a lump, or a mass. A suspicious lesion needs to undergo a [[biopsy]] that generally can be performed in an office setting under [[local anesthesia]]. Small lesion can be excised under local anesthesia.
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| Supplemental evaluation may include a [[chest X-ray]], an [[IVP]], [[cystoscopy]] and [[proctoscopy]], as well as blood counts and metabolic assessment.
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| == Differential diagnosis == | | ==[[Vulvar cancer historical perspective|Historical Perspective]]== |
| Other neoplastic lesions that need to be considered in the differential diagnosis are Paget disease of the vulva and VIN. Non-neoplastic vulvar disease includes [[lichen sclerosus]], squamous cell [[hyperplasia]], and [[vulvar vestibulitis]]. Infectious disease lesions can be caused by a number of diseases including [[herpes genitalis]], [[human papillomavirus]], [[syphilis]], [[chancroid]], [[granuloma inguinale]], and [[lymphogranuloma venereum]].
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| == Etiology == | | ==[[Vulvar cancer classification|Classification]]== |
| The etiology of the cancer is unclear; however, some condition such as [[condyloma]] or squamous [[dysplasia]]s may have preceded the cancer. [[Human papillomavirus]] (HPV) is suspected to be a possible risk factor in the etiology of vulvar cancer. Patients infected with [[HIV]] tend to be more susceptible to vulvar malignancy. Also, smokers tend to be at higher risk.
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| == Staging == | | ==[[Vulvar cancer pathophysiology|Pathophysiology]]== |
| Preclinical staging has been supplemented by surgical staging since 1988. [[International Federation of Gynecology and Obstetrics|FIGO]]’s revised staging TNM classification system uses criteria of tumor size (T), involvement of lymph nodes (N), and metastasis (M). Stage I describes the early stage of the cancer that still appears to be confined to the site of origin, stage II and III define less or more extensive extensions to neighboring tissue and lymph nodes, while stage IV indicates metastatic disease.<ref name ="figo">{{cite web | url = http://www.igcs.org/guidelines/guideline_staging-booklet.pdf| author = International Federation of Gynecologists and Obstetricians (FIGO)| title = Staging classification and clinical practice guidelines of gynaecologic cancers | year = 2000 |accessdate = 2006-10-13}}</ref>
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| == Treatment == | | ==[[Vulvar cancer causes|Causes]]== |
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| Staging and treatment are generally handled by an [[oncologist]] familiar with gynecologic cancer. The extent of the surgery is dictated by the surgical staging.<ref name="figo"/>
| | ==[[Vulvar cancer differential diagnosis|Differentiating Vulvar cancer from other Diseases]]== |
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| [[Surgery]] is a mainstay of therapy and usually accomplished by use of a [[radical vulvectomy]], removal of vulvar tissue as well as the removal of lymph nodes from the inguinal and femoral areas. Complications of such surgery include wound infection, sexual dysfunction, edema and thrombosis. | | ==[[Vulvar cancer epidemiology and demographics|Epidemiology and Demographics]]== |
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| Surgery is significantly more extensive when vulvar cancer has spread to adjacent organs such as urethra, vagina, and rectum.
| | ==[[Vulvar cancer risk factors|Risk Factors]]== |
| In cases of early vulvar carcinoma the surgery may be less radical and disfiguring and consist of wide excision or a simple vulvectomy.
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| [[Radiation therapy]] and [[chemotherapy]] are usually not a primary choice of therapy but may be used in selected cases of advanced vulvar cancer. | | ==[[Vulvar cancer screening|Screening]]== |
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| == Prognosis == | | ==[[Vulvar cancer natural history|Natural History, Complications and Prognosis]]== |
| The prognosis of vulvar cancer shows overall about a 75% [[five year survival rate]], but, of course, individually affected by many factors, notably stage and type of the lesion and age and general medical health. Five-year survival is down to about 20% when pelvic lymph nodes are involved but better than 90% for patients with stage I lesions. Thus early diagnosis is imperative.
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| == Help and Support == | | ==Diagnosis== |
| | [[Vulvar cancer staging|Staging]] | [[Vulvar cancer history and symptoms|History and Symptoms]] | [[Vulvar cancer physical examination|Physical Examination]] | [[Vulvar cancer laboratory findings|Laboratory Findings]] | [[Vulvar cancer x ray|X Rays]] | [[Vulvar cancer CT|CT]] | [[Vulvar cancer MRI|MRI]] | [[Vulvar cancer ultrasound|Ultrasound]] | [[Vulvar cancer other imaging findings|Other Imaging Findings]] | [[Vulvar cancer other diagnostic studies|Other Diagnostic Studies]] |
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| There is a support group for women who have/had vulva cancer/other vulva problems called VACO (Vulva Awareness Campaign Organisation). The website address for this is vaco.co.uk. It's just as easy as checking breasts. Women must check their vulva and to report any problems to their doctor as soon as possible.
| | ==Treatment== |
| | [[Vulvar cancer medical therapy|Medical therapy]] | [[Vulvar cancer surgery|Surgery]] | [[Vulvar cancer primary prevention|Primary Prevention]] | [[Vulvar cancer secondary prevention|Secondary Prevention]] | [[Vulvar cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Vulvar cancer future or investigational therapies|Future or Investigational Therapies]] |
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| ==References== | | ==Case Studies== |
| {{reflist|2}}
| | [[Vulvar cancer case study one|Case #1]] |
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| ==External links== | | ==External links== |
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| [[Category:Gynecology]] | | [[Category:Gynecology]] |
| [[Category:Oncology]] | | [[Category:Oncology]] |
| [[Category:Overview complete]] | | [[Category:Up-To-Date]] |
| | | [[Category:Oncology]] |
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