Herpes simplex virus infections increase that woman’s risk, women that are HIV positive are at much higher risk, those that are smokers, and those that are immunosuppressed or renal transplant patients for example that have an HPV infection are at much higher risk to go on to develop cervical cancer. There are at least 10-20 million women with HPV infections and probably you can equate that to the same number of men out there. Of those 20 million, only about 1.2 million go on to develop these preinvasive lesions, cervical dysplasia, and only about 13,000 a year develop invasive cancer. Because a patient has HPV show up on a Pap smear with cytologic changes associated with HPV, or has mild dysplasia caused by HPV, doesn’t mean that she is going to go on to develop invasive cancer. Unfortunately we don’t have an antiviral agent or an HPV vaccine yet available. So to identify which patients are at high risk and low risk is somewhat of a clinical challenge to the gynecologist and the GYN-oncologist.
Most patients with invasive cervix cancer we would hope would be picked up with an abnormal Pap smear, appropriately referred to a gynecologist. The patient would undergo colposcopy, which is nothing more than a 15 power dissecting binocular microscope to look at the cervix, identify the lesion, biopsy the invasive lesion and go on to stage and treat. Cold knife conization is a larger biopsy. Yet unfortunately most patients that we see today still have gross lesions that Papanicolaou was trying to prevent or avoid, but have gross lesions that can be directly biopsied by the gynecologist. Identifying that patient is a common problem in the United States yet today.
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The symptoms associated with cervix cancer is vaginal bleeding. It is one of the classic symptoms, although not oftentimes volunteered in my experience, but if you ask the patient, yes she has had bleeding after intercourse; it stops after a day or so and doesn’t reoccur until she has intercourse again. As the cervix cancer progresses you can get pelvic pain, obstruction of the lymphatics and lead to lymphedema or obstruction of ureters and ultimately uremia. But the most common early symptom is abnormal bleeding, and again managing that patient by telephone is inappropriate. She needs to be seen, a Pap smear obtained and examined.
Posted on November 24th, 2008 by Canadian Health in
Vulva cancer Among the rarest of the vulvar carcinomas, basal cell carcinomas occur once for every 40 invasive squamous cell carcinomas. They are distinguished by cords and masses of palisading basal cells pushing into the underlying connective tissue, and, like basal cell carcinomas elsewhere, they do Not metastasize. A history of longstanding vulvar pruritus and delay in diagnosis are common. The lesions frequently have a slightly elevated margin at their periphery. Basal cell carcinomas are most commonly found over the anterior two thirds of the labia majora and occur most frequently in white women older than age 50 years.
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The variability in clinical appearance of the vulvar tumors suggests that biopsy confirmation should be obtained on all lesions for which there is the least doubt regarding the diagnosis. In addition to basal cell carcinomas, vulvar benign lesions can include epidermal inclusion cyst, len-tigo, Bartholin duct obstruction, carcinoma in situ, melanocytic nevi, acrochordons, mucous cysts, hemangiomas, postinflammatory hyperpigmentation, seborrheic keratoses, varicosities, hidradenomas, verrucae, unusual neurofibromas, ectopic tissue, syringomas, and abscesses.
Basal cell carcinoma of the vulva is rare and was initially believed always to be indolent, locally invasive, and nonmetastasizing. However, there are reports of metastasis to regional lymph Nodes. Metastasizing basal cell carcinoma of the vulva manifests several features that distinguish it from most of the nonmetastasizing tumors. These include vaginal bleeding at presentation; advanced clinical stage; invasion of subcutaneous fat, urethra, and vagina; tumor thickness greater than 1 cm; and a pattern of growth like that of morphea. Vulvar basal cell carcinoma behaves much like its counterpart in sites other than the vulva, locally recurring but metastasizing only on rare occasions. Simple wide excision of the tumor is curative in most cases. More aggressive surgery may be warranted for large tumors that are locally destructive and extend into the subcutaneous tissue.
Posted on November 19th, 2008 by Canadian Health in
Vulva cancer Soft tissue sarcomas make up fewer than 2% of vulvar malignancies. They occur over a wide age range, including the pediatric population, and usually appear as a rapidly enlarging and painful mass. Most tumors on the vulva are related to the leiomyosarcoma group, although the fibrous histiocytomas, rhabdomyosarcomas, hemangiosarcomas, and the newly described epithelioid sarcomas may also occur on the vulva. The prognosis for such lesions is variable depending on the biologic character of the individual sarcoma, but may well be related to hematogenous metastasis. Radical vulvectomy with groin dissection has yielded the lowest incidence of recurrent disease, but many patients die rapidly.
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Superficial perineal leiomyosarcomas are rare and may be more aggressive than superficial leiomyosarcomas in general. The tumor is well differentiated and shows immunoreactivity for smooth muscle “-actin and “-desmin.
The natural history of vulvar leiomyosarcomas is characterized by an indolent protracted course and frequent local recurrence, followed by distant fatal metastases. Surgery, chemotherapy, and radiotherapy achieve palliation rather than cure.
