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Vulvakarzinom

Diagnostik und Therapie

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Der Gynäkologe Aims and scope

Zusammenfassung

Das Vulvakarzinom ist ein seltener Genitaltumor der Frau. Der Häufigkeitsgipfel liegt im Alter zwischen 70 und 79 Jahren mit einer langsamen Tendenz zur altersmäßigen Vorverlagerung. In über 90% handelt es sich um ein Plattenepithelkarzinom. Die zugehörige intraepitheliale Präneoplasie VIN 3 tritt am häufigsten bei Frauen unter 35 Jahren auf. Haute geht man davon aus, dass 2 Typen unterschieden werden können: eine durch das humane Papillomavirus (HPV) induzierte, eher bei jüngeren Frauen auftretende Neoplasie und eine HPV-unabhängige Neoplasie eher im höheren Alter. Bereits die VIN 3 sollte chirurgisch entfernt werden. Die invasiven Karzinome können im Stadium I und II durch eine lokale weite Exzision im Gesunden reseziert werden, die inguinofemoralen Lymphknoten werden ab einer Eindringtiefe von 1,1 mm reseziert. Bei größeren Tumoren wird eine Vulvektomie mit beidseitiger Lymphonodektomie erforderlich. Bei weit fortgeschrittenen Tumoren kommen multimodale Therapieplanungen zum Einsatz, dabei kann eine primäre Radiotherapie oder Radiochemotherapie einer Salvage-Operation vorangestellt werden.

Abstract

Vulvar cancer is a rare entity. It appears mostly in older women aged 70–79 years with a slow tendency to younger age. More than 90% of the tumors show a squamous differentiation. The correspondent preneoplasia is VIN 3. This lesion occurs in women mostly younger than 35 years. Experts assume vulvar cancer to appear in two different types: HPV-induced type in younger women and non-HPV-dependent type in older women. The preneoplasia VIN 3 already should be treated by resection or destruction. Invasive carcinomas stage I or II can be treated by wide local excision. The inguinofemoral lymph nodes should be resected if invasion exceeds 1 mm in depth. In larger primary tumors, vulvectomy with bilateral inguinofemoral node dissection is indicated. In advanced tumor stages, multimodal concepts are applied: primary radiotherapy or radiochemotherapy may precede a salvage operation.

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  1. Sprecher der Organkommission Vulva- und Vaginaltumoren, Arbeitsgemeinschaft Gynäkologische Onkologie

    H. G. Schnürch

  2. Frauenklinik , Lukaskrankenhaus, Preussenstraße 84, 41464, Neuss

    H. G. Schnürch

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Schnürch, H.G. Vulvakarzinom. Gynäkologe 36, 781–792 (2003). https://doi.org/10.1007/s00129-003-1419-1

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