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Diagnostik und Therapie des Vulva- und Vaginalkarzinoms

Diagnosis and treatment options of vulvar and vaginal cancer

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Zusammenfassung

Sowohl das Vulva- als auch das primäre Vaginalkarzinom gehören zu den seltenen Malignomen der Frau, die Inzidenz des Vulvakarzinoms nimmt allerdings zu. Jüngst wurde berichtet, dass in den vergangenen 10 Jahren die Inzidenz der vulvären intraepithelialen Neoplasien (VIN) sowie der Vulvakarzinome in Europa und den USA gestiegen ist.

Der wichtigste ätiologische Faktor ist das Vorliegen einer Infektion mit dem humanen Papillomavirus (HPV). Eine HPV-Impfung wirkt jedoch vorbeugend. Die operative Therapie ist, v. a. in den frühen Stadien, nach wie vor Therapie der Wahl und richtet sich nach der Lokalisation und Ausbreitung des Tumors. Zur Reduktion der postoperativen Komplikationsrate wurde die Radikalität der Vulvektomie gesenkt, ohne dass sich die Prognose verschlechtert hat. Für das Vaginalkarzinom sind derartige Ansätze zur Senkung der Radikalität nicht bekannt. Die Strahlentherapie bleibt die Behandlungsalternative bei fortgeschrittener Erkrankung. Aufgrund der relativen Seltenheit der Erkrankungen ist zwar eine evidenzbasierte Therapieempfehlung möglich, allerdings nur auf einem sehr niedrigen Evidenzniveau.

Abstract

Both vulvar and vaginal carcinomas are rare malignancies in women. However, within the past decade a distinct increase in the incidence of vulvar intraepithelial neoplasia (VIN) as a precursor lesion, and an increase of vulvar cancer have been reported within Europe and the U.S. The most important factor in developing vulvar cancer is human papillomavirus (HPV) infections but prophylactic HPV vaccination has been proven to be highly effective. Surgery is the first choice in treating patients with vulvovaginal carcinoma, especially in the early stages. The operative treatment options depend on the localization and spread of the tumor. In an attempt to decrease the incidence of complications, research was made into surgical modifications without compromising the prognosis. For the treatment of vaginal cancer no approaches for reducing the degree of radical surgery are known. Radiation treatment remains a therapy option in advanced disease. As vulvovaginal cancer is relatively rare it is possible to give evidence-based treatment recommendations but usually on a low evidence level.

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  1. Gynäkologisches Tumorzentrum, Klinik für Frauenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Thill

  2. Klinik für Strahlentherapie und Radioonkologie, Marienhospital Herne und Katholisches Klinikum Bochum, Ruhr-Universität Bochum, Bochum, Deutschland

    I.A. Adamietz

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  1. M. Thill
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Correspondence to M. Thill.

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Dieser Beitrag basiert auf der Publikation „Diagnostik und operative Therapie des Vulva- und Vaginalkarzinoms“ von M. Thill, M.K. Bohlmann, C. Dittmer, K. Diedrich und D. Fischer; erstmals 2009 erschienen in Der Onkologe 15:28–39.

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Thill, M., Adamietz, I. Diagnostik und Therapie des Vulva- und Vaginalkarzinoms. Onkologe 17, 1163–1180 (2011). https://doi.org/10.1007/s00761-011-2175-9

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