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Journal ArticleDOI

Clinical, Pathological, Preventive and Therapeutic Aspects in Cancer De Vulva

23 Jan 2020-Vol. 4, Iss: 1, pp 01-15
TL;DR: The treatment of malignant neoplasms of the vulva, in general, surgery is the primary treatment.
Abstract: Vulvar cancer is rare, occupies the fourth most common type of gynecological cancer mainly affects postmenopausal, there are no screening tests or effective strategies to reduce its incidence, only the timely treatment of preneoplastic lesions; It is initially asymptomatic, chronic pruritus or vulvar pain is reported, or the presence of tumor or ulcer; alone, the biopsy confirms the diagnosis and histopathological type. Surgical staging involves the removal of the primary lesion and locoregional lymph node evaluation. In current practice, surgical management is conservatively substituted for radical vulvectomy and depends mainly on the histopathological type and staging, mainly the nodal state. Conclusion: The treatment of malignant neoplasms of the vulva, in general, surgery is the primary treatment.
Citations
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Journal ArticleDOI
TL;DR: Vulvar and vaginal intraepithelial neoplasms are classified as premalignant conditions and the etiology and pathogenesis of these diseases are not entirely clear due to their complexity.
Abstract: Leukoplakia, kraurosis and pointed condylomas (papillomas) of the vulva represent the group of background benign vulvar diseases. Vulvar and vaginal intraepithelial neoplasms are classified as premalignant conditions. The etiology and pathogenesis of these diseases are not entirely clear due to their complexity. Despite the easy visual assessment of anatomic areas involved in the pathological process, these diseases are rarely diagnosed at an early stage, which might indicate insufficient vigilance of doctors and patients in relation to the early symptoms. Therefore, this field of oncogynecology needs further development ln terms of diagnosisprevention, screening and treatment.

14 citations

01 Jan 2012
TL;DR: The vulvoscopy, vaginoscopy and high resolution anoscopy are complementary techniques for the exploration of lower genital tract that includes the vulva and vagina as an integral part of it.
Abstract: The vulvoscopy, vaginoscopy and high resolution anoscopy are complementary techniques for the exploration of lower genital tract. The colposcopic examination methodology includes the vulva and vagina as an integral part of it. Its aim is to locate and topographic diagnosis of lesions. Colposcopy is not diagnosed. The main indication is secondary prevention (early diagnosis) of cancer. These techniques are of great clinical value, with implications for diagnosis, treatment and monitoring. Colposcopy manifestation of these lesions in different anatomical areas are considered a subclinical disease.

3 citations

References
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Journal ArticleDOI
TL;DR: A mathematical proof is devised that found that the comorbidity summary measures are appropriate prognostic or adjustment mechanisms in survival analyses and the theoretical justification that validates the use of such scores under many conditions is provided.
Abstract: Background Comorbidity adjustment is an important component of health services research and clinical prognosis. When adjusting for comorbidities in statistical models, researchers can include comorbidities individually or through the use of summary measures such as the Charlson Comorbidity Index or Elixhauser score. We examined the conditions under which individual versus summary measures are most appropriate. Methods We provide an analytic proof of the utility of comorbidity summary measures when used in place of individual comorbidities. We compared the use of the Charlson and Elixhauser scores versus individual comorbidities in prognostic models using a SEER-Medicare data example. We examined the ability of summary comorbidity measures to adjust for confounding using simulations. Results We devised a mathematical proof that found that the comorbidity summary measures are appropriate prognostic or adjustment mechanisms in survival analyses. Once one knows the comorbidity score, no other information about the comorbidity variables used to create the score is generally needed. Our data example and simulations largely confirmed this finding. Conclusions Summary comorbidity measures, such as the Charlson Comorbidity Index and Elixhauser scores, are commonly used for clinical prognosis and comorbidity adjustment. We have provided a theoretical justification that validates the use of such scores under many conditions. Our simulations generally confirm the utility of the summary comorbidity measures as substitutes for use of the individual comorbidity variables in health services research. One caveat is that a summary measure may only be as good as the variables used to create it.

508 citations


"Clinical, Pathological, Preventive ..." refers background in this paper

  • ...Defects of the groin, pubis, vagina or urethra are often present in gynecological surgery for vulvar cancer; this creates singular geometries of defects that must be considered three-dimensionally as a single form, in order to correctly choose the flap for reconstruction [42, 49]; There is a wide arsenal of traditional and piercing flaps....

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  • ...Secondary objectives include reconstruction to improve sensitivity, sexual function, aesthetics of the external shape and minimal morbidity of the donor site of the flap [41,42, 49], some drawbacks are mainly due to the size of the defect with minimal consideration for defects associated surrounding, beyond the vulvar and perineal edge....

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  • ...Women with vulvar cancer with lymph node metastasis benefited more from the addition of Qt to Rt [49]....

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Journal ArticleDOI
TL;DR: The addition of HPVs 31/33/45/52/58 to HPV types included in current vaccines (HPV16/18) could prevent almost 90% of HPV positive female anogenital lesions worldwide and take into account that most HPV-related cancers are ICC ones, the 9-valent HPV vaccine could potentially avoid almost 88% of all female anogenic cancers.

