Cancer of the Vulva
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Invasive squamous cell carcinoma accounts for 90% of all invasive malignancies of the vulva, which are responsible for only 1-4% of all female cancers. Other less-common malignant lesions of the vulva are melanoma, adenocarcinoma, and sarcoma. More than three fourths of all patients diagnosed with cancer of the vulva are age 55 years or older, with at least 30% of these women older than 75 years. Approximately 500 deaths from vulvar cancer occur annually in the United States. Because of recognizable symptoms and ease of examination by biopsy, malignancies of the vulva can be detected in an early stage, when therapy can be curative. Death from vulvar cancer results from failure to control the disease after it has progressed beyond the vulva. Such instances often result from delay by the patient in obtaining care and by the physician in performing diagnostic biopsy. Regular examination of all women and increased efforts in patient education can help minimize treatment delay. Recognition of the clinical characteristics of vulvar malignancies and promotion of ready use of office biopsy could prove highly beneficial. Viagra for woman at cheap online pharmacy.
The cause of vulvar malignancies remains unknown, although the association of squamous cell carcinoma of the vulva with other neoplasms of the anogenital mucosa has long suggested a common etiology. Preliminary data on oncogenesis, however, has not been conclusive. The association of high-risk types of human papillomavirus (HPV) such as 16, 18, 31, 33, 35, and 39 with high-grade epithelial neoplasia and invasive carcinomas of the anogenital tract has been established. Vulvar cancer appears to have a multifactorial etiology, however, and HPV infection alone is probably not sufficient for malignant transformation. Primary among cofactors may be the patient’s own immune competence, including conditions of local immunodeficiency. The role of chronic vulvar dystrophy is unclear, although there is a common association. Whereas the risk of progression of vulvar dystrophy to malignancy is low, vulvar dystrophy is frequently associated with epidermoid carcinoma.
Multicentric and confluent vulvar intraepithelial neoplasia (VIN) lesions predominate among younger women, whereas the unifocal lesions, which are most likely to be associated with invasive carcinoma, are more common in older women. The lesions may appear to be white because of thick surface keratin or red if hyperemia is present within the dermal papillae. Pigmentation is common, especially with bowenoid neoplasia. Often the lesions appear as slightly raised and possibly confluent white areas resembling flat condylomata. Colposcopy with 4-5% acetic acid heightens the whitening and allows for delineation of the margins of the vulvar lesions. Subclinical HPV infections of the vulva can be distinguished with acetic acid at times. Thickened, nodular, ulcerated areas are most suspicious, as are areas of vascular prominence and atypical tissue.
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