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Diagnostik und operative Therapie des Vulva- und Vaginalkarzinoms

Diagnosis and treatment options in vulvar and vaginal cancer

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Zusammenfassung

Sowohl das Vulva- wie auch das primäre Vaginalkarzinom gehören zu den seltenen Malignomen der Frau. Allerdings steigt die Inzidenz des Vulvakarzinoms. Erst kürzlich konnte ein Anstieg der vulvären intraepithelialen Neoplasien (VIN) sowie der Vulvakarzinome in Europa und den USA für die letzten 10 Jahre berichtet werden. Der wichtigste ätiologische Faktor ist das Vorliegen einer HPV-Infektion, eine HPV-Impfung beugt der Entstehung eines Vulva-/Vaginalkarzinoms jedoch effektiv vor. Die operative Therapie ist, v. a. in den frühen Stadien, nach wie vor Therapie der Wahl vulvovaginaler Karzinome und richtet sich nach der Lokalisation und der Ausbreitung des Tumors. Um die Komplikationsrate reduzieren zu können, wurden Möglichkeiten gesucht, die operative Radikalität zu senken. Eine dieser Möglichkeiten bestand darin, die radikale Vulvektomie durch eine radikale lokale Exzision zu ersetzen, ohne dabei die Prognose zu verschlechtern. Für das Vaginalkarzinom sind solche Ansätze zur Senkung der Radikalität nicht bekannt. Aufgrund der relativen Seltenheit der Erkrankungen ist zwar eine evidenzbasierte Therapieempfehlung möglich, allerdings nur auf einem sehr niedrigen Evidenzlevel.

Abstract

Both vulvar and vaginal carcinomas are rare malignancies in women. However, within the past decade, a distinct increase in vulvar cancer as well as in vulvar intraepithelial neoplasia as a precursor lesion has been reported both in Europe and the United States. The most important factor in developing vulvar cancer is human papillomavirus (HPV) infection, but prophylactic HPV vaccination has proven to be a highly effective preventative measure. Surgery is the first choice in treating patients with vulvovaginal carcinoma, especially in its early stages. The operative treatment options depend on localization and spread of the tumor. In an attempt to decrease the incidence of complications, researchers are working to modify the surgical procedure without compromising the prognosis; replacing radical vulvectomy by less wide local excision is one of these modifications. For treating vaginal cancer, no approaches for reducing the radicality are known. Because vulvovaginal cancer is relatively rare, it is possible to give evidence-based treatment recommendations, but usually on a low-evidence level. The aim of this paper is to elucidate the diagnostics and surgical treatment options for managing vulvovaginal cancer.

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

    M. Thill, M. K. Bohlmann, C. Dittmer, K. Diedrich & D. Fischer

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  1. M. Thill
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  2. M. K. Bohlmann
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  3. C. Dittmer
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  4. K. Diedrich
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  5. D. Fischer
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Correspondence to M. Thill.

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Thill, M., Bohlmann, M., Dittmer, C. et al. Diagnostik und operative Therapie des Vulva- und Vaginalkarzinoms. Onkologe 15, 28–39 (2009). https://doi.org/10.1007/s00761-008-1538-3

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