174 citations

Journal ArticleDOI
TL;DR: This large multicenter study in vulvar cancer observed that adjuvant radiotherapy was associated with improved prognosis in node-positive patients and will hopefully help to overcome concerns regarding adjUvant treatment, however, outcome after adjuant radiotherapy remains poor compared with node-negative patients.
Abstract: Background: Women with node-positive vulvar cancer have a high risk for disease recurrence. Indication criteria for adjuvant radiotherapy are controversial. This study was designed to further understand the role of adjuvant therapy in node-positive disease. Methods: Patients with primary squamous-cell vulvar cancer treated at 29 gynecologic cancer centers in Germany from 1998 through 2008 were included in this retrospective exploratory multicenter cohort study. Of 1618 documented patients, 1249 had surgical groin staging and known lymph node status and were further analyzed. All statistical tests were two-sided. Results: Four hundred forty-seven of 1249 patients (35.8%) had lymph node metastases (N+). The majority of N+ patients had one (172 [38.5%]) or two (102 [22.8%]) positive nodes. The three-year progression-free survival (PFS) rate of N+ patients was 35.2%, and the overall survival (OS) rate 56.2% compared with 75.2% and 90.2% in node-negative patients (N-). Two hundred forty-four (54.6%) N+ patients had adjuvant therapy, of which 183 (40.9%) had radiotherapy directed at the groins (+/-other fields). Three-year PFS and OS rates in these patients were better compared with N+ patients without adjuvant treatment (PFS: 39.6% vs 25.9%, hazard ratio [HR] = 0.67, 95% confidence interval [CI[= 0.51 to 0.88, P = .004; OS: 57.7% vs 51.4%, HR = 0.79, 95% CI = 0.56 to 1.11, P = .17). This effect was statistically significant in multivariable analysis adjusted for age, Eastern Cooperative Oncology Group, Union internationale contre le cancer stage, grade, invasion depth, and number of positive nodes (PFS: HR = 0.58, 95% CI = 0.43 to 0.78, P < .001; OS: HR = 0.63, 95% CI = 0.43 to 0.91, P = .01). Conclusion: This large multicenter study in vulvar cancer observed that adjuvant radiotherapy was associated with improved prognosis in node-positive patients and will hopefully help to overcome concerns regarding adjuvant treatment. However, outcome after adjuvant radiotherapy remains poor compared with node-negative patients. Adjuvant chemoradiation could be a possible strategy to improve therapy because it is superior to radiotherapy alone in other squamous cell carcinomas.

162 citations


"Clinical, Pathological, Preventive ..." refers background in this paper

  • ...The groin and pelvis nodes may need to be included in the radiation field depending on the state of the groin nodes [60, 62]....

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  • ...Predictive factors of prevalence and extent of N + in vulvar cancer, invasion of the lymphovascular space, tumor stage, age and depth of infiltration are associated with the prevalence of lymph node metastasis; The stage and tumor size are associated with the number of lymph node metastasis [57, 59,60, 62]....

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Journal ArticleDOI
TL;DR: The classification, epidemiology, clinical features, histomorphology, ancillary markers and molecular genetics of both types of VIN are reviewed, and the morphological challenges faced by pathologists in interpreting these lesions are discussed.

149 citations


"Clinical, Pathological, Preventive ..." refers background in this paper

  • ...Selfexamination should be encouraged in women with lichen sclerosus, injury related to the development of vulvar cancer and there should be an early evaluation of any patient with signs (for example, in pigmented lesions, irregular ulcers) or symptoms (such as Pruritus chronic vulvar) commonly associated with vulvar disease, which could be candidates for a vulvar skin biopsy [29, 31]....

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  • ...The following histopathological points [27, 31] should be taken into account:...

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  • ...In relation to sample analyzes, the following should be taken into account [29, 31]:...

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  • ...The effective strategy to reduce the incidence of vulvar cancer is the timely treatment of predisposing and preneoplastic lesions associated with the development of vulvar cancer; There are two main pathological pathways that lead to SCC of vulva [28, 31]:...

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Journal ArticleDOI
TL;DR: Developing clinically relevant and evidence-based guidelines to improve the quality of care for women with gynecologic cancers across Europe based on the best available evidence and expert agreement is published.
Abstract: Objective The aim of this study was to develop clinically relevant and evidence-based guidelines as part of European Society of Gynaecological Oncology's mission to improve the quality of care for women with gynecologic cancers across Europe. Methods The European Society of Gynaecological Oncology Council nominated an international development group made of practicing clinicians who provide care to patients with vulvar cancer and have demonstrated leadership and interest in the management of patients with vulvar cancer (18 experts across Europe). To ensure that the statements are evidence based, the current literature identified from a systematic search has been reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group (expert agreement). The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 181 international reviewers including patient representatives independent from the development group. Results The guidelines cover diagnosis and referral, preoperative investigations, surgical management (local treatment, groin treatment including sentinel lymph node procedure, reconstructive surgery), radiation therapy, chemoradiation, systemic treatment, treatment of recurrent disease (vulvar recurrence, groin recurrence, distant metastases), and follow-up.

131 citations


"Clinical, Pathological, Preventive ..." refers background in this paper

  • ...[5, 8] This system is applicable for most malignant tumors that originate in the vulva, except melanoma....

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  • ...org ISSN: 2578-8965 Page 6 of 15 Less than 1% of patients who have small lateral lesions (less than 4cm and ≥ 2cm of the vulvar midline) and negative ipsilateral nodes have lymph node metastasis of the contralateral groin and, therefore, an ipsilateral LDN is the appropriate treatment for these patients [8, 40, 51,53]....

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  • ...Treatment should be individualized and performed by a multidisciplinary team in an oncology center with experience in the treatment of these tumors [2, 8,10]....

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