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Dermatofibrosarcoma protuberans of the vulva is an uncommon low-grade sarcoma of dermal origin. Although wide excision is the treatment of choice, microscopic tumor projections beyond the central tumor Nodule explain the tumor’s propensity for local recurrence. Frozen sections of margins may be useful to ensure complete resection.
Epithelioid sarcoma typically involves extremities of young men and may be confused histologically with various benign and malignant processes. Epithelioid sarcoma of the vulva is a soft tissue malignancy arising from the tenosynovial tissue and can present as a painless lump of the vulva. The suggested mode of treatment can range from wide excision to radical vulvectomy with groin Node dissection.
Posted on November 19th, 2008 by Canadian Health in
Vulva cancer Bartholin gland cancer is a rare malignancy that should be considered in the differential diagnosis of a labial mass. The tentative diagnosis of adenocarcinoma of the Bartholin gland is based on the cytologic findings and location of the tumor. The nuclei are oval to oblong, and some cells have a peripherally displaced nucleus. The chromatinic material is slightly increased, and some nuclei have prominent nucleoli. The cytoplasm is basophilic and abundant. Microcalcifications and psammoma bodies are numerous. The prognosis is generally poor because of the aggressive metastatic tendencies of this cancer. The etiology of Bartholin gland cancer remains unknown, and No optimal plan of treatment has been established. Early detection followed by radical vulvectomy and bilateral inguinal-femoral Node dissection may improve survival.
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Posted on November 14th, 2008 by Canadian Health in
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Melanomas are the second most common vulvar malignancy and occur frequently in white women between the ages of 50 and 80 years. Melanomas may arise from preexisting lesions and occur mainly on the labia minora and clitoris. Patients at increased risk for melanoma include those with a family history of melanoma and those with dysplastic nevi elsewhere on the body. Dysplastic melanoma nevi occur in 2-5% of white adults and in one third of patients with cutaneous melanoma. Most patients present with a lump or tumor on the external genitalia, although complaints of itching, bleeding, or discharge are often described. A change in a preexisting mole may Not prompt some patients to seek attention because it is difficult to observe vulvar lesions adequately. Most pigmented lesions in this location should be excised unless they have been present and unchanged for years. Considerable debate centers viagra super active on the optimal treatment for vulvar melanoma as well as those clinical pathologic factors influencing prognosis. Primary tumors can be assessed by microstaging with the Breslow microstaging classification. According to the Breslow tumor thickness classification, a 0.75-mm depth of invasion has a 95-99% 5-year survival rating; a 0.76- to 1.49-mm thickness has a 90-95% survival rating; a 1.50- to 4.00-mm thickness has a 60-75% survival rating; and a depth of invasion greater than 4.00 mm has a survival rating of less than 50%. Tumor thickness, inguinal Node metastasis, and older age at diagnosis are independent prognostic factors. Radical vulvectomy does Not seem to improve survival compared with less radical procedures. Radical local excision for patients with malignant melanoma of the vulva is recommended canadian pharmacy. Whether patients who have more than a superficially invasive melanoma should also have inguinal lymph Node dissection is controversial.
Some investigators have observed that ulceration, tumor thickness, and positive inguinal lymph Nodes are the most important prognostic factors. A low-risk and a high-risk group of patients have been identified for recurrence. The low-risk patient has a Nonulcerative tumor less than 3 mm thick without clinical evidence of inguinal lymph Node metastases and can be treated by local excision with a 2-to 3-cm margin. The high-risk patient has a tumor that is ulcerative or more than 3 mm thick and has also been treated by local excision without elective inguinal Node dissection. If clinical suspicion of inguinal Node metastases exists, inguinal Node dissection is indicated for better local control of the disease.
Posted on November 13th, 2008 by Canadian Health in
Vulva cancer Verrucous carcinoma of the vulva is much less common than squamous cell carcinoma. The clinical and morphologic distinctions between these neoplasms are important to understand because of their contrasting biologic behavior and treatment. Verrucous lesions rarely metastasize.
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Both cancers present with symptoms of pruritus and a Noticeable mass. On examination, both tumors commonly occur on the labia and are exophytic. If infection occurs in association with verrucous carcinoma, the resulting induration of the surrounding tissue as well as reactive regional lymph Node enlargement may lead to an erroneous diagnosis of advanced squamous cell carcinoma. One third of squamous cell carcinomas are flat and ulcerative. It may be difficult to distinguish verrucous from squamous cell carcinomas.
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Verrucous carcinomas are thick neoplasms that may invade and compress the underlying stroma with pushing margins. Therefore, it is crucial to recognize the microscopic features of this well-differentiated squamous cell neoplasm so as Not to mistake it for a squamous cell carcinoma, which has the capacity to metastasize to inguinal lymph Nodes. Human papillomavirus has been implicated in the development of both of these tumors.
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The treatment of vermcous carcinoma is wide local excision. Because there may be recurrence if the surgical resection margins show signs of neoplastic involvement, the pathologist should carefully evaluate the margins. Recurrence of verrucous carcinoma connotes a poor prognosis.